Osteoarthritis

Overview of Osteoarthritis

Osteoarthritis refers to a group of conditions characterized by progressive degeneration of articular cartilage, subchondral bone, and other joint structures. The disease process usually begins with excessive or abnormal mechanical stresses to the articular surfaces, with a chronic inflammatory process leading to the characteristic changes of all the joint structures. Radiographic appearance of osteoarthritis is characterized by loss of joint space, subchondral bone sclerosis, and osteophyte formations. Radiographic signs for the extent of joint changes may not correlate strongly with the client's current symptoms. Weight-bearing joints of the lower extremities and the spine are affected most often. Clients with this condition experience significant joint pain and stiffness that limit mobility and result in diminished daily activities.¹ As the condition progresses, the client experiences more fatigue and discomfort with daily activities and may choose to self-limit activities to reduce these symptoms. Exercise programs have been found to be highly effective for the treatment of osteoarthritis.²

Effects of Exercise Programs on Clients With Osteoarthritis

Comorbidities to Consider

• Reduced physical activities typically lead to weight gain and a progression of atherosclerosis that can exacerbate the client endurance impairment and further reduce tolerance to activities.³

Client Examination

Keys to Examination of Clients

• Examine images or imaging reports to assess the extent of osteoarthritic changes to joint structures.

• Employ the Western Ontario and McMaster Osteoarthritis Index (WOMAC) to assess the client's pain, disability, and joint stiffness.⁴

• Discuss with clients their social support, understanding of their disease process, and self-efficacy for maintaining an exercise program.^5,6

Recommended Baseline Testing of Fitness Levels

• Walking tests can be performed to assess a client's walking velocity and tolerance to endurance activities.^3,7 Exercise capacity assessed with cycling may be preferred by clients with significant lower extremity osteoarthritis.

• Use functional activities of squatting or stepping as well as strength assessments for lower extremity muscle groups.^5,7

Exercise Prescription

Type: Walking, cycling, aquatic activities, weight training

Intensity: Start at low intensities

Duration: Start at 10–20 minutes

Frequency: Three to five times per week

Getting Started

Aerobic activities are recommended for clients with osteoarthritis for promoting weight loss and improving physical function.^2,8 Clients beginning an exercise program should be allowed to self-select the intensity of their exercise, as joint pain will be a limiting factor.^7,8 Clients should be encouraged to increase their intensity to a level of 60% to 80% of their maximum ...