It’s Time for an “Exercise Prescription” in OA

The benefits of exercise for patients with osteoarthritis has been well documented. From strength training to low-impact exercise, researchers have explored exercise as prescription medicine for years. At the 2015 American College of Rheumatology annual meeting, there were more than 300 talk and poster presentations that included some form of exercise. 

The science is in, but it’s not complete, write the authors of a review article published online in the Feb. 23 issue of Arthritis Care and Research. The researchers are calling for more research that is uniquely designed to lead to comprehensive exercise clinical practice guidelines for osteoarthritis.

Guidelines currently exist, to a degree, but none in the way that Marcas Bamman, Ph.D., of the University of Alabama and colleagues describe in the Arthritis Care and Research article. In 2012, the American College of Rheumatology recommended various exercise regimens to treat knee and hip osteoarthritis. The American College of Sports Medicine, Arthritis Foundation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, European League Against Rheumatism and the American Academy of Orthopaedic Surgeons support and encourage the adoption of exercise to relieve arthritic symptoms.

But despite these recommendations, more than 30 percent of people with arthritis still don’t exercise, according to a 2009 Centers for Disease Control and Prevention report.

Arthritis is highly individualized. No two patients experience pain in the same way and no two conditions are alike. Despite the fluidity of the disease and the complexity of individual cases, one fact remains the same:  exercise does relieve pain and improve outcomes.[[{"type":"media","view_mode":"media_crop","fid":"46206","attributes":{"alt":"(©AdamGregor/Shutterstock.com)","class":"media-image media-image-right","id":"media_crop_6078227981925","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5354","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"(©AdamGregor/Shutterstock.com)","typeof":"foaf:Image"}}]]

Adherence to an exercise program could be more successful if patients were given a specific exercise prescription designed for their individual needs with stated goals in mind. It would require more than participating in leisure physical activities, such as walking.

“Prescriptive exercise is a structured, well-defined weekly exercise program that yields physiologic and fitness benefits well beyond leisure time physical activity (as recommended by professional associations),” they wrote.

The researchers are calling for evidence-based guidelines for prescriptive exercise that are based on rigorous, large-scale clinical trials on:

* Variations in dosing variables (such as intensity and frequency) specifically for OA.

* The wide variability in outcomes among individuals who complete the same exercise plan (e.g., high versus low responders).

* How specific doses of exercise affect the relative efficacy and toxicity of common treatments for OA (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, or intra-articular corticosteroids.

* The interactions between exercise training and anti-inflammatory, analgesic therapies.

“By ultimately developing a research agenda that will lead to a base of evidence, we may achieve dramatic improvements in OA outcomes beyond that of pharmacologic management. Such a base of evidence is essential in order for the medical community to implement prescriptive exercise as a key component of standard care,” they wrote.

As with pharmacological approaches in osteoarthritis care, prescriptive exercise would include recommended optimal dosages (mode, duration, frequency) for maximum effectiveness and safety by specific population and disease.  

Ironically, patients with osteoarthritis exercise less than healthy populations, but stand to benefit from exercise (and weight loss) most. The lack of exercise can be attributed to lack of information, lifestyle and other factors.

Equally challenging is getting physicians to follow treatment guidelines. A 2011 study in Arthritis Care and Research found that only 5 to 10 percent of clinicians follow treatment guidelines.

References:

The American College of Rheumatology, 2015 annual meeting absracts. 

Marcas M. Bamman, Timothy M. Wick, et al. "Exercise Medicine for Osteoarthritis: Research Strategies to Maximize Effectiveness," Arthritis Care and Research. Online Feb. 23, 2016. DOI: 10.1002/acr.22680

E Roddy, W Zhang, et al. "Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee-the MOVE consensus,"Rheumatology. Aug. 6, 2004. 

"American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee," 

Arthritis Care & Research. 

Vol. 64, No. 4, April 2012, pp 465– 474. DOI 10.1002/acr.21596 

Exercise and Arthritis,

The American College of Sports Medicine.