Academic journal article Annual Review of Gerontology & Geriatrics

Exercise for Osteoarthritis of the Hip and Knee

Academic journal article Annual Review of Gerontology & Geriatrics

Exercise for Osteoarthritis of the Hip and Knee

Article excerpt

ABSTRACT

Osteoarthritis (OA) is the most common form of arthritis and is a painful, chronically disabling joint disease that often significantly compromises function and independence. With the generalized rise in the age of the global population, the number of people suffering from musculoskeletal disorders throughout the world will increase dramatically over the coming decades. International clinical guidelines recommend exercise for the treatment of OA. Given the current and predicted future global burden of OA of the hip and knee, the aim of this chapter is to summarize the evidence from recent systematic reviews published in English on the effectiveness of land- and water-based exercise programs for people with OA of the hip and knee. The primary outcomes considered, based on the recommendations of the Outcome Measures in Rheumatology (OMERACT) conference OMERACT III, are pain and function. Recent systematic reviews have examined the effectiveness of exercise on pain and function compared with controls: land-versus water-based exercise, individual versus group exercise, and exercise prior to surgery for people with OA of the hip, the knee, and lower limb (hip and knee combined). Generally, most forms of exercise have been demonstrated to have significant positive effects on pain and function at the end of the exercise program, but unless participants continue the program, the sustainability of these effects in the longer term are questionable. However, exercise appears to be a safe intervention, with few adverse effects reported. A number of considerations relating to the design and reporting of primary research in this area are discussed.

INTRODUCTION

Osteoarthritis (OA) is the most common form of arthritis and is a painful, chronically disabling joint disease that often significantly compromises function and independence. OA can present in the spine and hands, but the most frequently affected joints are the main load-bearing joints, the hips and knees. Approximately one in four people may develop symptomatic hip OA in their lifetime (Murphy et al., 2010); the lifetime prevalence for hip OA is estimated to be 25.3% but it is much higher for knee OA, 44.7% (Murphy et al., 2008). The global age-standardized point prevalence for hip and knee OA in 2010 was 3.8% (95% uncertainty interval 3.6 to 4.1) and was higher in females peaking at age 50 years (March et al., 2014).

The symptoms of OA include pain, joint stiffness, muscle weakness and atrophy, altered proprioception, and limitations in functional activities and social participation. Joint malalignment may be present in progressive disease states and this can result in bone-on-bone joint pain. Hip and knee OA accounts for about 10.5% of the total disability burden in terms of years lived, with disabilities for all musculoskeletal diseases combined.

With the generalized rise in the age of the global population, the number of people suffering from musculoskeletal disorders throughout the world will increase dramatically over the coming decades. For example in the United States, the number of adults with arthritis is projected to increase from 47.8 million in 2005 to 67 million in 2030 (Hootman & Helmick, 2006). This will result in an exponential increase in the global burden of disability from OA hip and knee; therefore, finding cost-effective and safe treatment to minimize the symptoms for people with OA hip and knee is imperative.

Traditionally, treatment of OA involves pharmacological interventions such as paracetamol/acetaminophen, nonsteroidal anti-inflammatory drugs, and intra-articular steroids. Nonpharmacological interventions include exercise, education, weight reduction, appliances, heat and cold therapy, transcutaneous electrical nerve stimulation, pulsed electromagnetic field, and laser and galvanic stimulation; joint replacement is the most common surgical intervention.

THE ROLE OF PHYSICAL ACTIVITY AND EXERCISE

It is well documented that regular moderate-intensity physical activity-such as walking, cycling, or participating in sports-has been shown to have significant benefits for general health of populations, such as reducing the risk of cardiovascular diseases, diabetes, colon and breast cancer, and depression; decreasing the risk of a hip or vertebral fracture; and helping control weight. …

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