Physical Activity: Physical Activity in the Management of Osteoarthritis of the Knee and Hip

Abstract

Symptomatic osteoarthritis (OA) affects more than 4 million adults in this country and is associated with joint degeneration, chronic pain, muscle atrophy, decreased mobility, poor balance, and physical disability. The prevalence of comorbid conditions such as heart disease, hypertension, and obesity is greater in those with symptomatic OA. Obesity is a risk factor for OA, and weight loss has been shown to reduce pain and improve physical function. The role of physical activity/inactivity in the development of OA is not clear. Limited evidence suggests that a sedentary lifestyle may increase the risk for OA, while high levels of physical activity have also been suggested to contribute to the development of OA. Regular aerobic exercise may moderate the functional decline associated with OA. Both aerobic and strength training have been reported to reduce pain and improve physical function in persons with knee and hip OA, although very few studies have specifically examined the effects of regular physical activity on the OA hip. While it is generally recommended that exercise programs for OA incorporate both aerobic and strength-training activities, no studies have been performed to evaluate the efficacy of combining these 2 modes of exercise compared with either alone. Little work has been done to determine the optimal exercise program for individuals with OA. One study suggests that exercise interventions should be performed a minimum of 3 days per week for a duration of at least 35 minutes. Exercise programs should be individualized based on the patient's preferences, abilities, limitations, and comorbidities. It is recommended that exercise programs for OA incorporate strategies designed to promote adherence. Home-based exercise appears to be as effective as supervised exercise programs.