The Sweet Spot
Osteoarthritis and Rheumatoid Arthritis
Knee and hip osteoarthritis represent two of the most common causes of disability in the world (Musemeci et al., 2014). Social, psychological and economical costs are involved with the condition and numerous consequences are experienced by the individual including pain, reduced range of motion, reduced functionality and ability to perform activities of daily living. Osteoarthritis generally requires long term therapeutic treatment that often involves lifestyle interventions (Krauss et al., 2016).
Rheumatoid arthritis affects 1% of the world’s population (Cooney et al., 2010). The inflammatory presentation and persistent episodes or flare ups result in pain and stiffness, leading to progressive joint deformities and loss of function. Secondly, chronic inflammation can result in an increased risk of secondary complications such as cardiovascular disease. Lifestyle interventions such as exercise as shown to improve function and reduce cardiovascular risk in patients with RA (Cooney et al., 2010).
Treatment Options Using Exercise as Medicine for Osteoarthritis and Rheumatoid Arthritis
Exercise is used as a lifestyle intervention to reduce the effects of rheumatoid and osteoarthritis. Physical exercises are recommended as the first line of treatment to reduce risk factors such as overweight, obesity and joint tissue inflammation. Physical activity has been recognised as an effective, economical and accessible tool to everyone in the treatment and prevention of osteoarthritis. Exercise also leads to a reduction in pain and an increase in physical functioning.
Supervised exercise sessions completed three times a week with a focus on aerobic capacity, quadriceps strengthening and lower extremity performance indicate the greatest reduction in pain and most significant improvements in functionality (Juhl et al., 2014).
There is strong evidence that supports the short-term efficacy of joint specific exercise programs with respect to pain reduction and increase of functionality in subjects with knee and hip osteoarthritis (Krauss et al., 2016). Research supports positive knee and hip osteoarthritis outcomes of regular exercise engagement. Such improvement includes, increased health related quality of life, reduced pain and physical function at mid and long-term assessments, and greater self-efficacy and physical activity levels. These improvements allow surgery to be delayed, or prevent replacement surgery completely. Exercise is also known to be an efficient intervention with regards to personal and social costs when directly compared with surgical interventions (Krauss et al., 2016).
As supported by research, three supervised exercise sessions per week for at least eight weeks results in improvements in perceived pain, functionality, quadriceps strength and aerobic fitness when directly compared to non-exercise control groups of the same patient demographics. Patients completing regular exercise observe reductions in depressive symptoms, weight and other risk factors contributing to potential comorbidities (Krauss et al., 2016).
So how do I use exercise as medicine to reduce my symptoms of arthritis?
At The Exercise Therapist we prescribe exercise as medicine for patients with osteoarthritis and rheumatoid arthritis. The difference in our management of these clients is evident during episodes or flare ups. For patients experiencing a RA flare up, they experience a significant impact on joint function and therefore in these episodes we reduce the amount of loading and impact on these joints during exercise. However, a flare up or episode of agitation in patients with osteoarthritis, there is significantly less impact on the affected nerve, and the joint is still able to be loaded.
The Thrive Clinic follows a four stage exercise prescription model to ensure all patients are thriving. Following a comprehensive global postural musculoskeletal screening, where anomalies and weaknesses are identified, an individualised functional strength and conditioning program will be prescribed. The program will be based on four key postural aspects: postural mobility, trunk conditioning, VMO and glute med coordination and activation, and scapulohumeral rhythm. Note, although thoracic and upper mobility may not have any direct operative link, full body biomechanics and postural orientations have a large impact on re-injury predisposition and global post-operative recovery. Patients that have followed this procedure in a supervised domain have seen improvements in functionality, strength and confidence in their own ability.
Your GP will assess your eligibility for a Chronic Disease Management (CDM) Referral. These allocated CDM sessions will be used for initial and follow-up assessments and reviews.
We offer eight or twelve week programs where patients attend The Thrive Clinic two or three sessions a week. Patients complete their specific exercise program in a supervised setting where technique and feedback is provided. Reviews are completed every four-weeks, allowing not only the individual but the GP to monitor their progress. If covered by Exercise Physiology, patients may receive up to $150 back from their private health fund at the completion of their program.
Juhl, C., Christensen, R., Roose, E.M., Zhang, W. & Lund, H. (2014). Impact of exercise type and dose on pain and disability in knee osteoarthritis. Arthritis and Rheumatology, 66(3), 622-636. doi: 10.1002/art.38290
Cooney, J., et al. (2010). Benefits of exercise in rheumatoid arthritis. Journal of Aging Research, 2011. doi:10.4061/2011/681640
Krauss, I., Mueller, G., Haupt, G., Steinhiber, B., Janssen, P., Jentner, N., Martus, P. (2016). Effectiveness and efficiency of an 11-week exercise intervention for patients with hip or knee osteoarthritis: A protocol for a controlled study in the context of health services research. BMC Public Health, 16(367), 1-16. doi: 10.1186/s12889-016-3030-0
Musumeci, G., Loreto, C., Imbesi, R., Trovato, F.M., Di Giunta, A., Lombardo, C., Castorina, S. & Castrogiocanni, P. (2014). Advantages of exercise in rehabilitation, treatment and prevention of altered morphological features in knee osteoarthritis. A narrative review. Histology and Histopathology, 29(6), 707-719. doi: 10.14670/HH-29.707
The Exercise Therapist : Katie Stewart : Subscribe @ www.theexercisetherapist.com