Does regular exercise reduce the pain and stiffness of osteoarthritis?

The Journal of Family Practice. 2008 July;57(7):476-477

July 1, 2008|Family Medicine

Jason Blackham, MD;Joseph P. Garry, MD;Doyle M. Cummings, PharmD;Roger G. Russell, MLS

Another systematic review examined the effect of therapeutic exercise on hip and knee osteoarthritis.⁴ The standardized mean difference in ES for pain reduction was moderate, 0.46 (95% CI, 0.35-0.57). For self-reported physical functioning, the standardized mean difference was small, 0.33 (95% CI, 0.23-0.43). Study limitations included enrollment of patients with only early or mild osteoarthritis, low numbers of intent-to-treat studies, short-term nature of the studies, and inadequate sample sizes.

Advanced osteoarthritis

In a Cochrane systematic review that evaluated the intensity of exercise,⁵ only 1 study with 39 participants met the inclusion criteria. This limited-power study found no difference between the effect of low-intensity and high-intensity exercise on pain reduction or function.

Both aerobic and strengthening exercises seem to help

A 2005 systematic review examined aerobic walking and quadriceps strengthening for knee osteoarthritis using pain as the primary outcome and self-reported disability as the secondary outcome.⁶ In the exercise group, the weighted, pooled ES for pain reduction and self-reported disability was moderate at 0.52 (95% CI, 0.34-0.70) and 0.46 (95% CI, 0.25-0.67) respectively. The quadriceps strengthening group showed a small weighted, pooled ES for pain reduction of 0.32 (95% CI, 0.23-0.42) and disability of 0.32 (95% CI, 0.23-0.41); pain and disability measures were variable. None of the included clinical trials were blinded.

FAST TRACK

Tai chi for arthritis decreases joint pain while improving balance

Two other reviews examined strengthening and aerobic exercises for osteoarthritis, including studies using isokinetic, concentric, and eccentric strengthening; water therapy; walking; yoga; and tai chi.^7,8 The exercises appeared to have beneficial effects on pain. However, results from the studies of each type of exercise weren’t combined and ES wasn’t calculated.

No reviews assessed the effect of exercise on reducing stiffness.

Recommendations

The American College of Rheumatology recommends that nonpharmacologic therapy for osteoarthritis include education, aerobic exercise programs, physical therapy with range of motion, and muscle strengthening.⁹ The American Geriatric Society and the Centers for Disease Control and Prevention also recommend regular exercise.^10,11

References

Download Article