ReviewA review of the clinical evidence for exercise in osteoarthritis of the hip and knee☆
Section snippets
Background
This paper provides an overview of appropriate exercise intervention for the special needs of people with osteoarthritis (OA) of the hip or knee. It is beyond the scope of this paper to discuss exercise prescription for the prevention of OA or following joint replacement surgery. Instead, it will focus on exercise for the management of symptoms in those with established hip and knee OA and briefly mention the limited research into the effects of exercise on structural disease progression.
Role of exercise in treatment of hip and knee osteoarthritis
Given the large body of evidence demonstrating the beneficial clinical effects of exercise in people with lower limb OA varying in severity from mild to severe, exercise therapy is regarded as the corner-stone of conservative management for the disease.3, 4, 5 The main goals of exercise in this patient group are to reduce pain, improve physical function and optimize participation in social, domestic, occupational and recreational pursuits 5. Regular exercise can improve physiological
Exercise prescription – boundaries of evidence
There are a number of areas where evidence is limited or research has not been undertaken. Relative to knee OA, there is far less research on exercise for hip OA and findings from studies involving patients with knee OA cannot necessarily be directly extrapolated to the hip given differences in biomechanics, impairments, rapidity of progression and risk factors. Therefore, while current international treatment guidelines recommend therapeutic exercise for people with symptomatic hip OA,26, 27
Exercise prescription – recommendations
Recommendations for exercise prescription in those with hip or knee OA have been developed by Roddy et al.26 and are summarized in Table 1. Essentially exercise therapy should be individualized and patient-centred taking into account factors such as patient age, mobility, co-morbidities and preferences. An assessment of specific impairments such as strength, range of motion, aerobic fitness and balance is needed to determine the most appropriate exercise regime.
Type of exercise. There are
Special considerations
Safety. In general, exercise is safe and well tolerated by most people with lower limb OA including those with severe disease and there are few contraindications to exercise resulting from the OA per se although co-morbidities need to be considered. It is not uncommon for patients to experience some discomfort at the affected joint during exercise and patients should be advised that this is normal and does not indicate a worsening of their OA disease. Exercise practitioners should not adopt a
Summary
Exercise is a key component of the management of OA symptoms and has been shown to be beneficial for individuals with OA disease of all severities. Exercise practitioners play an important role in prescribing appropriate exercise for patients taking into account individual symptoms, problems and preferences. Encouraging exercise adherence behaviours and reinforcing healthy lifestyle habits will assist in optimizing outcomes from treatment. Furthermore, exercise programs should be combined with
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A review of evidence commissioned by Exercise and Sports Science Australia.