Date:
Exercises For Osteoarthritis
Illustration showing people doing strengthening, range of motion, and aerobics-heart and lung health exercises.
People with osteoarthritis should do different kinds of exercise for different benefits to the body. Consult your health professional before starting.
4. Get plenty of sleep: Getting a good night's sleep on a regular basis
can minimize pain and help you cope better with the effects of your
disease. If arthritis pain makes it difficult
to sleep at night, speak with your doctor and or physical therapist
about the best mattress or comfortable sleeping positions or the
possibility of timing medications to provide more pain relief at night.
You may also improve your sleep by getting enough exercise early in the
day, avoiding caffeine or alcoholic beverages at night, keeping your
bedroom dark, quiet, and cool, and taking a warm bath to relax and
soothe sore muscles at bedtime.
5. Have fun: While having osteoarthritis certainly isn't fun, it
doesn't mean you have to stop having fun. If arthritis makes it difficult to
participate in favorite activities, ask an occupational therapist about
new ways to do them. Activities such as sports, hobbies, and volunteer
work can distract your mind from your own pain and make you a happier,
more well-rounded person.
6. Keep a positive attitude: Perhaps the best thing you can do for your
health is to keep a positive attitude. People must decide to make the
most of things when faced with the challenges of osteoarthritis. This
attitude - a goodhealth mindset - doesn't just happen. It takes work,
every day. And with the right attitude, you will achieve it.
Enjoy a "Good-Health Attitude"
- Focus on your abilities instead of disabilities.
- Focus on your strengths instead of weaknesses.
- Break down activities into small tasks that you can manage.
- Incorporate fitness and nutrition into daily routines.
- Develop methods to minimize and manage stress.
- Balance rest with activity.
- Develop a support system of family, friends, and health professionals.
What Research Is Being Done on Osteoarthritis?
The leading role in osteoarthritis research is played by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services' National Institutes of Health (NIH). NIAMS funds many researchers across the United States to study osteoarthritis. Scientists at NIAMS Multidisciplinary Clinical Research Centers conduct basic and clinical research aimed at understanding the causes, treatment options, and prevention of arthritis and musculoskeletal diseases.
In 2004, NIAMS and other institutes and offices of the NIH began recruiting participants for the Osteoarthritis Initiative (OAI). The OAI is a collaboration that pools the funds and expertise of the NIH and industry to hasten the discovery of osteoarthritis biomarkers: physical signs or biological substances that indicate changes in bone or cartilage. Researchers are collecting images and specimens from approximately 5,000 people at high risk of having osteoarthritis as well as those at high risk of progression to severe osteoarthritis during the course of the study. Scientists are following participants for 5 years, collecting biological specimens (blood, urine, and DNA), images (x rays and magnetic resonance imaging scans), and clinical data annually. For updates on this initiative, go to www.niams.nih.gov/Funding/Funded_Research/Osteoarthritis_Initiative/default.asp.
Other key areas of research supported by NIAMS and other institutes within NIH include the following:
Animal models of osteoarthritis
Animal models help researchers learn many things about osteoarthritis, such as what happens to cartilage, how treatment strategies might work, and what might prevent the disease. Animal models also help scientists study osteoarthritis in very early stages before it causes detectable joint damage. In a study that concluded in 2004, a group of researchers led by David Kingsley, Ph.D., of Stanford University, and supported by NIAMS, used mice to study the role of genes in the body's production of cartilage.
Diagnostic tools
Scientists are searching for ways to detect osteoarthritis at earlier stages so they can treat it sooner. Abnormalities in the blood, joint fluid, or urine of people with osteoarthritis may provide clues. Other scientists use new technologies to analyze the differences between the cartilage from different joints. For example, many people have osteoarthritis in the knees or hips, but few have it in the ankles. Can ankle cartilage be different? Does it age differently? Answering these questions will help us understand the disease better. Many studies now involve the development of a rapid magnetic resonance imaging (MRI) procedure that doctors use to quickly and noninvasively evaluate joint cartilage. The procedure could potentially be used to diagnose the disease. More importantly, it may be an effective method to study disease progression.
Genetics studies
Osteoarthritis in all its various forms appears to have a strong genetic connection. Gene mutations may be a factor in predisposing individuals to develop osteoarthritis. For example, scientists have identified a mutation (a gene defect) affecting collagen, an important part of cartilage, in patients with an inherited kind of osteoarthritis that starts at an early age. The mutation weakens collagen protein, which may break or tear more easily under stress. Scientists are looking for other gene mutations in osteoarthritis. Researchers have also found that the daughters of women who have knee osteoarthritis have a significant increase in cartilage breakdown, thus making them more susceptible to disease. In the future, a test to determine who carries the genetic defect (or defects) could help people reduce their risk for osteoarthritis by making lifestyle adjustments.
Tissue engineering
This technology involves removing cells from a healthy part of the body and placing them in an area of diseased or damaged tissue to improve certain body functions. Currently, it is used to treat small traumatic injuries or defects in cartilage, and, if successful, could eventually help treat osteoarthritis. Researchers at NIAMS are exploring three types of tissue engineering. The two most common methods being studied today include cartilage cell replacement and stem cell transplantation. The third method is gene therapy.
Cartilage cell replacement: In this procedure, researchers remove cartilage cells from the patient's own joint and then clone or grow new cells using tissue culture and other laboratory techniques. They then inject the newly grown cells into the patient's joint. Patients with cartilage cell replacement have fewer symptoms of osteoarthritis. Actual cartilage repair is limited, however.
In one area of research, scientists are testing fibroblastic cells (precursors to cells that make up components of connective tissue) for their ability to differentiate into cartilage cells in a lab dish. The researchers will then see if the resulting cartilage cells can form functional joint cartilage.
Stem cell transplantation: Stem cells are primitive cells that can transform into other kinds of cells, such as muscle or bone cells. They usually are taken from bone marrow. In the future, researchers hope to insert stem cells into cartilage, where the cells will make new cartilage. If successful, this process could be used to repair early cartilage damage and avoid the need for surgical joint replacements later in life.
Gene therapy: Scientists are working to genetically engineer cells that would inhibit certain enzymes that may help break down cartilage and cause joint damage. In gene therapy, cells are removed from the body, genetically changed, and then injected back into the affected joint. They reside in the joint and secrete substances that inhibit the damaging enzymes.
Patient education
Effective treatment for osteoarthritis takes more than medicine or surgery. Getting help from a variety of health care professionals often can improve patient treatment and self-care. (See "Who Treats Osteoarthritis?") Research shows that adding patient education and social support is a low-cost, effective way to decrease pain and reduce the amount of medicine used. One NIAMS-funded project involves developing and testing an interactive Web site by which health professionals and patients could communicate concerning appointments and treatment instructions, thus giving patients a greater role in and control of their care.
Exercise and weight reduction
Exercise plays a key part in a comprehensive treatment plan. Researchers are studying exercise in greater detail and finding out just how to use it in treating or preventing osteoarthritis. For example, several scientists have studied knee osteoarthritis and exercise. Their results included the following:
- Walking can result in better functioning, and the more you walk, the farther you will be able to walk.
- People with knee osteoarthritis who are active in an exercise program feel less pain. They also function better.
Research has shown that losing extra weight can help people who already have osteoarthritis. Moreover, overweight or obese people who do not have osteoarthritis may reduce their risk of developing the disease by losing weight. A NIAMS-funded study is investigating the use of regular aerobic exercise in people with osteoarthritis of the knee to determine if standard guidelines for cardiovascular fitness may be useful for the treatment of early osteoarthritis as well.
Treatment
Researchers are studying the effectiveness of a variety of different types of treatment. These include:
Drugs to prevent joint damage: No treatment actually prevents osteoarthritis or reverses or blocks the disease process once it begins. Present treatments just relieve the symptoms.
Researchers are looking for drugs that would prevent, slow down, or reverse joint damage. Drugs under study include:
- doxycycline, an antibiotic drug that may stop certain enzymes known to damage cartilage. A recent clinical trial found that doxycycline had a modest effect on slowing the rate at which the joint space narrows in the knee. The trial also found that people who were taking doxycycline experienced joint pain less often than those who were not.
- The bisphosphonate drug risedronate: In a recent British study of several hundred people with mildto-moderate osteoarthritis of the knee, those treated with risedronate showed a clear trend toward reduced symptoms and improved joint structure.
More studies are needed for both drugs.
Estrogen: In studies of older women, scientists found a lower risk of osteoarthritis in those who had used oral estrogens for hormone replacement therapy. The researchers suspect that having low levels of estrogen could increase the risk of developing osteoarthritis.
However, the 15-year, NIH-funded Women's Health Initiative found that taking estrogen plus progestin increased the risk of heart attack, stroke, blood clots, and breast cancer, while taking estrogen alone increased the risk of stroke and blood clots. The Food and Drug Administration recommends that hormone therapy be used at the lowest doses for the shortest duration needed to achieve treatment goals. Hormone therapy should always be used under a doctor's care.
Several other research projects are underway. The goal of one is to determine if estrogen protects cartilage. Other projects are examining the effects on joint cartilage of a selective estrogen receptor molecule (SERM) called raloxifene, which is often used in place of estrogen to treat and prevent osteoporosis.
Complementary and alternative therapies:
- Acupuncture: One of the most popular alternative pain-relief methods is acupuncture, an ancient Chinese practice in which fine needles are inserted at specific points in the body. According to research funded by the National Center for Complementary and Alternative Medicine, acupuncture may help reduce pain and improve function for individuals with knee osteoarthritis when used as an adjunct to medication.
One study underway compares the benefits of acupuncture with physical therapy to the benefits of physical therapy alone. The hope is that acupuncture will help relieve pain that makes exercise difficult and, therefore, will improve the effectiveness of traditional exercise physical therapy.
- Glucosamine and chondroitin sulfate: In recent years, the nutritional supplement pair glucosamine and chondroitin has shown some potential for reducing the pain of osteoarthritis, though no conclusive proof has emerged to date. Both of these nutrients are found in small quantities in food and are components of normal cartilage.
The recently concluded Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), which was cosponsored by the National Center for Complementary and Alternative Medicine and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, assessed the effectiveness and safety of these supplements, when taken together or separately.
The trial found that the combination of glucosamine and chondroitin sulfate did not provide significant relief from osteoarthritis pain among all participants. However, a smaller subgroup of study participants with moderate-to-severe pain showed significant relief with the combined supplements.
The 4-year trial was conducted at 16 sites across the United States. The results were published in the Feb. 23, 2006 edition of the New England Journal of Medicine.
- Other complementary and alternative therapies: Other research suggests that certain hyaluronic acid preparations, substances called anthraquinones, gelatin-related substances, and electrical stimulation may have a beneficial effect on cartilage growth and repair. Although these agents have shown varying degrees of promise in basic and clinical studies, additional trials are needed.
- Vitamins D, C, E, and beta carotene: The progression of osteoarthritis may be slower in people who take higher levels of vitamin D, C, E, or beta carotene. NIAMS is sponsoring a clinical trial on use of Vitamin D to treat osteoarthritis. More studies are needed to confirm these reports.
- Green tea: Many studies have shown that green tea possesses anti-inflammatory properties. One recent study showed that mice predisposed to a condition similar to human osteoarthritis had mild arthritis and little evidence of cartilage damage and bone erosion when green tea polyphenols were added to their drinking water. Another study showed that when added to human cartilage cell cultures, the active ingredients in green tea inhibited chemicals and enzymes that lead to cartilage damage and breakdown. Further studies are looking at the effects of green tea compounds on human cartilage.
- Prolotherapy: This is a popular, growing, and unregulated therapy for chronic musculoskeletal pain in which an irritant solution is injected into painful ligaments and adjacent joint spaces. However, no rigorous, scientifically valid clinical trials have proven the therapy's action or usefulness. A clinical trial sponsored by the National Center for Complementary and Alternative Medicine is studying prolotherapy's effectiveness for the pain of knee osteoarthritis. It is also using animals to assess the healing response after prolotherapy.
Hope for the Future
Research is opening up new avenues of treatment for people with osteoarthritis. A balanced, comprehensive approach is still the key to staying active and healthy with the disease. People with osteoarthritis should combine exercise, relaxation, education, social support, and medications in their treatment strategies. Meanwhile, as scientists unravel the complexities of the disease, new treatments and prevention methods should become apparent. Such developments are expected to improve the quality of life for people with osteoarthritis and their families.
Additional Resources
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484
Toll Free: 877-22-NIAMS (226-4267)
TTY: 301-565-2966
Fax: 301-718-6366
Email: NIAMSinfo@mail.nih.gov
Website: www.niams.nih.gov
NIAMS provides information about various forms of arthritis and other rheumatic diseases, and other bone, muscle, joint, and skin diseases. It distributes patient and professional education materials and refers people to other sources of information. Additional information and updates can also be found on the NIAMS Web site.
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