INTRODUCTION

Individuals with osteoarthritis (OA) of the hip or knee often experience weakness in their lower extremities^1,21de Zwart AH, Dekker J, Lems WF, Roorda LD, Van Der Esch M, Van Der Leeden M. Factors associated with upper leg muscle strength in knee osteoarthritis: A scoping review. Journal of rehabilitation medicine. 2018;50(2):140-50.
²Øiestad BE, Juhl CB, Eitzen I, Thorlund JB. Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. A systematic review and meta-analysis. Osteoarthritis and Cartilage. 2015;23(2):171-7. which, combined with poor neuromuscular function, may lead to functional and mobility decline over time. A sedentary lifestyle is one of the major risk factors of OA as it aggravates symptoms and contributes to a lower quality of life.³³Musumeci G, Aiello FC, Szychlinska MA, Di Rosa M, Castrogiovanni P, Mobasheri A. Osteoarthritis in the XXIst century: Risk factors and behaviours that influence disease onset and progression. International Journal of Molecular Sciences. 2015;16(3):6093-112. Physical deconditioning due to inactivity not only exacerbates symptoms but can also negatively impact overall health.^1,41de Zwart AH, Dekker J, Lems WF, Roorda LD, Van Der Esch M, Van Der Leeden M. Factors associated with upper leg muscle strength in knee osteoarthritis: A scoping review. Journal of rehabilitation medicine. 2018;50(2):140-50.
⁴Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47.

Regular exercise and physical activity are among the most effective conservative treatments to improve symptoms and maintain physical fitness in people with OA of the hip or knee.^4,54Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47.
⁵Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best evidence rehabilitation for chronic pain part 5: Osteoarthritis. Journal of Clinical Medicine. 2019;8(11):1769. Exercise and physical activity are related but not equal and have a variety of benefits and components (see below).

Self-management strategies (Standard 3) should be discussed in conjunction with introduction of exercise prescription and physical activity programs. If the individual with OA gains confidence in understanding their body and options for modifying their exercises and physical activities, they will be better able to safely exercise and carry out their day-to-day activities.

Understanding Prescribed Exercise vs. Physical Activity

PRESCRIBING MOVEMENT

During care planning with an individual, the Primary Clinician should offer options for exercise and physical activity to address strength and flexibility, in balance with cardiovascular fitness. Alternatively, depending on the scope of the Primary Clinician’s expertise, they can refer to other clinicians, in particular those qualified and experienced in prescribed exercise to develop a targeted exercise program. Most recommended exercises and physical activities for hip and knee OA target lower extremities, including trunk/core, gluteal, quadriceps, hamstring, and calf muscles.

It is important to use shared decision-making techniques to build movement into a care plan. If the individual is choosing exercise and activity they are interested in, they will be more likely to enjoy and complete them. A well-rounded movement plan:^4,64Bowden JL, Hunter DJ, Deveza LA, Duong V, Dziedzic KS, Allen KD, et al. Core and adjunctive interventions for osteoarthritis: Efficacy and models for implementation. Nature Reviews Rheumatology. 2020;16(8):434-47.
⁶Holden MA, Button K, Collins NJ, Henrotin Y, Hinman RS, Larsen JB, et al. Guidance for implementing best practice therapeutic exercise for people with knee and hip osteoarthritis: what does the current evidence base tell us? Arthritis Care & Research. 2020;Accepted for publication.

• Accommodates for the individual’s baseline wellness;
• Addresses the individual’s:
  • Needs
  • Goals
  • Symptoms
  • Socioeconomic status
  • Preferences and
  • Values
• Has a preliminary plan for progression
• Collects outcome measures
• And incorporates:
  • Daily movement goals (see below)
  • Education on safe practices:
    • Recovery strategies
    • Pain tracking and managing strategies
    • Pacing and modification strategies and
  • Strategies to improve motivation to maintain an active lifestyle

Prescribed movement can be suggested as independent work for the individual or as part of joining structured programs. The Tables of Examples for the Conservative OA Treatments provides a variety of categorized examples of independent or structured programs. Structured programs may be offered on-site or virtually, with individual supervision or in a group setting. Note that structured programs may incur costs. The individual’s socioeconomic status should be considered before selecting treatment options.

Over time, work with the individual with OA to safely and gradually progress the intensity, frequency and duration of an exercise or physical activity. Build relationships with the community-based exercise program providers in the area to ensure individuals with OA are directed to the program that is most applicable to their needs.

Movement Target

With clinician approval for medical safety a target of 150 minutes of moderate to vigorous aerobic movement per week is recommended^7,87Canadian Society for Exercise Physiology. Canadian 24-hour movement guidelines: An integration of physical activity, sedentary behavior, and sleep Ottawa, Ontario: Canadian Society for Exercise Physiology; 2021 [Available from: https://csepguidelines.ca/].
⁸World Health Organization. WHO guidelines on physical activity and sedentary behavior. Geneva; 2020. .