News Review From Harvard Medical School -- Study Supports Exercise for Knee Arthritis
Exercise probably is the best treatment other than surgery for knee pain caused by osteoarthritis, a research review finds. Current guidelines already recommend exercise. But the review did not support other recommended treatments. It found no long-term benefit from tai chi or massage. With electrical stimulation, pain actually got worse over time, the review found. The new study was based on a review of 193 earlier studies. It found that only a few types of physical therapy helped to reduce pain or disability or help function of the knee. Exercise worked best. The authors said people should get an exercise prescription from a physical therapist. Aerobic exercise or strength training both can help, they said. Sticking with the plan improved results. But strenuous workouts were no better than moderate exercise. The journal Annals of Internal Medicine published the study. HealthDay News wrote about it November 6.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Osteoarthritis is a disease that doesn't go away. It generally gets worse with time. The main problem is loss of the cartilage that covers and protects the ends of the bones where they meet at a joint. Without this protective coating, bone rubs against bone. This causes the joint to get irritated and inflamed. The result is pain and stiffness. Often this also creates pain in the muscles and ligaments that surround the joint.
Osteoarthritis is the leading cause of disability in the United States. Osteoarthritis can occur in any joint. But it strikes the knees, hips, spine and hands most often. The chance of developing osteoarthritis increases with advancing age.
Knee osteoarthritis affects 37% of Americans age 65 and older. Other than age, the main factor that increases risk is carrying more body weight.
Other than surgery, there are no cures for knee osteoarthritis. So treatment goals are:
- Controlling pain
- Decreasing stiffness
- Remaining active to limit disability
- Losing weight, if necessary, to help slow down how quickly the disease gets worse
Pain medicines help relieve discomfort. Sometimes they also may improve stiffness. But pills alone are not enough. Physical activity is a must. But what types of exercise and physical therapy are the most helpful?
That's the question this analysis of many published studies tried to answer. The researchers analysis suggested that the following activities were most effective:
- Aerobic exercise -- improved disability, reduced pain and decreased stiffness
- Aquatic exercise -- improved disability
- Strengthening exercise -- reduced pain and stiffness
- Ultrasound treatment -- provided short-term pain relief
What Changes Can I Make Now?
The main thing we can learn from this review is that exercise needs to be the main therapy for knee osteoarthritis. Exercising may be the last thing you want to do when your joints are stiff and achy. But it's crucial for easing pain and staying active.
Aerobic exercise should be your first choice, if possible. Choose whatever works for you to increase your heart rate. Options include walking, jogging, riding a bike (outdoors or indoors on a stationary bike) or swimming.
The researchers did not have enough evidence to look at whether aerobic aquatic exercise can help relieve pain and stiffness. This a type of exercise that increases your heart rate and is performed in a pool. This should be as helpful as any other type of aerobic exercise. Even if you can't get your heart rate up, exercising in a pool improves disability.
Most doctors recommend leg muscle strengthening. Stronger and larger muscles absorb more impact as you use your knees and lessen the direct strain on them.
What Can I Expect Looking to the Future?
Maintaining a healthy weight and avoiding joint injury can help prevent osteoarthritis. But many people who do all the right things still get this disease. We still have much to learn about prevention. And effective treatment other than surgery remains elusive.