A new review has suggested that the usual recommended treatment for osteoarthritis may not be as beneficial as first thought.
Doctors often suggest exercise as the standard treatment advice for this painful condition but, warn Hunter Bennett and Lewis Ingram in The Conversation, there is reason to be cautious following findings from the new review.
Bennet and Ingram write:
The European research team conducted an “umbrella review” – an overview of systematic reviews, which collate and analyse the findings from individual studies to answer a specific question. Reviewing previously published systematic reviews provides an even bigger snapshot of a given research topic.
After searching thousands of studies, they included five major systematic reviews (comprising 100 individual studies, with 8 631 patients) before adding another 28 recent trials (involving another 4 360 patients).
Using these data, they looked at the effect of exercise on knee, hip and hand osteoarthritis, and compared it with several alternatives, including doing nothing, placebo (fake) treatments, education, manual therapy, painkillers, injections and surgery.
What did they find?
Compared with doing nothing and placebos, they found that exercise resulted in small reductions in pain in the hip, knee and hand: between six and 12 points on a 100-point scale.
However, exercise did not seem to improve function any more than either of these comparisons.
For knee and hip osteoarthritis, there was evidence that exercise was just as effective at reducing pain and improving function as medicines such as ibuprofen and corticosteroids, which are injected into the joint to reduce inflammation. These also reduced pain by around 5%-10%.
The researchers concluded exercise was less effective at improving pain and function than a total joint replacement in people with knee and hip osteoarthritis.
What were the limitations?
First, the authors lumped all types of exercise together. This means strength training, aerobic exercise, stretching, aquatic exercise and tai chi were all considered to be the same.
This is crucial, because we know not all exercise is created equal. Previous reviews have shown, for example, that aerobic exercise might be best for reducing pain and function in people with knee osteoarthritis, while stretching was least effective.
Similarly, the authors didn’t consider the clinical status of the patients. Evidence has shown people with more severe pain and worse function at the start of an intervention see better responses to exercise than those with less pain and good function.
Second, the review treated both supervised and unsupervised exercise the same.
Yet research shows supervised training results in much better outcomes than unsupervised – probably because a trainer is there to help push the patient along.
Third, the authors didn’t account for the duration of the exercise, and most study periods were quite short: around 12 weeks.
It’s likely that sticking to an exercise regime over the long term will have better results, leading to a larger scope for improvement than if you just did something for a few weeks.
As such, the results of this review may not accurately reflect the benefits of exercise in people with osteoarthritis who commit to consistent exercise as an ongoing part of their weekly routine (which is often recommended).
Finally, the review didn’t account for the dose of exercise the studies used. Improvements in pain and function seem to increase with total weekly exercise in people with osteoarthritis. One review, for example, found the optimal benefits occurred at around 150 minutes of moderate intensity exercise per week.
These limitations suggest this new review possibly undersells the benefits of exercise for osteoarthritis.
Less pain, better physical and mental health
Putting aside the limitations of the review, the small reductions in pain the review reports might still have a positive impact on someone’s life. A 10% reduction in pain could make a meaningful difference to your ability to move around, work, socialise and care for others.
The review also found exercise can reduce pain to the same extent as non-steroidal anti-inflammatory medications and corticosteroids – without the side effects or the costs.
Exercise can also improve heart health, enhance your mood, help with weight management and reduce the risk of chronic diseases, such as cancer and diabetes.
These factors can have a huge impact on your health and happiness.
What to do
Based on the findings of this new review, sufferers should be confident that any type of exercise will lead to some degree of pain relief.
However, based on prior evidence, it’s likely even greater overall health benefits could probably be derived from exercising if it is maintained.
The best type of exercise is the one that gets done, especially if it is stuck to in the long term.
Hunter Bennett – Lecturer in Exercise Science, Adelaide University, Australia;
Lewis Ingram – Lecturer in Physiotherapy, Adelaide University, Australia
The Conversation article – Does exercise really work for osteoarthritis? (Creative Commons Licence)
See more from MedicalBrief archives:
Why knee osteoarthritis patients avoid restorative activity – Australian study
No link between physical activity and knee osteoarthritis — Meta-analysis