Osteoarthritis and Physical Activity
Osteoarthritis can cause pain and stiffness in joints. This is often accompanied by muscle weakness which can increase joint load and instability. There is strong evidence that increasing physical activity reduces pain and improves function, quality of life, and confidence 1.
Pain and functional improvement can be similar to that achieved with painkillers 2. Many people are afraid to exercise because they wrongly believe that it will further damage their joints but doing nothing is harmful to the tissues in and around the joints. Our body’s natural reaction is to immobilise a painful joint but too much rest makes things worse because the muscles become weak and so it loses its ability to provide proper movement. Maintaining a healthy weight through diet and exercise prevents excessive stress through the joint. Along with joint health, regular activity prevents and treats many conditions such as diabetes and cardiovascular disease (such as heart attack and stroke).
Regular physical activity also gives you more energy, builds confidence and can help you to sleep more soundly at night. You can combine your activity time with family and friends or use it as an opportunity to reflect on things and listen to your favourite music.
Physical Activity Recommendations for inactive adults with OsteoarthritisAim to do the following three types of activity:
- Aerobic activity at relative moderate intensity for at least 150 minutes (2 hours and 30 minutes) a week – one way to approach this is to do 30 minutes on at least five days each week.
- Muscle strengthening activity on two or more days a week which work all major muscles groups (legs, hips, back, abdomen, chest, shoulder and arms)
- Flexibility exercises on a daily basis
The Three Types of Activity and Osteoarthritis
You may find the following weekly approach useful if you have been inactive for a while.
Aerobic activity, also known as endurance activity, is when large muscle movements, maintained over a period of time, make the heart and lungs work harder.
Activity? – Any type that you can comfortably maintain is ideal. Choose exercises that you enjoy, such as walking, cycling or group fitness classes. Low impact exercises are better but you should vary the type according to any pain experienced. Some examples for different aerobic activity types can be seen in the table below.
How long (duration)? – You can split your total activity amount into minimum bouts of 10 minutes if needed. If you have been inactive for a long time, start with short daily amounts and increase this as your body allows and you feel more confident. Remember not to sit for hours. A regular break from sitting every hour is healthy.
How hard (intensity)? – Try to progress gradually over time to a relatively moderate-intensity activity. When doing moderate intensity activity you will feel warm, mildly out of breath and mildly sweaty. The ‘talk test’ is a simple way to measure moderate intensity. This means that you can still talk, but not sing, during the activity. Intensity levels reached will vary from time to time according painful joints.
How often (frequency)? – If you aim to do 30 minutes per day then do this at least 5 times per week so that you reach the 150 minutes total per week. Distribute the sessions over the week and aim to have no more than 2 consecutive days without physical activity. When you start any new activities make sure you give your body enough time to recover and adapt to the new stress.
Painful joints often lead to weaker, smaller muscles. Strength training can prevent pain and weakness from progressing over time. Specific exercises for the most effected joint can be recommended by your doctor or a physiotherapist.
Aim to do strengthening activities on at least 2 days a week. Some activities, such as climbing stairs, digging the garden or walking up hill, combine aerobic and muscle strengthening types. They should work all the major
muscle groups in your body such as legs, hips, back, chest, abdomen, shoulders and arms. Begin with simple movements and add loads such as your own body weight or additional weights when you feel confident and you have a good range of joint movement. If you have difficulties moving the joint fully then do not use additional weights.
If you are using weights such as dumbbells, try to do at least 1 set of 8-12 repetitions per activity. The correct weight choice is the one which is hard to complete by the end of the set. A repetition is one complete movement of an activity, like doing a sit up or bicep curl.
Daily flexibility exercises can prevent pain, stiffness, and injury of muscles and joints. People often experience a sense of wellbeing and relaxation during flexibility exercises. Some quick and simple movements can be found in our separate exercise sheet. Yoga, Tai Chi and Pilates are examples of some activities which combine strength and flexibility as well as balance training.
Examples of Aerobic Activities for adults with joint pain
|Walking||This is safe and inexpensive. Wear soft, well-cushioned shoes which provide good shock absorption. Choose ones that fit well without squashing the toes. Walk on flat, even ground.|
|Cycling||Cycling avoids heavy joint load and increases fitness and muscle strength. You can progress to outdoor cycling which can help with balance. Choose a comfortable bike seat and adjust the seat height so that the knee’s angle is 10-15 degree when most extended. Cycling does requires 90 degrees of bending at the knee.|
|Swimming and Running in Water||This type of exercise avoids heavy stress on joints. The joints are supported in water, which make them easier to move. Some neck pain made worse by swimming is often due to poor technique only. Aqua- aerobic exercises sessions can also offer a great overall workout.|
|Treadmill||Easy to use but requires good balance. Choose a treadmill with soft surface and handrails. Avoid downward grades.|
|Fitness classes||Choose aerobic classes that have the least amount of high impact. Some classes such as step-aerobics are a great way to keep fit but the impact involved may be too high for your weight bearing joints.|
- If you have led a very sedentary lifestyle, begin by doing low intensity exercise of short duration, e.g. 10 minutes. Increase your level of activity gradually to avoid injury. The development of weak, poorly activated muscles due to long term pain from joints can make some people lose balance and fall. Start slowly and progress as you feel stronger.
- Stop exercising if you feel dizzy, sick, unwell or very tired.
- See a doctor if you are having chest pain, black outs or breathlessness on mild exertion.
- Increasing physical activity may hurt when you first start but it should not increase day by day and always stop if pain becomes more acute. Most people usually attain some pain relief after 6-8 weeks.
- If you experience pain which persists or gets worse on the following day you may have increased your intensity or your session time too quickly.
- If you have difficulty moving the joint in full range of motion, do not use additional weights. You may benefit from Physiotherapy support.
- If your joints become hot or swollen, leave out strengthening exercises until it settles down again.
- Ice packs wrapped in a damp towel should be applied to painful joints if you feel that you have overdone things or if the joint is swollen after exercise. See your doctor if symptoms are more than what you would expect or if things do not settle down
Please see the following safety considerations if you have other long term health conditions.
- Angina (Coronary Heart Disease)
- Previous Myocardial Infarction (Heart Attack)
- Cardiovascular Risk
- Chronic Kidney Disease
- Chronic Obstructive Pulmonary Disease (COPD)
- Type 2 Diabetes
- Rheumatoid Arthritis
This leaflet has been provided for information only. ALWAYS check with your doctor if you have any concerns about your condition or treatment. Prescription4exercise.com is not responsible or liable, directly or indirectly, for ANY form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by this information.
- Start Active, Stay Active – a report on physical activity for health from the four home countries ‘ Chief Medical Officers. UK Department of Health, July 2011. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128209
- ACSM’s Guidelines for Exercise Testing and Prescription, American College of Sports Medicine, 2009
- Swedish National Institute of Public Health. Physical Activity in the Prevention and Treatment of Disease. Professional Associations for Physical Activity, Sweden, 2010. Osteoarthritis. p498-509. http://www.fyss.se
Other useful sites
- Fransen M, McConnell S. Land-based exercise for osteoarthritis of the knee: ameta-analysis of randomized controlled trials. J Rheumatol 2009;36:1109-17. ↩
- Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, et al. OARSI recommendations for the management of hip and knee osteoarthritis: Part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010;18:476-99. ↩