Benefits of Exercise for Arthritis
Benefits of Exercise for OsteoarthritisPhysical activity is the best non-drug treatment for improving pain and function in OA.
While you may worry that exercising with osteoarthritis could harm your joints and cause more pain, research shows that people can and should exercise when they have osteoarthritis. In fact, exercise is considered the most effective non-drug treatment for reducing pain and improving movement in patients with osteoarthritis.
What Exercises Work Best for Osteoarthritis?
Each of the following types of exercises plays a role in maintaining and improving the ability to move and function:
Range of motion or flexibility exercises. Range of motion refers to the ability to move your joints through the full motion they were designed to achieve. These exercises include gentle stretching and movements that take joints through their full span. Doing these exercises regularly can help maintain and improve the flexibility in the joints.
Aerobic/endurance exercise. These exercises strengthen the heart and make the lungs more efficient. This conditioning also reduces fatigue and builds stamina. Aerobic exercise also helps control weight by increasing the amount of calories the body uses. Aerobic exercises include walking, jogging, bicycling, swimming or using the elliptical machine.
Strengthening exercises. These exercises help maintain and improve muscle strength. Strong muscles can support and protect joints that are affected by arthritis.
Two types of exercise are particularly good for most people with osteoarthritis.
Walking. It is (usually) free, it is easy on the joints and it comes with a host of benefits. One major plus is that it improves circulation – and wards off heart disease, lowers blood pressure and, as an aerobic exercise, strengthens the heart. It also lowers the risk of fractures (by stopping or slowing down the loss of bone mass) and tones muscles that support joints.
Aquatic (water) exercises. These are particularly helpful for people just beginning to exercise as well as those who are overweight. Aquatic exercises do not involve swimming, rather they are performed while standing in about shoulder-height water. The water helps relieve the pressure of your body’s weight on the affected joints (hips and knees in particular), while providing resistance for your muscles to get stronger. Regular aquatic exercise can help relieve pain and improve daily function in people with hip and knee OA.
How Much Exercise Is Good for Osteoarthritis?
Always follow the advice from your doctor or physical therapist. In general, range-of-motion exercises should be done every day.
The weekly recommendation for aerobic exercise is 150 minutes of moderate-intensity OR 75 minutes of vigorous-intensity OR an equivalent combination. This translates into taking a 30-minute swift walk or bike ride five times per week OR
jogging, swimming, or biking that gets your heart pumping for 25 minutes three times per week OR any combination of these based on your ability and preference.
“Exercise is good. But exercise intelligently,” says Bashir Zikria, MD, an assistant professor of sports medicine at Johns Hopkins University Medical Center in Baltimore. “Low-impact exercises, like walking, cycling or using an elliptical machine are smart choices,” says Dr. Zikria. “If you run, play basketball or do other high-impact activities, avoid hard surfaces and don’t do it every day.”
Multiple studies show that mild to moderate exercise is beneficial for people with arthritis. However, everyone’s circumstances are different, so having a discussion about exercise with your doctor is important. Together with your doctor and/or physical therapist you can design an exercise plan that is best for you.
Exercise May Delay or Prevent Hip SurgeryPatients who were in an exercise program were less likely to need replacement surgery.
People with mild to moderate hip osteoarthritis (OA) may be able to avoid hip surgery if they exercise, according to a study published in Annals of the Rheumatic Diseases in 2013. The study showed that people who participated in an exercise program for one hour at least twice a week for 12 weeks were 44 percent less likely to need hip replacement surgery six years later compared with a similar group of people who did not exercise. Also, those who exercised reported improved flexibility and ability to perform physical activities compared with those who did not exercise.
“The take away message from our study is that all patients with mild to moderately symptomatic hip osteoarthritis, with tolerable pain, should be offered a targeted exercise therapy program in addition to patient education to improve physical function and postpone the need for total hip replacement surgery,” says lead study author Ida Svege, a PhD candidate, from Norwegian Research Centre for Active Rehabilitation at Oslo University Hospital in Norway.
This is the first study to show that exercise therapy can avoid the need for total hip replacement in people with hip OA. The authors say they expected the study to show that exercise had no effect on the need for hip surgery and were surprised by their results. But they emphasize that the findings do not apply to people with severe hip OA, knee OA or back pain because the effect of exercise was not studied in these groups.
The study included 109 people, between the ages of 40 and 80 years, with mild to moderate hip OA in one or both hips (confirmed on X-ray). None of the participants were planning to have hip replacement surgery at the time they enrolled in the study.
All participants attended three group sessions of patient education designed for people with hip OA. They were then randomly assigned to an exercise program or none (both groups were similar at the start of the study in terms of age, severity of hip OA, gender, and other factors). Those in the exercise program participated in one hour of strengthening, flexibility, and functional exercises two or three times a week for 12 weeks. A physical therapist supervised them at least once a week (patients were considered “compliant” if they attended the program for at least 20 of 24 sessions). People who were not assigned to exercise had a two-month follow-up visit in the physical therapy clinic.
During approximately six years of follow-up, hip surgery was performed in 22 patients in the exercise group and 31 patients in the group receiving only patient education – a statistically significant difference. Furthermore, the time until needing hip surgery was prolonged by about two years in those assigned to exercise: a median of 5.4 years compared to 3.5 years for people in the group that did not exercise. Additionally, those who participated in exercise therapy said that had better hip function than those not assigned to exercise. There was no significant difference between the two groups for pain and stiffness.
“These findings support the general clinical recommendations stating that patients diagnosed with hip OA should be offered patient education and exercise therapy as the first treatment approach,” says Svege. “This is important for patients who may avoid surgery and its potential complications.”
Although the study did not document whether any of the patients continued to exercise beyond 12 weeks, Ms. Svege says, “I would absolutely recommend patients with hip OA to continue to exercise, and in fact, all patients in this study were advised to increase or maintain their level of activity.”
She notes that total hip replacement surgery remains a good option for people with advanced disease, severe pain, and functional limitations.
“This study is of interest, and may reflect the fact that those who exercise have less pain than those who do not. The main reason for surgery is pain,” says Scott Zashin, MD, a rheumatologist in private practice in Dallas, Texas.
Dr. Zashin said that it was notable that there was less progression of joint disease (as seen on X-ray) in patients who exercised compared to those who did not, whether or not they had surgery.
Exercising With OsteoarthritisPhysical activity is the best non-drug treatment for improving pain and function.
While you may worry that exercising with osteoarthritis could harm your joints and cause more pain, research shows that people can and should exercise when they have osteoarthritis. Exercise is considered the most effective non-drug treatment for reducing pain and improving movement in osteoarthritis.
Three kinds of exercise are important for people with osteoarthritis: exercises involving range of motion, also called flexibility exercises; endurance or aerobic exercises; and strengthening exercises. Each one plays a role in maintaining and improving your ability to move and function.
Speak with your doctor or physical therapist about exercising with osteoarthritis and the specific exercises that are best for you.
Range of motion/flexibility: Range of motion refers to the ability to move your joints through the full motion they were designed to achieve. When you have osteoarthritis, pain and stiffness make it very difficult to move certain joints more than just a little bit, which can make even the simplest tasks challenging.
Range-of-motion exercises include gentle stretching and movements that take joints through their full span. Doing these exercises regularly – ideally every day – can help maintain and even improve the flexibility in your joints.
Aerobic/endurance: These exercises strengthen your heart and make your lungs more efficient. This conditioning has the added benefit of reducing fatigue, so you have more stamina throughout the day. Aerobic exercise also helps control your weight by increasing the amount of calories your body uses. Furthermore, this type of exercise can help you sleep better and improve your mood.
How much should you exercise? Current recommendations for
150 minutes of moderate-intensity aerobic exercise per week
75 minutes of vigorous-intensity aerobic exercise per week
an equivalent combination of moderate and vigorous exercise
Strengthening: Strengthening exercises help maintain and improve your muscle strength. Strong muscles can support and protect joints that are affected by arthritis.
Does stress affect OA?
Yes, having a chronic disease like osteoarthritis can be stressful. Stress, in turn, can make dealing with a disease like osteoarthritis more difficult – and painful.
That’s because when you feel stressed, your body becomes tense. This muscle tension can increase pain, making you feel helpless and frustrated because the added pain may limit your abilities. This, in turn, can depress you. Stress, depression and limited and lost abilities can all contribute to pain, which then perpetuates the cycle. If you understand how your body reacts physically and emotionally to stress and learn how to manage stress, you can break the destructive cycle.
How will losing weight help?
Excess body weight is a risk factor for the both the development and progression of osteoarthritis. For every pound of body weight you gain, your knees gain three pounds of added stress; for hips, each pound translates into six times the pressure on the joints. After many years of carrying extra pounds, the cartilage that cushions the joints tends to break down more quickly than usual.
Conversely, losing weight can reduce additional stress on joints that can cause cartilage to wear away. Easing the pressure on joints by shedding extra pounds can also reduce pain in osteoarthritis-affected joints, which will help you feel and move much better.
Can OA be prevented?
Although you can’t do anything about the genes you inherit from your parents, you can and should take extra care in minimizing your other risk factors – primarily excess weight and joint injuries.
By maintaining a healthy body weight you avoid putting additional stress on your joints. This stress can wear away at cartilage more quickly than usual and lead to osteoarthritis in weight-bearing joints such as the knees.
Injuries from routine falls or severe bangs and bumps during athletic activities can cause major damage to the cartilage. These injuries can cause cartilage tears, or they can permanently alter the way your joints move so that they wear down cartilage more than usual. You can avoid injuries that may lead to osteoarthritis by taking care of your body. Warming up and stretching before athletic activity and exercise can help you prevent serious injury. If you do injure yourself, see your doctor to receive proper treatment. Injuries left untreated may heal improperly, which could lead to further damage later on.