Physio findings: emphasise the many benefits of exercise for joint pain

Clinicians need to step up the exercise advice they give to people with longstanding osteoarthritic joint pain. Although such advice has physical and psychological benefits, people shy away from it for fear of causing further harm, a synthesis of available evidence finds.

Exercise is recommended to reduce the pain and disability of osteoarthritis, but it isn’t clear what impact it has on physical, emotional and mental health. To tease out this inter-relationship, the authors reviewed evidence published up to March 2016 on the impact of exercise on people with longstanding osteoarthritic knee or hip-joint pain. 

The synthesis of 21 studies, which involved 2,372 people aged 45 and older, showed that participation in exercise programmes probably slightly improves pain, movement, depression and the ability to connect with others, but makes little or no difference to anxiety. It may also boost self-confidence and sociability.

People who exercised rated their pain 1.2 points lower on a scale of zero to 20 after about 45 weeks: a score of 5.3 compared with 6.5 with no exercise, equivalent to an improvement of 6 per cent. Movement ability improved by about 5 per cent over 41 weeks, equivalent to an increase of 5.6 points on a scale of 0 to 100: 44.3 with exercise versus 49.9 without. And confidence in abilities rose by 2 per cent after 35 weeks, equivalent to an increase of 1.1 points on a scale of 17 to 85: 65.4 with exercise versus 64.3 without.

Those who exercised were 2 per cent less depressed, equivalent to half a point on a scale of zero to 21 after 35 weeks: 3 points versus 3.5. 

The exercisers also felt less anxious about themselves – 2 per cent less, equivalent to a 0.4 drop on a zero to 21 scale after 24 weeks: 5.4 versus 5.8.Exercise resulted in social interaction improving by 7.9 points over 36 weeks on a scale of zero to 100, representing a change of 8 per cent: 81.5 versus 73.6.

Twelve studies examined views and experiences of exercise. People were initially confused about the cause and characteristics of their pain, and this shaped their feelings, behaviour, and decisions about management. 

Although they thought movement and exercise were beneficial to joints, movement was painful and they worried this might be harmful. They didn’t feel they had enough information from medical professionals about what they should and should not do, so avoided physical activity and exercise for fear of doing further damage.

Overall, people who took part in exercise programmes had positive experiences, which made them feel that exercise could ease pain, and improve physical and mental health, and general quality of life. 

Giving reassurance and clear advice on the value of exercise in symptom control, challenging misconceptions and providing enjoyable forms of exercise may encourage wider participation and benefit the health of many people, the authors conclude. Hurley M, et al. Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review. Cochrane Database of Systematic Reviews 2018. 

Activity levels for older people  need to be much higher 

Physical activity levels for older people may need to be much higher than currently recommended, the findings of an Australian study suggest.

The researchers drew on interviews with more than 1,500 Australian adults over the age of 50 about their physical activity levels. Their health was then tracked for 10 years.

The interviewees were taking part in the Blue Mountains Eye Study, one of the world’s largest epidemiology studies, looking at potential links between diet and lifestyle, and long-term health.

People who did the most physical activity were twice as lively to avoid stroke, heart disease, angina, cancer and diabetes as those who did the least, and to be in optimal physical and mental shape 10 years later, the findings showed.

More than 5,000 metabolic equivalent (MET) minutes of physical activity each week was associated with the greatest reduction in risk.

The World Health Organisation (WHO) currently recommends at least 600 MET weekly minutes of physical activity, equivalent to 150 minutes of brisk walking or 75 minutes of running.

‘Our study showed that high levels of physical activity increase the likelihood of surviving an extra 10 years free from chronic diseases, mental impairment, and disability,’ said lead researcher Bamini Gopinath, associate professor at the University of Sydney.

‘Our findings suggest that physical activity levels need to be several times higher than what the [WHO] currently recommends to significantly reduce the risk of chronic disease,’ she added.

‘We encourage older adults who are inactive to do some physical activity, and those who currently only engage in moderate exercise to incorporate more vigorous activity where possible.’ Gopinath B, et al. Physical activity as a determinant of successful aging over 10 years. Nature Scientific Reports 2018.

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