Home 5 Hip & Knee OA Individuals Standards 5 Core Treatment 2 – Exercise and Physical Activity

 

 

 

 

Standards

1-3: Setting Up for Success
4-6: Core Treatments
7-9: Rounding out the OA Journey

FOR PEOPLE LIVING WITH OSTEOARTHRITIS

Standard 5. Core Treatment 2: Exercise and Physical Activity

Exercise and physical activity programs are an important part of the care plan when you have OA of the hip or knee. Programs tailored for your needs offer support and information on progressive exercises and how to modify or change the activities as your symptoms change. These programs focus on improving your strength, endurance, and movement, which will help support regular movement and improve your overall health. Working with your clinician team will make sure your priorities, values, and preferences are part of setting exercise and physical activity goals.

Overview

  • You might find that over time your legs are weaker, which may mean that you won’t be able to use or move them as well as before.1,2
    1 de Zwart AH, Dekker J, Lems WF, Roorda LD, Van Der Esch M, Van Der Leeden M. Factors associated with upper leg muscle strength in knee osteoarthritis: A scoping review. Journal of rehabilitation medicine. 2018;50(2):140-50. 2Øiestad BE, Juhl CB, Eitzen I, Thorlund JB. Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. A systematic review and meta-analysis. Osteoarthritis and Cartilage. 2015;23(2):171-7.

  • Not being active (sedentary) is one of the major risk factors of osteoarthritis, as it can make your symptoms worse, which can affect your quality of life and your overall health.1-4
    1 de Zwart AH, Dekker J, Lems WF, Roorda LD, Van Der Esch M, Van Der Leeden M. Factors associated with upper leg muscle strength in knee osteoarthritis: A scoping review. Journal of rehabilitation medicine. 2018;50(2):140-50. 2Øiestad BE, Juhl CB, Eitzen I, Thorlund JB. Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. A systematic review and meta-analysis. Osteoarthritis and Cartilage. 2015;23(2):171-7. 3Musumeci G, Aiello FC, Szychlinska MA, Di Rosa M, Castrogiovanni P, Mobasheri A. Osteoarthritis in the XXIst century: Risk factors and behaviours that influence disease onset and progression. International Journal of Molecular Sciences. 2015;16(3):6093-112. 4Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47.

  • Regular exercise and physical activity are among the best treatments to improve your symptoms4,5 and maintain your overall wellness.
    • 4Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47. 5Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best evidence rehabilitation for chronic pain part 5: Osteoarthritis. Journal of Clinical Medicine. 2019;8(11):1769.

  • Most recommended exercises and physical activities for hip and knee OA focus on the lower half of your body (below the waist), including the trunk/core, gluteal, quadriceps, hamstring, and calf muscles​
  • Prescribed exercise can be done on your own or by joining a program. Over time and when it’s safe, you can gradually increase your daily physical activity by increasing how often, and how long you do the program.​
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    Speak with your clinician about strategies to manage your osteoarthritis along with the prescribed exercises that meet your needs and physical activity programs. Once you’re comfortable with your body and your options for modifying or changing your exercises and physical activities, you’ll be better able to safely exercise and do your day-to-day activities.

    The Treatment Menu from your Toolkit gives you several choices for both exercise and physical activity. Use these ideas to help you tell your clinician what you’re interested in. If you choose something you’re interested in, you’ll be more likely to enjoy it and to keep doing the exercise or physical activity.

    Note: Structured programs may cost money so talk with your clinician about what you’re able and willing to incorporate into your budget.

    Prescribed Movement

    During your care planning, your primary clinician should offer options for exercise and physical activity to focus on strength and flexibility and balancing it with your heart health. Or your primary clinician can refer you to other clinicians specialized in prescribed exercise to work with you to develop an exercise program.

    Most recommended exercises and physical activities for hip and knee osteoarthritis focus on the lower half of your body (below the waist), including the trunk/core, gluteal, quadriceps, hamstring, and calf muscles. The muscles of the stomach and back help support the hips and knees.

    It’s very common to be afraid that you’re going to hurt your joint even more or end up with an injury while exercising or doing your activities. However, your pain and stiffness aren’t directly related to the health of your joint.

    It may feel confusing to be told you have to move a sore joint or body part, but exercise and moving a sore joint are important to keep joints healthy and slow the osteoarthritis. If you have other health conditions that could make activity risky for you, such as heart or lung conditions, make sure your clinicians know and work with them to safely modify your program.

    A well-rounded movement plan4-6

    4Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47.

    5Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best evidence rehabilitation for chronic pain part 5: Osteoarthritis. Journal of Clinical Medicine. 2019;8(11):1769.

    6Holden MA, Button K, Collins NJ, Henrotin Y, Hinman RS, Larsen JB, et al. Guidance for implementing best practice therapeutic exercise for people with knee and hip osteoarthritis: what does the current evidence base tell us? Arthritis Care & Research. 2020;Accepted for publication.

    Accommodates for your baseline wellness

    Addresses your: needs, goals, symptoms, budget limits, preferences, and values.

    Has an early plan for progression and incorporates:

    • Daily movement goals (see below)
    • Education on safe practices strategies for:
      • Recovery
      • Tracking and managing pain
      • Pacing and modifying your activities

    Physical Activity Target

    Once your clinician approves, a target of 150 minutes of moderate to vigorous aerobic movement per week is recommended.7,8

    7Canadian Society for Exercise Physiology. Canadian 24-hour movement guidelines: An integration of physical activity, sedentary behavior, and sleep Ottawa, Ontario: Canadian Society for Exercise Physiology; 2021 [Available from: https://csepguidelines.ca/ 8World Health Organization. WHO guidelines on physical activity and sedentary behavior. Geneva; 2020.

    Moderate Activity

    You can carry a conversation while doing these activities.

    Examples
    Brisk walking, biking, household chores, yard work, and dancing

    Vigourous Activity

    You’d feel a little out of breath during a conversation while doing these activities.

    Examples
    Faster-paced walking, biking uphill, and swimming

    Tips for Self-managing Movement

    Your clinician team will show you how to safely do exercise and physical activities within reasonable limits and acceptable pain levels. You’ll also learn how to use your pain as a guide when doing any exercise or activity. If you’re starting on your own before you see a clinician, you can use the following as a guide:

    • Start by measuring your ‘baseline’ pain
      • Baseline pain is rating how strong your pain is while you’re sitting or resting and noting where it hurts
      • Rate the pain between 0 and 10 (0 = no pain; 10 = the worst pain you can imagine) for each place where you feel it
    • Do the recommended exercise or activity
    • Once you’re done the exercise or activity, rate your pain and note the again where it hurts

    If the pain goes back to baseline within 24 hours after you did the exercise or activity, keep doing them.

    If your pain isn’t back to the baseline within 24 hours, the exercise or activity you did may have been too much for your joint.

    Speak with your clinician team for advice on how to adjust the exercise and activity so that you do return to your baseline within 24 hours.