Is it safe to exercise with Knee Osteoarthritis?

Knee osteoarthritis (OA) is a common degenerative joint disease that affects millions of people worldwide, causing pain, stiffness, and reduced function. As a result, many individuals with knee osteoarthritis may wonder if it is safe to engage in exercise, fearing it could worsen their condition. However, recent research and clinical guidelines suggest that exercise not only is safe but also highly beneficial for those with knee osteoarthritis. In this blog post, we will delve into the safety and benefits of exercise for knee osteoarthritis, referencing key studies and practical recommendations.

Understanding Knee Osteoarthritis

Osteoarthritis is characterized by the breakdown of cartilage in the joints, leading to pain, swelling, and decreased mobility. While there is no cure for osteoarthritis, various treatment strategies aim to manage symptoms and improve quality of life. Among these strategies, exercise stands out as a particularly effective intervention.

Is Exercise Safe for Knee Osteoarthritis?

The short answer is yes, exercise is safe for individuals with knee osteoarthritis. Numerous studies have demonstrated that regular physical activity can reduce pain, improve function, and enhance overall quality of life in people with knee osteoarthritis.

A systematic review by Raposo et al. (2021) found that exercise programs are safe and effective for knee osteoarthritis patients. The review highlighted that various types of exercise, including Pilates, aerobic, and strengthening exercises, performed for 8-12 weeks with 3-5 sessions per week, yielded significant improvements in pain management, strength and overall function. Both aquatic and land-based exercise programs were found to have comparable and positive effects.

Types of Exercise and Their Benefits

When considering exercise for knee osteoarthritis, it’s important to focus on activities that promote joint health without causing undue stress. Here are some of the most effective types of exercise:

1. Aerobic Exercise

Aerobic exercises, such as walking, cycling, and swimming, improve cardiovascular health and overall endurance. While the cardiovascular improvements are well known, what is often not considered with aerobic exercise is the amount of low-intensity movement that is happening at the knee joint. Your joint health is dictated on how much the joint is moved as this is how the synovial fluid can be moved and nutrition to the joint optimized.

2. Strength Training

Strength training focuses on building the muscles around the knee joint, providing better support and reducing the load on the joint. Killingmo et al. (2024) emphasized the effectiveness of strength training, which included neuromuscular and strength exercises tailored to individual needs. The findings indicated that strength exercise was particularly cost-effective from a healthcare perspective and should be prioritized if a choice must be made between aerobic and strength exercises. At Pursuit Physiotherapy we will take the time to create a tailored exercise program (for at home or in the gym) to address your assessed weakness and limitatons.

3. Flexibility and Balance Exercises

Exercises that improve flexibility and balance are crucial for maintaining range of motion and preventing falls. Stretching, yoga, and balance training can help keep the joints flexible and improve stability, reducing the risk of injury. Many patients with arthritis tend to avoid moving their knee to end range straightening or bending as it can be uncomfortable. Working on flexibility ensures the range of motion of the joint can be preserved or improved. While it can uncomfortable, over time there will be improvements in range of motion and pain tolerance.

Clinical Evidence Supporting Exercise

Several key findings from the studies mentioned provide robust evidence supporting the safety and efficacy of exercise for knee osteoarthritis:

• Pain Reduction: Exercise has been shown to diminish pain sensitivity and temporal summation, leading to hypoalgesia (reduced pain perception) (de Vita, et al 2018).

• Improved Functional Performance: Positive outcomes in functional performance tests, such as the 6-minute walk test (6MWT) and the Timed Up and Go (TUG) test, demonstrate that exercise can enhance mobility and daily function (Raposo et al., 2021).

• Range of Motion (ROM): Significant improvements in ROM and balance were observed in patients engaging in regular exercise, further supporting its role in managing knee osteoarthritis symptoms (Wang et al,, 2011).

Practical Recommendations

For individuals with knee osteoarthritis, the following practical recommendations can help ensure a safe and effective exercise regimen:

1. Consult Your Physiotherapist: Before starting any exercise program, it is crucial to consult with a healthcare provider or physical therapist to tailor an exercise plan that suits your specific needs and condition.

2. Start Slow and Progress Gradually: Begin with low-impact exercises and gradually increase the intensity and duration as your fitness and pain sensitivity improve.

3. Incorporate Variety: Include a mix of aerobic, strength, flexibility, and balance exercises to address different aspects of joint health.

4. Listen to Your Body: Pay attention to how your body responds to exercise. While some discomfort is normal, sharp pain should be a signal to stop and consult a healthcare professional.

5. Stay Consistent: Consistency is key to reaping the benefits of exercise. Aim for regular sessions spread throughout the week rather than sporadic intense workouts.

When to See an Orthopaedic Specialist

While physiotherapy and exercise can significantly improve knee osteoarthritis symptoms, there are times when you should seek further medical advice. Consider seeing an orthopaedic specialist if:

• Pain prevents you from performing daily activities.

• You cannot fully straighten or bend your knee more than 100 degrees.

• Pain persists or worsens despite following a physiotherapy program for three months.

Conclusion

Exercise is a safe and highly effective strategy for managing knee osteoarthritis. By incorporating a well-rounded exercise routine that includes aerobic, strength, flexibility, and balance training, individuals with knee osteoarthritis can experience reduced pain, improved function, and enhanced quality of life. Always consult with your Victoria physiotherapist to create a personalized exercise plan and monitor your progress. With the right approach, exercise can be a powerful tool in the management of knee osteoarthritis.

References

1. Raposo F, Ramos M, Lúcia Cruz A. Effects of exercise on knee osteoarthritis: A systematic review. Musculoskeletal Care. 2021;19(4):399-435. doi:10.1002/msc.1538

2. Killingmo RM, Øiestad BE, Risberg MA, Maas E, Grotle M. Cost-effectiveness of strength exercise or aerobic exercise compared with usual care for patients with knee osteoarthritis: secondary results from a multiarm randomised controlled trial in Norway. BMJ Open. 2024;14(5):e079704. Published 2024 May 23. doi:10.1136/bmjopen-2023-079704

3. DeVita, P., Aaboe, J., Bartholdy, C., Leonardis, J. M., Bliddal, H., & Henriksen, M. (2018). Quadriceps‐strengthening exercise and quadriceps and knee biomechanics during walking in knee osteoarthritis: A two‐ centre randomized controlled trial. Clinical Biomechanics,59, 199–206.

4. Wang TJ, Lee SC, Liang SY, Tung HH, Wu SF, Lin YP. Comparing the efficacy of aquatic exercises and land-based exercises for patients with knee osteoarthritis. J Clin Nurs. 2011;20(17-18):2609-2622. doi:10.1111/j.1365-2702.2010.03675.x