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 Americans develop three million new cases of osteoarthritis each
year. Most vulnerable are those who are older, obese, have previous
joint injuries, overuse, weak muscles or genetic risk factors.
“It is nice to finally have some hip-specific data, as hip and knee
osteoarthritis are often grouped together and it is almost certain
that there are differences between these groups of patients, as well
as differences in those with multiple joint osteoarthritis,” said
Dr. Amanda E. Nelson of the Thurston Arthritis Research Center at
the University of North Carolina Medical Center in Chapel Hill, who
was not part of the new study.
“However, the studies are still small and heterogeneous, and larger,
longer-term studies of more specific interventions are certainly
needed to provide more specific recommendations,” she said.
The review only considered pain, not joint function, which may also
improve with physical activity, Nelson told Reuters Health by email.
The researchers, lead by Kay M. Crossley of La Trobe University in
Bundoora, Australia, reviewed 19 studies of water-based or
land-based exercise therapy or manual therapy for hip pain, 10 of
which were designed specifically for hip osteoarthritis.
Four studies found short-term benefits, up to three months later,
with water-based exercise compared to minimal pain management. Six
found similar benefit for land-based exercise therapy in the short
term, but there was no evidence for benefit in the medium or long
term, up to one year after therapy.
Manual therapy, which includes joint manipulation, active stretching
and massage, did not appear to provide additional benefit on its own
or in combination with exercise, the researchers reported in the
British Journal of Sports Medicine.
That’s not encouraging, said Dr. Kim Bennell of The University of
Melbourne in Australia, who was also not part of the review.
“However, the number of studies is relatively small and there was a
lot of variation in the methods of the studies, so further research
is needed in this area to confirm the results.”
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Most doctors do not recommend exercise therapy, relying instead on
pain-relieving drugs for osteoarthritis, despite agreement across
guidelines and organizations that non-drug approaches are
worthwhile, Nelson said.
“There are numerous potential barriers to recommendation and
treatment including access to care, financial concerns, and the
burden of managing multiple medical conditions in a short visit with
a provider, among others,” she said. “Therefore, although the
guidelines are in agreement, it is likely that the majority of
patients are not receiving this recommendation from their providers,
and that even fewer actually follow through on the recommendation if
given.”
The 19 studies in the review all tested different type, frequency
and duration of exercise, so the best sort of exercise, how much and
how often to do it, remains to be determined, she said.
It would appear that a 12-week program with exercises generally
including strengthening and range of motion three times per week is
beneficial, Bennell told Reuters Health by email.
“Based on the overall body of work in physical activity, though, any
regular physical activity is likely to be beneficial to most
patients,” Nelson said. “It is safe to say that most adults do not
get enough physical activity, and that this is even more of an issue
among those with osteoarthritis.”
SOURCE: http://bit.ly/1Z1OiCu British Journal of Sports Medicine,
online November 26, 2015.
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