Exercise & Sports Science Australia (ESSA) updated Position Statement on exercise and physical activity for people with hip/knee osteoarthritis
This Position Statement is an update to the existing statement. It is intended for all health practitioners who manage people with hip/knee osteoarthritis. It synthesises the most recent evidence (with a focus on clinical guidelines and systematic reviews) for exercise in people with hip/knee osteoarthritis, and provides guidance to practitioners about how best to implement exercise in clinical practice. Clinical practice guidelines for hip/knee osteoarthritis advocate physical activity and exercise as fundamental core components of evidence-based management.
Research evidence indicates that exercise can reduce joint pain, increase physical function, and improve quality of life in hip/knee osteoarthritis, and that a range of exercise types (both supervised and unsupervised) may be beneficial. Exercise dosage should be guided by the principles of the American College of Sports Medicine. As people with osteoarthritis experience many barriers to exercise, practitioners should take an active role in monitoring and promoting adherence to exercise in order to optimise therapeutic benefits.
Any exercise program prescribed (including the dosage) should be within the capability of the individual to perform. It is quite normal for people with hip/knee OA to experience some joint discomfort with exercise, particularly with exercise in weight-bearing postures. Exercise practitioners may be afraid of aggravating pain, with data suggesting that 83% of accredited exercise physiologists always or most of the time prescribe ‘nonpainful’ exercise for knee OA. There is no evidence that exercising with tolerable levels of joint pain is harmful, and in fact, exercise programmes where pain is allowed/encouraged may be more beneficial for reducing pain in the short-term in chronic musculoskeletal disorders compared to pain-free exercises. It is possible that exercising with some pain or discomfort may help reduce fear avoidance, kinesiophobia and catastrophising, and/or increase self-efficacy.
