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Why Is Exercise Effective in Reducing Pain in People with Osteoarthritis?

  • Osteoarthritis (T Appleton, Section Editor)
  • Published:
Current Treatment Options in Rheumatology Aims and scope Submit manuscript

Abstract

Purpose of the review

The aim of this narrative review was to summarize the beneficial effects of exercise for those with symptomatic hip and knee osteoarthritis (OA) utilizing data along the pipeline from translational to clinical studies to implementation into clinical practice.

Recent findings

Exercise is first line treatment for managing symptomatic hip and knee OA. Aerobic, strengthening and neuromuscular approaches are all effective in reducing pain and improving function. Exercise dose and supervision may be more important. Twelve or more supervised exercise sessions seem superior to fewer sessions. Education about the condition, the role of exercise in reducing pain and improving function, and strategies for increasing physical activity is also key as long-term adherence to ongoing home exercise after program attendance is needed to maintain effects. The proposed mechanisms by which exercise improves pain and function in people with OA include general systemic effects and those local to the joint. General mechanisms include neural and systemic inflammation effects. Local mechanisms include exercise effects on muscle and other joint-related structures as well as local joint inflammation. Exercise effects on pain are as large or larger than for medications such as paracetamol and NSAIDs. Similar magnitude in pain relief and improvement in function from clinical trials has been shown immediately after the program and at 1-year follow-up in evidence-based structured education and exercise programs implemented into clinical practice in several countries. These programs are cost-effective.

Summary

Although clinicians around the world are slowly adopting exercise as OA treatment, system changes are required to facilitate implementation of evidence-based exercise programs into clinical practice. Enhanced availability of education and supervised exercise programs and reimbursement schemes with support from publicly funded health services that reduce access barriers for patients are needed to support more universal evidence-based management and reduce the burden of symptomatic OA.

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Funding

Skou is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (grant agreement no. 801790).

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Authors and Affiliations

  1. Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Næstved, Denmark

    A. M. Davis PhD

  2. Departments of Physical Therapy and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    A. M. Davis PhD

  3. Krembil Brain Institute, Krembil Research Institute, University Health Network, Næstved, Denmark

    K. D. Davis PhD

  4. Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, Canada

    K. D. Davis PhD

  5. Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Næstved, Denmark

    S. T. Skou PhD

  6. Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

    E. M. Roos PhD

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Correspondence to A. M. Davis PhD.

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Conflict of Interest

Aileen M. Davis is a member of the Board of Osteoarthritis Research International (OARSI) and Associate Editor of Osteoarthritis and Cartilage. She is also on the Editorial Board of Arthritis Care and Research.

Karen D. Davis is the president of the Canadian Pain Society effective May 2020, and on the editorial boards of Pain Report, Pain, the Canadian Journal of Pain, and eNeuro. She is also a member of the Advisory Board of the Mayday Fund Fellows program, and the Institute of Neuroscience, Mental Health and Addiction of the Canadian Institutes of Health Research.

Soren T. Skou is an Associate Editor of the Journal of Orthopaedic & Sports Physical Therapy and has received grants from The Lundbeck Foundation, personal fees from Munksgaard, all of which are outside the submitted work. He is the co-founder of Good Life with Osteoarthritis in Denmark (GLA:D®), a not-for-profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice.

Ewa M. Roos is a Deputy Editor of Osteoarthritis and Cartilage, the developer of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and several other freely available patient-reported outcome measures and co-founder of GLA:D®.

Human and Animal Rights and Informed Consent

With regard to the authors’ research cited in this paper, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. In addition, all applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

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This article is part of the Topical Collection on Osteoarthritis

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Davis, A.M., Davis, K.D., Skou, S.T. et al. Why Is Exercise Effective in Reducing Pain in People with Osteoarthritis?. Curr Treat Options in Rheum 6, 146–159 (2020). https://doi.org/10.1007/s40674-020-00154-x

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