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 “We had a systematic review for Cochrane from 2008 and 2009, but
there were much less articles,” said Dr. Martin Van der Esch, who
coauthored the review. Since then, many more studies have been
published, and confirm the benefits of exercise for arthritis pain,
he told Reuters Health by phone.
Osteoarthritis, the breakdown of joint cartilage over time, causes
pain, swelling and reduced motion, usually of the hands, knees, hips
or spine. Joint injury, excess weight and older age increase the
risk for osteoarthritis, which affects more than 50 million adults
in the U.S., according to the Centers for Disease Control and
Prevention.
For the new Cochrane review, Van der Esch, of the Reade Centre for
Rehabilitation and Rheumatology in Amsterdam, the Netherlands and
colleagues analyzed 55 randomized controlled trials comparing a
land-based exercise program with no exercise among subjects with
osteoarthritis. The trials varied in type, duration and intensity of
exercise programs.
In general, the exercise programs significantly reduced pain and
moderately improved physical function of the knee immediately after
treatment. Some studies also found that general quality of life
improved.
Twelve studies followed up with participants two to six months later
and found that knee pain was still reduced, as the authors explain
in the British Journal of Sports Medicine.
It may seem counterintuitive that exercising a painful joint could
reduce pain, Van der Esch said.
“The idea is that if you have more muscle strength, then the knee is
more stable and you have less wear and tear,” he explained.
Land-based, weight-bearing exercise strengthens the muscles around
the knee, he said.
“Avoiding activities because of pain leads you to lose more muscle
strength and have muscle weakness and unstable joints, so more wear
and tear,” he said.
“Often people believe that activity ‘wears out’ joints, and patients
can sometimes experience (a worsening) of symptoms after exercise or
activity,” said Danielle A.W.M. van der Windt, an arthritis expert
at Keele University in Staffordshire, U.K.
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But “the vast majority of people will not have any adverse reaction
to controlled, supervised exercise, and people with significant
osteoarthritis can ride a bicycle, go swimming or exercise at a gym
with often minimal discomfort,” she told Reuters Health by email.
Van der Windt was not part of the new review.
Outside of exercise, the only real treatments for osteoarthritis are
simple painkillers or, in severe cases, joint replacement surgery,
Van der Esch said.
Some recent studies suggest that exercise could be as effective as
medication for pain relief, and exercise has no pharmaceutical side
effects, he said.
“In the review we couldn’t find really specific exercises that are
best, the type of exercise program is not really most important,” he
said. “The most important factor is exercising regularly.”
“Internationally we always say you have to move at least 30 minutes
per day,” he said.
Water-based exercise does improve fitness, which has some benefit,
but doesn’t put a load directly on the knee itself so is less
beneficial than land-based exercise, he said.
SOURCE: http://bit.ly/1N4xd80 British Journal of Sports Medicine,
online September 24, 2015.
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