EVIDENCE-BASED ANSWER
Yes, moderately. Exercise helps reduce the pain, but it’s unclear whether it helps with stiffness. Exercise moderately reduces pain in elderly patients with osteoarthritis (strength of recommendation [SOR]: A, 3 systematic reviews, including high-quality studies) and has a small effect on reducing self-reported disability (SOR: B, 2 systematic reviews, including reviews of smaller studies). No studies have evaluated the effect of exercise on stiffness.
Clinical commentary
Exercise takes 4 to 6 weeks to help
Lauren DeAlleaume, MD
Department of Family Medicine, University of Colorado Health Sciences Center, Denver
Talk to your patient about exercise preferences and concerns. Would your patient rather exercise with an organized group that provides instruction and support, or engage in a solitary activity such as walking? Referral to a physical therapist may be helpful. Remind your patient that exercise generally takes 4 to 6 weeks to help and must be continued to maintain improvements. Remind your patient to start slowly; an every-other-day regimen is often preferable initially.
The Arthritis Foundation (www.arthritis.org) offers exercise programs, videos, and patient education materials. Tai chi for Arthritis, developed by an Australian family physician and tai chi expert, has been shown to decrease joint pain while improving balance and physical function. A list of certified instructors can be found at www.taichiforarthritis.com. The People with Arthritis Can Exercise (PACE) program and aquatic exercise programs are also available in many places through the Arthritis Foundation. These programs, designed specifically for people with arthritis, feature instructors who are trained in injury avoidance.
Evidence summary
Exercise therapy for osteoarthritis aims at reducing pain and disability by improving muscle strength, range of motion, joint stability, and fitness.1,2 A Cochrane systematic review of hip and knee osteoarthritis3 defined exercise therapy as activities performed actively, passively, or against resistance. The outcomes were reported as effect sizes (ES): Typically, an ES of 0.2 is considered small, 0.5 medium, and 0.8 large.
Exercise, regardless of intensity, may ease pain of mild disease
Land-based therapeutic exercise demonstrated a combined treatment effect of 0.39 (95% confidence interval [CI], 0.30-0.47) for reducing pain. Individual treatments (ES=0.52; 95% CI, 0.32-0.72) or exercise classes (ES=0.47; 95% CI, 0.34-0.60) had a larger effect than home-based programs (ES=0.28; 95% CI, 0.16-0.40). However, these studies only included patients with early or mildly symptomatic osteoarthritis, which may limit their applicability to more severe disease.