Top tips – managing physical activity and OA

Many clinicians worry about prescribing physical activity for those with OA and making things worse; like-wise patients are also unaware of the best course of action to take.

Physical activity is highly beneficial for osteoarthritis. It has been proven to:

  • Reduce pain
  • Reduce stiffness
  • Improve physical function
  • Improve quality of life
  • Improve general health
  • Improve mental health.

Here are some key points, which I feel we should enforce to our patients.

1. Physical Activity should be a cornerstone of treatment for Osteoarthritis.

Numerous studies support the improvement in function and pain that occurs through physical activity. Therefore, we must ensure that those with osteoarthritis are given physical activity advice. Fantastic resources such as the evidence based Moving Medicine project will hopefully help to support clinicians provide advice to patients.

2. Reassure patients, they won’t make their arthritis worse and that physical activity is safe.

Due to the term wear and tear still commonly banded around, many patients believe their joints will “wear” quicker if used more. We need to dispel this myth as clinicians to ensure they become more physically active.

3. Advise patients around making the right choices about mode of activity.

Exercise prescription is always a challenge and needs to be specific to the individual, their function and their pain. Having worked as an exercise professional prior to medicine, there are very few activities that are “off limits”.

Depending on the joints affected, caution may be taken with more high impact activities as well as extremely repetitive higher repetition resistance training under heavy loads. Strength training however is important. With more severe osteoarthritis, particularly of the lower limb, lower impact choices such as walking, cycling, rowing, swimming and using a cross trainer may be more appropriate.

Exercise or physical activity choices also need to challenge the individual and be appropriate to their goals. There are a range of exercise professionals e.g. those with an Active IQ Exercise Referral Level 3 qualification who have the skills to prescribe exercise to those with osteoarthritis if more specific programmes were required.

4. Set Realistic Goals.

This is important. While the CMO guidelines may recommend 150 minutes of moderate exercise and two strength training sessions, this may be difficult if the patient’s starting point is considerably low or they are inactive (less than 30min a week). Therefore, a realistic starting point needs to be set.

Physical activity benefits for adults and older adults infographic.

5. Progress and increase patient physical activity safely.

Once the patient is regularly physically active by whatever means they have chosen, then they can start to progress their exercise. Getting the habit formed first is critical. In the world of strength and conditioning a researcher named Tim Gabett is the current gospel for managing how much activity to do and how to increase it. However, with regards to health, there is no clear consensus and anecdotally I use the 10% rule and advise patients not to increase their time/distance/speed depending on the variable being measured by more than 10% from the week before. Physical activity is a critical part of osteoarthritis management. Please see the other resources and training opportunities below that maybe relevant to a health care professional working with those with osteoarthritis.

Contact dane.vishnubala@nhs.net for more information.

Moving Medicine

www.movingmedicine.ac.uk (see featured article).

Public Health England: Clinical Champions Programme

For clinicians, interested in learning more about physical activity and prescribing it to their patients. Contact PhysicalActivity@phe.gov.uk to organise free training and access your local Physical Activity Champion.

PHE provides funded training supported by Sport England and the Burdett Trust and is delivered by a range of health professionals. Training can be delivered to a range of primary and secondary care settings.

Active IQ Exercise Referral Qualification

Active IQ is a UK based Awarding organisation regulated by OfQual.

To learn more about the Exercise Referral Qualification please visit the Active IQ website www.activeiq.co.uk.

Royal College of GPs: Physical Activity and Lifestyle Priority

Physical activity and lifestyle is a key priority for the RCGP. Toolkits and resources are being developed to support clinicians to provide better advice and care in this area. There is definitely a noticeable shift in culture around physical activity occurring. See the parkrun feature and visit http://www.rcgp.org.uk/parkrun for more information.

British Association of Sport and Exercise Medicine (BASEM)

BASEM is a member organisation for clinicians working in sports medicine, musculoskeletal medicine or exercise medicine. BASEM runs and supports a range of courses and conferences all year around as well as hosting online learning for its members as well as grants and prizes. Visit www.basem.co.uk.