Top

Published in:

01-12-2011 | Pain Aspects of Arthritis (Allison Bailey, Section Editor)

Effects of Exercise and Physical Activity on Knee Osteoarthritis

Authors: Stephan Esser, Allison Bailey

Published in: Current Pain and Headache Reports | Issue 6/2011

Abstract

Exercise is one of the most discussed and controversial nonpharmacologic management strategies for osteoarthritis (OA) of the knee. Health care providers and patients share varied and often pseudoscientific beliefs regarding the effects of exercise on knee OA formulated on outdated notions of the etiology, pathophysiology, and progression of the condition. Based on the contemporary literature, regular light to moderate physical activity has both preventive and therapeutic benefits for individuals with knee OA. Exercise regimens with strong evidence of benefit include those that focus on aerobic/cardiovascular conditioning and lower extremity strength training. Health care providers should confidently incorporate exercise recommendations into clinical management and offer patients evidence-based and individually tailored exercise prescriptions to help manage the painful and often disabling symptoms of this condition.

Guccione AA, Felson DT, Anderson JJ, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Pub Health. 1994;84(3):351–8.CrossRef

Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991–1994. J Rheumatol. 2006;33(11):2271–9.PubMed

Public Health and Aging: Trends in Aging --- United States and Worldwide MMWR 2003; 52(06);101–106.

http://www.cdc.gov/arthritis/basics/osteoarthritis.htm

Lawrence RC, Felson DT, Helmick CG, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58(1):26–3.PubMedCrossRef

• Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis & Rheumatism 2008;59(9):1207–1213. This study highlights the lifetime risk of symptomatic knee OA. Awareness should encourage health care providers to develop preventive strategies and provide early interventions. CrossRef

• http://www.cdc.gov/NCHS/data/hestat/obesity_adult_07_08/obesity_adult_07_08.pdf. Obesity is a primary risk factor for knee OA and a wide range of metabolic/cardiovascular illnesses. Health care providers should be familiar with the prevalence data to better educate patients and facilitate meaningful change.

Gabriel SE, Crowson CS, Campion ME, et al. Direct medical costs unique to people with arthritis. J Rheumatol. 1997;24(4):719–25.PubMed

Maetzel A, Li LC, Pencharz J, Tomlinson F, Bombardier C. The economic burden associated with osteoarthritis, rheumatoid arthritis and hypertension: a comparative study. Ann Rheum Dis. 2004;63(4):395–401.PubMedCrossRef

10.

A National Public Health Agenda for Osteoarthritis 2010 http://www.cdc.gov/arthritis/docs/OAAgenda.pdf

11.

Buckwalter JA, Saltzman C, Brown T. The impact of osteoarthritis. Clin Orthoped Rel Res. 2004;427S:S6–S15.CrossRef

12.

Leigh JP, Seavey W, Leistikow B. Estimating the costs of job related arthritis. J Rheumatol. 2001;28(7):1647–54.PubMed

13.

Guccione AA, Felson DT, Anderson JJ, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Pub Health. 1994;84(3):351–8.CrossRef

14.

Michaud CM, McKenna MT, Begg S, Tomijima N, Majmudar M, Bulzacchelli MT, et al. The burden of disease and injury in the United States 1996. Popul Health Metr. 2006;4:11.PubMedCrossRef

15.

Iannone F, Lapadula G. The pathophysiology of osteoarthritis. Aging Clin Exp Res. 1003;15(5):364–72.

16.

Pelletier-Martel J, Lajeunesse D. New thoughts on the pathophysiology of osteoarthritis: One more step toward new therapeutic targets. Current Rheumatology Reports. 2006;88(1):30–6.CrossRef

17.

Bonnet CS, Walsh DA. Osteoarthritis, angiogenesis and inflammation. Rheumatology. 2005;44(1):7–16.PubMedCrossRef

18.

Cicuttini FM, Baker J, Hart DJ, Spector TD. Association of pain with radiological changes in different compartments and views of the knee joint. Osteoarthritis and Cartilage. 1996;4:143–7.PubMedCrossRef

19.

Altman RD, Hochberg MC, Moskowitz RW, et al. Recommendations for the medical management of osteoarthritis of the hip and knee-2000 update. Arthritis Rheum. 2000;43:1905–15.CrossRef

20.

Bosomworth N. Exercise and knee osteoarthritis: benefit or hazard? Canadian Family Physician. 2009;55(9):871–8.

21.

Bellucci G, Seedhom BB. Mechanical behavior of articular cartilage under tensile cyclic load. Rheumatology. 2001;40:1337–45.PubMedCrossRef

22.

Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthritic knee joints. Acta Orthop Scand. 1980;51:871–9.PubMedCrossRef

23.

Hall AC, Urban JPG, Gehl KA. The effects of hydrostatic pressure on matrix synthesis in articular cartilage. J Orthop. 1991;9:1–10.

24.

Roos EM, Dahlberg L. Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of osteoarthritis. Arthritis Rheum. 2005;52(11):3507–14.PubMedCrossRef

25.

Kiviranta I, Tammi M. Moderate running exercise augments glycosaminoglycans and thickness of articular cartilage in the knee joint of young beagle dogs. J Orthopaed Res. 1988;6(2):188–95.CrossRef

26.

Otterness IG, Eskra JD, Bliven ML, et al. Exercise protects against articular cartilage degeneration in the hamster. Arthritis Rheum. 1998;41:2068–76.PubMedCrossRef

27.

Galois L, Etienne S, Grossin L, et al. Moderate-impact exercise is associated with decreased severity of experimental osteoarthritis in rats. Rheumatology (Oxford). 2003;42:692–3.CrossRef

28.

Hallet M, Andrish JT. Effects of exercise on articular cartilage. Sports Medicine & Arthroscopy Review. 1994;2(1):29–37.CrossRef

29.

Gillquist J, Messner K. Anterior cruciate ligament reconstruction and the long term incidence of gonarthrosis. Sports Medicine. 1999;27(3):143–56.PubMedCrossRef

30.

• Oiestad BE, Engebretsen, L, Storheim K, Risberg MA. Knee Osteoarthritis After Anterior Cruciate Ligament Injury A Systematic Review Am J Sports Med 2009; 37(7): 1434–1443. This systematic review found that previously reported levels of post–ACL repair knee OA were inaccurate. They report a lower than previously described risk for knee OA after ACL repair. PubMedCrossRef

31.

Lohmander LS, Ostenberg A, Englund M, Roos H. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheu. 2004;50(10):3145–52.CrossRef

32.

Porat A, Rooa E. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis. 2004;63:269–73.CrossRef

33.

Golightly Y, Callahan L, Guskiewicz K. Early-onset arthritis in retired national football league players. J Phys Act Health. 2009;6:638–43.PubMed

34.

Kujala UM, Kettunen J, Paananen H, et al. Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum. 1995;38(4):539–46.PubMedCrossRef

35.

Sandmark H, Vingard E. Sports and risk for severe osteoarthrosis of the knee. Scandinavian J Med Sci Sports. 1999;9(5):279–84.CrossRef

36.

Theilin N, Holmberg S, Thelin A. Knee injuries account for the sports-related increased risk of knee osteoarthritis. Scandinavian J Med Sci Sports. 2006;16(5):329–33.CrossRef

37.

McAlindon TE, Wilson PW, Aliabadi P, et al. Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham Study. Am J Med. 1999;106(2):151–7.PubMedCrossRef

38.

Cheng Y, Macera CA, Davis DR, et al. Physical activity and Self-reported, physician-diagnosed osteoarthritis: is physical activity a risk factor? J Epidemiol. 2000;53(3):315–22.

39.

Hannan MT, Felson DT, Anderson JJ, Naimark A. Habitual physical activity is not associated with knee osteoarthritis: the Framingham study. J Rheumatol. 1993;20(4):704–9.PubMed

40.

Manninen P, Riihimaki H, Heliovaara M, Suomalainen O. Physical exercise and risk of severe knee osteoarthritis requiring arthroplasty. Rheumatology. 2001;40(4):432–7.PubMedCrossRef

41.

Urquhart D, Tobing J. What is the effect of physical activity on the knee joint? A aystematic review. Medicine & Science in Sports & Exercise. 2001;43(3):432–42.CrossRef

42.

Michel BA, Fries JF, Bloch DA, et al. Osteophytosis of the knee: association with changes in weight-bearing exercise. Clin Rheumatol. 1992;1(2):235–8.CrossRef

43.

•• Chakravarty EF, Hubert HB, Lingala VB, et al. Long Distance Running and Knee Osteoarthritis: A Prospective Study. American Journal of Preventive Medicine 2008; 35(2):133–138. Patients and clinicians frequently presume that weight-bearing activity, especially running, will accelerate or increase knee OA. This study calls into question the accuracy of this presupposition and should prompt readers to reconsider their understanding of the association of knee OA and regular weight-bearing exercise. PubMedCrossRef

44.

Whaley M, Brubaker P, Otto R. ACSM’s guidelines for exercise testing and prescription. 7th ed. Baltimore: Lippincott Williams and Wilkins; 2006.

45.

• Hagiwara Y, Ando A, Chimoto E, et al. Changes of articular cartilage after immobilization in a rat knee contracture model. Journal of Orthopaedic Research 2009; 27(2):236–242. In a rat model, as little as 1 week of forced joint immobility resulted in altered articular cartilage integrity. These changes highlight potential and incompletely understood risks for knee OA development and progression. PubMedCrossRef

46.

Hortobagyi T, Westerkamp L, Beam S, et al. Altered hamstring-quadriceps muscle balance in patients with knee osteoarthritis. Clin Biomech. 2005;20(1):97–104.CrossRef

47.

Shrier I. Muscle dysfunction versus wear and tear as a cause of exercise related osteoarthritis: an epidemiological update. Br J Sports Med. 2004;38:526–35.PubMedCrossRef

48.

Brucini M, Duranti R, Galletti R, et al. Pain thresholds and electromyographic features of periarticular muscles in patients with osteoarthritis of the knee. Pain. 1981;10:57–66.PubMedCrossRef

49.

Vecchiet L, Vecchiet J, Giamberardino MA. Referred muscle pain: clinical and pathophysiologic aspects. Curr Pain Headache Reports. 1999;3:489–98.

50.

Kovar PA, Allegrante JP, MacKenzie CR, et al. Supervised fitness walking in patients with osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 1992;116(7):529–34.PubMed

51.

Roddy E, Zhang W, Doherty M. Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review. Ann Rheum Dis. 2005;64:544–8.PubMedCrossRef

52.

Brosseau L, Pelland L, et al. Efficacy of Aerobic Exercises For Osteoarthritis (part II): A Meta-analysis Physical Therapy Reviews, 2004; 9(3);125-145(21).

53.

Ettinger WH, Burns R, Messier SP, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. JAMA. 1997;277(1):25–31.PubMedCrossRef

54.

Mangione KK, McCully K, Gloviak A, et al. The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. J Gerontol A Biol Sci Med Sci. 1999;54(4):M184–90.PubMedCrossRef

55.

Topp R, Woolley S, Hornyak J, et al. The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee. Arch Phys Med Rehabil. 2002;83:1187–95.PubMedCrossRef

56.

Jan MH, Lin JJ, Liau JJ, et al. Investigation of clinical effects of high- and low-resistance training for patients with knee osteoarthritis: a randomized controlled trial. Phys Ther. 2008;88(4):427–36.PubMedCrossRef

57.

Baker KR, Nelson ME, Felson DT, et al. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. J Rheumatol. 2001;28(7):1655–166.PubMed

58.

Mikesky AE, Mazzuca SA, Brandt KD, et al. Effects of strength training on the incidence and progression of knee osteoarthritis. Arthritis Care Res. 2006;55(5):690–9.CrossRef

59.

Lange AK, Vanwanseele B, Fiatarone Singh MA. Strength training for treatment of osteoarthritis of the knee: A systematic review. Arthritis Care Res. 2008;59(10):1488–94.CrossRef

60.

Jenkinson CM, Doherty M, Avery AJ, et al. Effects of dietary intervention and quadriceps strengthening exercises on pain and function in overweight people with knee pain: randomised controlled trial. BMJ. 2009;339:b3170.PubMedCrossRef

61.

Thomas K, Muir K, et al. Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. BMJ. 2002;325:752–5.PubMedCrossRef

62.

Slemenda C, Brandt K, et al. Quadriceps weakness and osteoarthritis of the knee. Ann Int Med. 1997;127(2):97–104.PubMed

63.

Hurley MV, Scott DL. Improvements in quadriceps sensorimotor function and disability of patients with knee osteoarthritis following a clinically practicable exercise regime. Rheumatology. 1998;37(11):1181–7.CrossRef

64.

McAlindon TE, Cooper C, Kirwan JR, Dieppe PA. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis. 1993;52:258–62.PubMedCrossRef

65.

Reilly S, Jones A, Muir K, Doherty M. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis. 1998;57:588–59460.CrossRef

66.

Sharma L, Dunlop DD, Cahue S, et al. Quadriceps strength and osteoarthritis progression in malaligned and lax knees. Ann Int Med. 2003;138(8):613–9.PubMed

67.

Silva L, Valim V, et al. Hydrotherapy Versus Conventional Land-Based Exercise for the Management of Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial Physical Therapy January 2008; 88(1):12–2

68.

Foley A, Halbert J, et al. Does hydrotherapy improve strength and physical function in patients with osteoarthritis—a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme. Ann Rheum Dis. 2003;62:1162–7.PubMedCrossRef

69.

Lund H and Weile U. A Randomized Controlled Trial of Aquatic and Land-Based Exercise in Patients with Knee Osteoarthritis Journal of Rehabilitation Medicine 2008;40 (2):137-144(8).

70.

Bareis E, Lund H, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2007 Oct 17;(4).

71.

Myeong SL, Pittler M, Ernst E. Tai chi for osteoarthritis: a systematic review. Clin Rheumatol. 2007;27(2):211–8.

72.

Song R, Lee E, Lam P, Bae S. Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. J Rheumatol. 2003;30(9):2039–44.PubMed

73.

Wang C, Schmid CH, Hibberd PL, et al. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis Care Res. 2009;61(11):1545–53.CrossRef

74.

http://www.cdc.gov/NCHS/data/hestat/obesity_adult_07_08/obesity_adult_07_08.pdf

75.

Morrison JB. The mechanics of the knee joint in relation to normal walking. J Biomech. 1970;3:51–61.PubMedCrossRef

76.

Park H, Park J, Yu R. Relationship of obesity and visceral adiposity with serum concentrations of CRP, TNF-α and IL-6. Diab Res Clin Pract. 2005;69(1):29–35.CrossRef

77.

Cicuttini F, Baker J, Spector T. The Association of obesity with osteoarthritis of the hand and knee in women:a twin study. J Rheumatology. 1996;23:1221–6.

78.

Messier S, Gutekunst D, Davis C, DeVita P. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum. 2005;52(7):2026–32.PubMedCrossRef

79.

Felson D, Zhang Y. Weight loss reduces the risk for symptomatic knee osteoarthritis in women the framingham study. Ann Int Med. 1992;116(7):535–9.PubMed

80.

Christensen R, Astrup A, Bliddal H. Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis and Cartilage. 2005;13(1):20–7.CrossRef

81.

Christensen R, Bartels E, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2007;66:433–9.PubMedCrossRef

82.

Peltonen M, Lindroos A, Torgerson J. Musculoskeletal pain in the obese: a comparison with a general population and long-term changes after conventional and surgical obesity treatment. PAIN. 2003;104(3):549–57.PubMedCrossRef

83.

Powell A, Teichtahl AJ, Wluka AE, Cicuttini FM. Obesity: a preventable risk factor for large joint osteoarthritis which may act through biomechanical factors. Br J Sports Med. 2005;39:4–5.PubMedCrossRef

84.

Spector T, Hart D, Doyle D. Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: the effect of obesity. Ann Rheum Dis. 1994;53(9):565–8.PubMedCrossRef

85.

Messier S, Loeser R. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the arthritis, diet, and activity promotion trial. Arthritis Rheum. 2004;50(5):1501–10.PubMedCrossRef

86.

Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16(2):137–62.PubMedCrossRef

87.

Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. The American college of rheumatology criteria for the classification and reporting of osteoarthritis of the knee. Arthritis Rheum. 1986;29:1039–49.PubMedCrossRef

Title: Effects of Exercise and Physical Activity on Knee Osteoarthritis
Authors: Stephan Esser
Allison Bailey
Publication date: 01-12-2011
Publisher: Current Science Inc.
Published in: Current Pain and Headache Reports / Issue 6/2011
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI: https://doi.org/10.1007/s11916-011-0225-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of Exercise and Physical Activity on Knee Osteoarthritis

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2011

Complementary and Alternative Medicine for Rheumatoid Arthritis and Osteoarthritis: an Overview of Systematic Reviews

Headache after Trauma: Physiological Considerations

Erratum to: Pain Management in Patients with Cancer: Focus on Opioid Analgesics

Tension-type Headache and Systemic Medical Disorders

Tension-Type Headache Mimics

Taking Care of the Challenging Tension Headache Patient