By Erika Breseman, Doctor of Physical Therapy (DPT), Dee Physical Therapy

The most common form of arthritis is osteoarthritis (OA), also known as degenerative joint disease (DJD), impacting over 32 million people in the United States alone. OA has become the leading cause of disability in the older adult population. However, with the right tools OA can be managed with exercise in order to improve pain and overall quality of life. To better understand OA and how to manage your symptoms, let’s break things down:

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What exactly is OA and how did I get it?
OA is a condition of the joints characterized by cartilage breakdown, bone remodeling and inflammation, which leads to stiffness, swelling, pain, decreased range of motion and impaired joint function. The most commonly affected joints are the knees and hips. There is no one specific known cause of OA; however, there are several associated risk factors, including the following: joint injury or overuse, age (50 and older), gender (females are more commonly affected than males), obesity and genetics.

How does exercise help?
Research has shown that participation in regular exercise can help to improve joint lubrication, pain, function, performance and quality of life in people with OA. Regular exercise can also help with weight loss, which further decreases joint pressure and stress. As we age, our muscles become weaker. However, through exercise we can improve our strength, building stronger muscles, which further provides increased joint support and protection. Regular exercise can ultimately help to delay the onset of arthritis-related disability. In addition, regular exercise can be helpful in the management of other chronic conditions, such as diabetes, heart disease and obesity.

How do I get started and what kind of exercise should I do?
When it comes to exercise and OA, it is important to start off gently and slowly and ease into beginning any new exercise regimen. It can take time for your body to adjust to a new level of activity, so listen to your body and pay attention to how well you are tolerating it. If you find that your arthritis symptoms are increasing, you may need to modify your level of activity. You can do this by decreasing the number of exercises, number of repetitions, weight, intensity and/or overall time spent exercising. This will allow you to continue to remain active, while minimizing arthritis symptoms. As your exercise tolerance improves, you can always increase your level of activity. However, you should continue to pay close attention to how your body is responding to the increased activity level and modify if needed.

When choosing a form of exercise, it is important to keep in mind that exercises should be “joint friendly,” meaning that they should be low-impact, put minimal stress on the body, and reduce risk of injury. It is best to avoid high-impact exercises, especially those that involve pounding and twisting of the joints, placing them at higher risk of injury. The following types of exercise are recommended for people with OA:

• Aerobic – improves cardiovascular endurance, increases blood flow to muscles, and reduces joint stiffness (i.e., walking, cycling, swimming, water aerobics)
• Mind-body – improves flexibility, improves balance, and promotes relaxation (i.e., yoga, tai chi)
• Flexibility – improves flexibility, improves range of motion, and reduces joint stiffness (i.e., stretching)
• Strength training – improves muscle and tendon strength and provides joint support and protection (i.e., body weight exercises, weightlifting)
• Mixed exercise – any combination of the exercise categories above

How often should I exercise?
When it comes to determining how often you should exercise, it depends on what type of activity you choose. Current recommendations:

• Aerobic – 150 minutes per week of moderate intensity aerobic exercise (i.e., 30 minutes per day, five days per week) or 75 minutes per week of vigorous intensity aerobic exercise (i.e., 15 minutes per day, five days per week)
• Mind-body – daily
• Flexibility – daily
• Strength training – At least two to three days per week
• Mixed exercise – any combination of the exercise recommendations above, as tolerated

 Sample Exercises
Here are two exercises you can try:

• Seated hamstring stretch – Start by sitting in a chair. Bend your left leg so that your foot is flat on the ground. Straighten your right leg so that your knee is completely straight, with the back of your heel resting on the ground and your toes pointed towards the ceiling. Gently lean your torso forward, moving at the hips, keeping your back straight. You should feel a gentle stretch in the back of your right leg. Hold for 30 seconds. Repeat three times. Repeat on the opposite side.
• Side-lying hip abduction – Start lying on your left side. Lift your right leg towards the ceiling and then gently lower back down. Repeat 10 times. Complete three sets, resting in between each set. Repeat on opposite side.

How can physical therapy help?
As individuals, we require exercise programs tailored to our specific needs. Variables to consider include the specific joint that is painful, pain intensity/severity, prior level of function, current level of function, personal goals and exercise preferences. These factors can vary greatly between individuals and play an important role in successful outcomes. Figuring out the right exercise program for you can seem daunting. A physical therapist can perform a thorough evaluation to determine your specific needs and work with you to create a customized exercise regimen that will help you to achieve your goals. In addition, a physical therapist can help monitor your overall response to a new exercise program, determine the appropriate dosage, and teach you self-management techniques to feel confident in continuing your exercise regimen independently, when you are ready.

References:

1. Goh S. et al. Relative efficacy of different exercises in knee and hip osteoarthritis: network meta-analysis. Sports Med. 2019; 49:743-761.
2. Kolasinski S. et al. 2019 American college of rheumatology/arthritis foundation guideline for management of osteoarthritis of the hand, hip and knee. Arthritis Care and Research. 2020;72(2):149-162.
3. “Physical Activity for Arthritis.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 8 Nov. 2018.