Exercise for osteoarthritis: the treatment too many patients miss

Stiff knees, sore hips and the persistent burden of chronic joint pain are commonly viewed as an inevitable consequence of ageing. However, although osteoarthritis is the most prevalent joint disease worldwide, specialists argue that its prevention and treatment remain seriously misaligned with the evidence.

The most effective medicine does not come from a packet of tablets or an operating theatre – it is movement. Across healthcare systems and countries, however, too few people are directed towards the single treatment shown to safeguard joints and reduce pain: exercise.

Exercise ranks among the most effective treatments for chronic and disabling joint conditions, including osteoarthritis. Even so, it reaches only a small proportion of patients.

Osteoarthritis, exercise and missed referrals

Studies of healthcare systems in Ireland, the UK, Norway and the United States reveal a consistent trend: less than half of those with osteoarthritis receive a referral for exercise or physiotherapy from their primary care provider.

More than 60 percent receive treatments that are not recommended by clinical guidelines, while roughly 40 percent are referred to a surgeon before non-surgical approaches have even been attempted.

The concern raised by these figures becomes clearer when considering how exercise supports joints. Osteoarthritis is overwhelmingly the most common type of arthritis and already affects over 595 million people globally.

A worldwide study published in The Lancet suggests this total may near one billion by 2050. Greater life expectancy, more sedentary ways of living, and increasing rates of overweight and obesity are all contributing to this rise.

People who remain regularly active, however, are physically and biologically helping to protect themselves both against developing the condition and against its most severe consequences.

Cartilage, the resilient protective tissue covering the ends of bones, has no blood supply of its own. Instead, it depends on movement.

When we walk or place weight through a joint, cartilage is compressed like a sponge: fluid is pushed out, then fresh nutrients are drawn back in. With every step, nutrients and the body's natural lubricants can circulate, helping to maintain healthy joints.

This is why the traditional description of osteoarthritis as straightforward "wear and tear" is inaccurate. Joints are not like car tyres that must inevitably wear away.

A more useful view is that osteoarthritis involves an ongoing cycle of wear and repair, where frequent movement and exercise are essential for healing and for the wellbeing of the whole joint.

A disease of the whole joint

Osteoarthritis is now recognised as a disease affecting the entire joint. It involves joint fluid, the bone beneath it, ligaments, nearby muscles and even the nerves involved in movement.

Therapeutic exercise works on each of these components. Muscle weakness, for example, is among the earliest indicators of osteoarthritis and can be improved through resistance training. Strong evidence shows that weak muscles raise the likelihood of both developing the disease and experiencing its progression.

Control of muscles and nerves can also be improved through neuromuscular exercise schemes such as GLA:D® (Good Life with osteoArthritis: Denmark), designed for hip and knee osteoarthritis. These programmes are generally provided in physiotherapist-led, supervised group sessions and concentrate on movement quality, balance and strength, with the aim of increasing joint stability and restoring confidence.

Substantial gains in pain, joint function and quality of life have been observed for as long as 12 months after participants complete the programme.

Exercise is valuable medicine for the entire body, with recorded benefits for more than 26 chronic diseases. For osteoarthritis, it not only builds cartilage and muscle strength, but also addresses the inflammation, metabolic changes and hormonal alterations that contribute to the disease.

Obesity is an important osteoarthritis risk factor, not simply because it places greater mechanical pressure on joints. Elevated concentrations of inflammatory molecules in the bloodstream and joint tissues can break down cartilage and speed up the disease.

Regular physical activity can oppose these effects in osteoarthritis at a molecular level: it reduces inflammatory markers, restricts cell damage and may even change gene expression.

Exercise first, surgery later

At present, no medicines can alter the progression of osteoarthritis. Joint replacement can transform life for certain people, but it remains major surgery and is not successful for everybody.

Exercise should be attempted before other options and maintained during every phase of the condition. It has considerably fewer side effects while providing many wider health advantages.

Osteoarthritis is not merely about "worn out" joints. Muscle strength, inflammation, metabolism and lifestyle all influence it.

Consistent, targeted exercise tackles several of these influences simultaneously – supporting cartilage protection, strengthening the whole joint and enhancing general health. Before surgery is considered, movement remains one of the most powerful treatments available.

Clodagh Toomey, Physiotherapist and Associate Professor, School of Allied Health, University of Limerick

This article has been republished from The Conversation under a Creative Commons licence. Read the original article.