Rehabilitation (exercise and strength training) and osteoarthritis: A critical narrative review

Abstract

Rehabilitation is widely recommended in national and international guidelines for managing osteoarthritis (OA) in primary care settings. According to the 2014 OA Research Society International (OARSI) recommendations, rehabilitation is even considered the core treatment of OA and is recommended for all patients. Rehabilitation for OA widely includes land- and water-based exercise, strength training, weight management, self-management and education, biomechanical interventions, and physically active lifestyle. We performed a critical narrative review of the efficacy and safety of rehabilitation for managing OA and discuss evidence-based international recommendations. The process of article selection was unsystematic. Articles were selected based on authors' expertise, self-knowledge, and reflective practice. For the purpose of the review, we focused on land- and water-based exercise and strength training for knee, hip and hand OA. Other aspects of rehabilitation in OA are treated elsewhere in this special issue. Exercise therapy is widely recommended for managing knee, hip and hand OA. However, the level of evidence varies according to OA location. Overall, consistent evidence suggests that exercise therapy and specific strengthening exercise or strength training for the lower limb reduce pain and improve physical function in knee OA. Evidence for other OA sites are less consistent. Therefore, because of the lack of specific studies, recommendations for hip and hand OA are mainly derived from studies of knee OA. In addition, no recommendations have been established regarding the exercise regimen. The efficacy and safety of exercise therapy and strength training need to be further evaluated in randomized controlled trials of patients with hip and hand OA. The optimal delivery of exercise programs also has to be more clearly defined.

Hip Osteoarthritis: Etiopathogenesis and Implications for Management

“…Rehabilitation for hip OA encompasses several different aspects, including patient education, weight management, land- and water-based exercise, and strength training [144]. While consistent evidence supports the efficacy of these strategies in the management of knee OA [145], the evidence in hip OA is far more variable [144].…”

“…While consistent evidence supports the efficacy of these strategies in the management of knee OA [145], the evidence in hip OA is far more variable [144]. Weight loss is recommended for people with hip OA who are overweight/obese; however unlike knee OA, there is a paucity of clinical trial evidence for weight loss in hip OA [146].…”

Nonoperative Options for Management of Articular Cartilage Disease

“…2 Improved strength can lead to decreased joint loading and increased joint stability. 12 A 2011 systematic review on the effect of strength training for knee OA showed moderate effect size for both decreasing pain and improving function. 2 Few studies evaluate the effectiveness of physical therapy for delaying progression of OA to the endpoint of joint replacement.…”

The effects of resistance training on muscle strength, joint pain, and hand function in individuals with hand osteoarthritis: a systematic review and meta-analysis

“…Among the conservative treatments available for OA, exercises have been shown to be cost-effective and useful in improving quality of life [6]. Exercise aims to reduce the magnitude of change observed in strength, joint range of motion, proprioception, and alignment, which are often impaired due to the natural course of the disease and disuse [7]. Such impairments lead to reductions in function and quality of life [8].…”