Dispelling myths Perhaps exercise doesn’t lead to arthritis - a review of the literature

August 22, 2019

 

For many years we have been told that if we have osteoarthritis, then we should modify our exercise. Maybe you have been told that you have arthritis in your knee and so you should give up running. Maybe you have been told to stop dancing because of the arthritis in your hips. Well, that is about to change! Within this article we detail what osteoarthritis is and explain the interesting findings from a recent systematic review on the effects of exercise (of various kinds) on osteoarthritis development. 

 

In its most simplistic definition, osteoarthritis is a part of the ageing process. Just as we develop wrinkles on our skin, we show signs of ageing on the inside as well. More formally, osteoarthritis can be described as the thinning of the lining of the bones/joints, and is associated with a reduction in joint space. It is a completely normal aspect of how we develop through the years, but may be accelerated following injury.

 

Out of interest, I made my way to the NHS website and looked at their definition of osteoarthritis, and the first line reads:

"Osteoarthritis is a condition that causes joints to become painful and stiff.”

From the https://www.nhs.uk/conditions/osteoarthritis/

 

This is not only disappointing to read, but a tad misleading. If we scanned the whole population of those over 35 years of age (yes, 35 years of age!!), we would identify areas of osteoarthritic changes in some joints of most people. Not all of these individuals would have symptoms of pain or stiffness. In fact, many would be unaware of anything out of the ordinary. Pain is a magically intricate beast, and we cannot be sure that osteoarthritis is the underlying cause of pain. Maybe in some it is, but it is likely that in most, it isn’t. Anyway, onto the literature review.

 

Bricca et al (2019 - see reference below if you want to read in more detail) recently performed a systematic literature review of the evidence around the effects of exercise on osteoarthritis (OA). Does exercise lead to OA or make those who already have signs of OA worse? They identified nine relevant studies, which compared various forms of exercise with a passive intervention.

Exercise regimes ranged from gym based circuits and strength training to sport-specific tasks such as volleyball, dancing and softball. The passive interventions ranged from modified diets, to TENS machines and placebo supplementations. 

 

The results were interesting. Bricca et al (2019) identified that knee joint loading exercise does not seem to be harmful for articular cartilage in people at increased risk of, or with, knee OA.

 

As with any piece of research, we need to take it with a pinch of salt. We are not familiar with the complexities of each individual that took part in these studies. There are a multitude of reasons as to why some may develop OA and exercise may or may not play a small part in this journey. More research is therefore required to solidify such findings. However, we can at least be reassured that maybe be don’t need to fearful of exercise. We know that there are many, many significant benefits of exercising regularly, and hopefully this signals the end of an era for the advice that "we shouldn’t exercise if we have osteoarthritis". 

 

So, Move More, Move Better and Get Stronger to help offset the development and symptoms of OA.

 

Until next time

 

Signing off,

 

James Boyd

Specialist Sports Physiotherapist

 

 

Reference

Bricca, A. et al (2019) Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials, BJSM, 53, 15, 940-947

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