This text was developed by Dr Francesca de Sousa Brito in collaboration with the Dunhill Medical Trust Project Working Group

Osteoarthritis (OA) is the most common type of arthritis and the major cause of chronic musculoskeletal pain and mobility disability in elderly populations worldwide³, accounting for 80% to 90% of hip and knee replacements in the United States and United Kingdom¹. It is considered a whole joint disease as the disease process involves changes in cartilage, bone, ligament and muscle². Approximately 40% of adults over the age of 65 have some form of symptomatic OA and its prevalence increases as a function of age. The highest prevalence is in the hip, hand and knee⁴.

Currently, there is no cure for OA but instead, treatment focuses on symptom management with the use of non-pharmacological, pharmacological or surgical options. Due to relatively low cost and reduced adverse effects, international clinical guidelines for managing OA recommend exercise as a core non-pharmacological therapy^1,2. It is recommended that engaging in moderate exercise at least three times per week can reduce the risk of arthritis related disability by 47%⁵.

Muscle mass peaks at about the age of 30 and then decreases 3-8% per decade, with increased loss after the age of 60 leading to the development of muscle loss (sarcopenia)⁴. In patients with arthritis, sarcopenia contributes to greater dependency due to loss of autonomy⁴. It is natural for patients with OA, suffering from pain in their joints to want to avoid exercise but without regular physical activity, muscle strength decreases. Strengthening muscles is vital as they stabilize joints and stop OA from getting worse⁴.

Although increased risk of OA is associated with joint injury suffered in sport, physical activity is beneficial for joint tissues and can help decrease symptoms by improving muscle strength, joint range of motion and flexibility, which is turn reduces stiffness, proprioception, balance and cardiovascular fitness^6,2. Exercise may also improve body weight and metabolic abnormalities, decrease fall risk but also improve mental health due to the release of endorphins². Exercise which involves the use of weights are beneficial for our muscles but also for our bone health, helping to prevent the occurrence of diseases such as osteoporosis.

The Versus Arthritis (formerly known as Arthritis Research UK) Complementary and Alternative Treatments Review in 2013 (attached below) lists T’ai chi, an ancient Chinese martial art that combines meditation, deep breathing and relaxation, with slow, graceful movements, as effective in treatment of osteoarthritis based on a number of trials. However, benefits appear to be limited to symptoms of knee osteoarthritis, rather than multiple joints. A more recent study also lists traditional Chinese exercise as effective in in alleviating pain, relieving stiffness and improving the physical function in knee osteoarthritis⁷. Exercises recommended by the Arthritis Foundation (www.arthritis.org) include exercises that improve the range of motion and mobility and muscle strengthening exercises, specifically walking as an aerobic form of exercise that tones the muscles and improves well-being, and water exercises for those with weaker muscles and experiencing stronger pain.

Here’s a short video by Versus Arthritis, explaining what happens to our joints when we exercise:

Having practiced Tai chi for three years, I can honestly say that I have felt the benefit in two main areas. Firstly,  it is a calm form of exercise, which absolutely makes me feel better  mentally – so I try to do at least 30 minutes of tai chi each morning.  Secondly,  it’s gently stretching movements have helped my flexibility.  I do suffer from osteoporosis and accept that it mainly helps with knee osteoarthritis, so I combine this with other strengthening exercises, such as walking and Pilates. S. Underwood 

I have not found any scientific proof that exercise helps in the maintenance of reasonably robust flexibility in later life, but I strongly believe that it does (…). By exercise I mean quite frequent movement of the body. Membership of gyms is unnecessary to maintain this function. Simple home-based routines are all that is necessary combined with some outdoor walking, running, or cycling. “Being active in our bodies”, according to the New Economics Foundation, is one of five simple acts which promote wellbeing. Do not sit in front of the television or computer screen too long. Keep Moving, a publication of Arthritis Research UK, and Small Steps to Feeling Good, published by the NHS give excellent information on simple exercises that can be done at home. In August 2020, the Department for Transport issued, what I consider to be the concerning statistic, that adults in England only walked on average 206 miles in 2019. This is only just over half a mile per day. My personal target is to walk one thousand miles per year. This equates to just over two- and three-quarter miles per day and can be achieved in less than an hour. It is not necessary to be active every day and I find that being active when I feel like it fills the bill. P. Boyle

Useful resources

1. Versus Arthritis review: https://www.versusarthritis.org/media/12780/complementary-and-alternative-therapies-report-2013.pdf
2. Versus Arthritis “Keep Moving”: https://www.versusarthritis.org/media/1310/keep-moving-information-booklet-with-poster.pdf
3. NHS “Small Steps to Feeling Good”: https://www.northtynesidecarers.org.uk/wp-content/uploads/2020/10/NHS-HOW-Fit-Leaflet-Design-NT-NG.pdf
4. https://www.howfittoday.co.uk/

References

1) Relative Efficacy of Different Exercises for Pain, Function, Performance and Quality of Life in Knee and Hip Osteoarthritis: Systematic Review and Network Meta-Analysis. Siew-Li Goh et al.  Sports Medicine 2019;49(5):743-761.

2) A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. Kim L.Bennell, Rana S. Hinman. Journal of Science and Medicine in Sport 2011; 14(1):4-9

3) OARSI recommendations for the management of hip and knee osteoarthritis Part III: changes in evidence following systematic cumulative update of research published through January 2009 W. Zhang et al. Osteoarthritis and Cartilage 2008; 16(2):137-162

4) Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review. C. Gay, et al. Annals of Physical and Rehabilitation Medicine 2016; 59(3):174-183

5) Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Penninx BW, et al. Arch Intern Med. 2001; 161(19):2309-16.

6) A Comprehensive Review of the Effectiveness of Different Exercise Programs for Patients with Osteoarthritis   Y.M. Golightly, K.D. Allen, D.J. Caine The Physician and Sportsmedicine 2012;40(4):52-65.

7) Effectiveness of Traditional Chinese Exercise for Symptoms of Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials R. Li et al. International Journal of Environmental Research and Public Health 2020;17(21):7873.