Knee Osteoarthritis? Ain’t Nobody got Time for That!
“exercise programs and their benefit to individuals with knee OA”
We find quite often that patients ask us questions about what the best exercises are for managing their knee osteoarthritis (OA). As physiotherapists we are educated in terms of providing exercises and appropriate parameters for these programs, and we often continue our education by researching topics that we seek to gain more information on. Since I see many patients that are over the age of 50 that have OA, I decided to find peer reviewed articles that provide more information about clinical practice guidelines. Let’s let out the inner nerd in me! Here goes nothing!
PART I
Through my search of literature I was able to find 1 high quality study (3 parts), which is a systematic review that provides significant amounts of information about recommendations for exercise. The name of the first part is called The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs (Brosseau et al., 2017). This article explains that mind-body exercise programs such as yoga and Tai Chi have effects on strength, cardiovascular, and respiratory function, along with the addition of physiological, clinical, and psychological effects when compared to traditional exercise programs (i.e., strengthening and aerobic programs). These additional effects include enhanced muscle function, proprioceptive acuity, balance, flexibility, and coordination with improvements in depression and anxiety symptoms (Brosseau et al., 2017). This article examined four high quality studies that looked at various mind-body activities and the results indicated that Hatha Yoga demonstrated significant improvements for pain relief and physical function. It also showed that Tai Chi Qigong had significant improvements for quality of life, pain relief, and physical function (Brosseau et al., 2017). With results like these it would be recommended that individuals trial these activities within their daily routines and other exercise programs. These other exercise programs could include strengthening programs and aerobic programs, which we will examine next.
PART II
The second part examines strengthening exercise programs and their benefit to individuals with knee OA (Brosseau et al., 2017). As clinicians we often recommend strength programs to patients with knee OA with the aim to strengthen lower extremity muscles while reducing the load and limiting direct knee joint stress during movement. In this part of the research article it examined 35 studies that looked at strength training and it’s effects on OA symptoms. The types of exercises that were performed in these studies included isotonic, isokinetic concentric-eccentric, isometric, and weight bearing exercises. The types of equipment that were used included therapeutic elastic bands, weights, and resistance devices. Most of these programs were performed 2-4 times per week for 40-60 minute sessions for a total of 4-6 months. The results indicated that strengthening programs demonstrate significant improvements for pain relief, physical function, and quality of life (Brosseau et al., 2017). The results also indicated that individuals with knee OA would experience benefits with a strengthening program, which can be completed with a variety of equipment (low cost), and a variety of exercises. With a large variety of exercise programs and equipment, anyone with knee OA can find something that interests them! With this in mind it is also important to consider the effects of aerobic programs as well.
PART III
The third and final part of the study being examined looked at aerobic exercise programs with respect to the management of knee OA (Brosseau et al., 2017). Aerobic training can be any type of cardiovascular conditioning which can include running, jogging, walking, swimming, jumping rope, just to name a few! These activities improve pulmonary and functional capacities that are important to perform daily activities such as groceries and taking the bus (Brosseau et al., 2017). This third part of the study examined 35 articles/studies, which showed that aerobic exercise programs when performed within a 12-week period demonstrated significant improvement for pain relief, physical function, and quality of life. These programs often had participants perform 20-40 minutes of aerobic activity 2-4 times per week. When this study looked at the combination of aerobic training and strengthening exercises the results indicated greater improvements. Which would indicate that individuals with knee OA should look at implementing both types of exercise programs in their schedule, or to at least trial them and see what happens to their symptoms.
Writer’s Recommendation
When looking at all of this information one can be overwhelmed as there are many recommendations. We know that mind-body, strengthening, and aerobic exercise programs benefit overall pain symptoms, quality of life, and physical function (Brosseau et al., 2017). It would be advantageous for anyone that has knee OA to trial these programs, but be careful! You don’t want to trial all three programs all at once, as it could be very taxing to your body, especially if pain symptoms are already high. The best way to start is to pick one or two of these exercise types and ease into it. Each week progress slowly and see first-hand what these programs do to your symptoms. If things improve then continue increasing activity gradually, if the symptoms increase then ease back and modify the programs. In either case it would be important to see a physiotherapist prior to starting a program, that way you can be advised in more detail of how to start a program and how to progress intensity.
Written by Sunny Deol, MSc.PT, Owner/Physiotherapist
References
Brosseau, L., Taki, J., Desjardins, B., Thevenot, O., Fransen, M., Wells, G. A., … Van der Esch, M. (2017). The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs. Clinical Rehabilitation, 31(5), 582–595. https://doi-org.login.ezproxy.library.ualberta.ca/10.1177/0269215517691083
Brosseau, L., Taki, J., Desjardins, B., Thevenot, O., Fransen, M., Wells, G. A., … Van der Esch, M. (2017). The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs. Clinical Rehabilitation, 31(5), 596–611. https://doi-org.login.ezproxy.library.ualberta.ca/10.1177/0269215517691084
Brosseau, L., Taki, J., Desjardins, B., Thevenot, O., Fransen, M., Wells, G. A., … Van der Esch, M. (2017). The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part three: aerobic exercise programs. Clinical Rehabilitation, 31(5), 612–624. https://doi-org.login.ezproxy.library.ualberta.ca/10.1177/0269215517691085