[et_pb_section fb_built=”1″ _builder_version=”4.16″ _module_preset=”default” background_color=”#c7c89b” custom_margin=”||||false|false” custom_padding=”||20px||false|false” global_colors_info=”{}”][et_pb_row _builder_version=”4.16″ _module_preset=”default” custom_margin=”||0px||false|false” custom_padding=”||0px||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text module_class=”heading” _builder_version=”4.16″ _module_preset=”default” text_font=”Source Sans Pro|600||on|||||” text_text_color=”#000000″ text_font_size=”40px” text_line_height=”1em” header_text_align=”left” header_2_font=”Source Sans Pro|600|||||||” header_2_text_align=”center” header_2_text_color=”#ffc212″ header_2_line_height=”1.4em” custom_margin=”||||false|false” custom_padding=”||||false|false” text_line_height_tablet=”” text_line_height_phone=”1em” text_line_height_last_edited=”on|phone” header_2_text_shadow_style=”preset1″ global_colors_info=”{}”]Core Treatment 2: Exercise & Physical Activity[\/et_pb_text][et_pb_text _builder_version=”4.17.4″ _module_preset=”default” text_font=”Source Sans Pro|600||on|||||” text_text_color=”#000000″ text_font_size=”22px” text_line_height=”1em” header_text_align=”left” header_text_color=”#FFFFFF” header_font_size=”38px” header_2_font=”Source Sans Pro|600|||||||” header_2_text_align=”center” header_2_text_color=”#ffc212″ header_2_line_height=”1.4em” custom_margin=”||0px||false|false” custom_padding=”||0px||false|false” header_2_text_shadow_style=”preset1″ global_colors_info=”{}”]<\/p>\n
STANDARD 5<\/p>\n
[\/et_pb_text][et_pb_text _builder_version=”4.16″ _module_preset=”default” text_font=”||||||||” text_text_color=”#000000″ text_font_size=”20px” text_line_height=”1.5em” custom_padding=”||20px||false|false” global_colors_info=”{}”]Individualized exercise and physical activity programs should be integrated into the care plan for people with osteoarthritis (OA) of the hip or knee. Individualized programs provide support and information on progressive exercises and how to modify those activities as symptoms change. These programs focus on improving strength, endurance and function which will help support regular movement and improve overall health. Use of shared decision-making techniques will ensure the individual\u2019s priorities, values and preferences are considered when setting their wellness goals.[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ fullwidth=”on” disabled_on=”on|off|off” _builder_version=”4.16″ _module_preset=”default” background_color=”#c7c89b” background_enable_image=”off” background_size=”contain” background_position=”center_left” custom_margin=”-12px||||false|false” custom_margin_tablet=”-12px||||false|false” custom_margin_phone=”0px||||false|false” custom_margin_last_edited=”on|phone” custom_padding=”||33px||false|false” global_colors_info=”{}”][et_pb_fullwidth_image src=”https:\/\/toolkit.albertaboneandjoint.com\/osteoarthritis\/wp-content\/uploads\/line-1.png” title_text=”line (1)” _builder_version=”4.16″ _module_preset=”default” width=”80%” max_width=”80%” global_colors_info=”{}”][\/et_pb_fullwidth_image][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.16″ _module_preset=”default” custom_margin=”0px||0px||true|false” custom_padding=”0px||0px||true|false” top_divider_color=”rgba(12,113,195,0.32)” top_divider_height=”27px” global_colors_info=”{}”][et_pb_row _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][lwp_divi_breadcrumbs _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][\/lwp_divi_breadcrumbs][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ custom_padding_last_edited=”on|phone” _builder_version=”4.16″ _module_preset=”default” background_color=”#FFFFFF” custom_padding=”0px||||false|false” custom_padding_tablet=”” custom_padding_phone=”0px||0px||true|false” global_colors_info=”{}”][et_pb_row column_structure=”1_2,1_2″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”||0px||false|false” global_colors_info=”{}”][et_pb_column type=”1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text module_class=”heading” _builder_version=”4.17.4″ _module_preset=”default” text_font=”|600||on|||||” text_text_color=”#000000″ text_font_size=”40px” header_text_color=”#000000″ header_2_font=”Source Sans Pro|600|||||||” header_2_text_align=”center” header_2_text_color=”#ffc212″ header_2_line_height=”1.4em” custom_padding=”||||false|false” header_2_text_shadow_style=”preset1″ global_colors_info=”{}”]<\/p>\n
OVERVIEW<\/p>\n
[\/et_pb_text][\/et_pb_column][et_pb_column type=”1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”1_2,1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.17.4″ _module_preset=”default” text_font_size=”18px” global_colors_info=”{}”]Key Messages for Exercise & Physical Activity<\/strong><\/p>\n [\/et_pb_text][\/et_pb_column][et_pb_column type=”1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.18.0″ _module_preset=”default” text_text_color=”#000000″ text_font_size=”18px” background_color=”#f2f2f2″ custom_padding=”20px|20px|20px|20px|true|true” border_radii=”on|20px|20px|20px|20px” global_colors_info=”{}”]<\/p>\n View All Resources<\/strong><\/a><\/p>\n View References<\/strong><\/a>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ module_class=”desk” _builder_version=”4.16″ _module_preset=”default” background_color=”rgba(255,255,255,0.86)” background_image=”https:\/\/toolkit.albertaboneandjoint.com\/osteoarthritis\/wp-content\/uploads\/Pngtree\u2014blue-hexagon-abstract-medical-technology_1298247-e1653654071890.jpg” background_size=”initial” background_position=”top_left” background_blend=”overlay” custom_margin=”||||false|true” custom_padding=”||100px||false|true” global_colors_info=”{}”][et_pb_row column_structure=”1_4,3_4″ _builder_version=”4.18.0″ _module_preset=”d55fc8c6-b5de-4b77-a65b-80d125d2b382″ global_colors_info=”{}”][et_pb_column type=”1_4″ _builder_version=”4.18.0″ _module_preset=”e067a3d0-44a1-4396-9c39-e633c5db2c25″ global_colors_info=”{}”][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Introduction<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Prescribing movement<\/a>[\/et_pb_text][\/et_pb_column][et_pb_column type=”3_4″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”||||false|false” global_colors_info=”{}”][et_pb_text _builder_version=”4.18.0″ _module_preset=”default” text_font_size=”18px” global_colors_info=”{}”]<\/p>\n Individuals with osteoarthritis (OA) of the hip or knee often experience weakness in their lower extremities1,2<\/sup>1<\/sup>de Zwart AH, Dekker J, Lems WF, Roorda LD, Van Der Esch M, Van Der Leeden M.\u202fFactors associated with upper leg muscle strength in knee osteoarthritis: A scoping review. Journal of rehabilitation medicine. 2018;50(2):140-50. 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<\/strong>.4,5<\/sup>4<\/sup>Bowden 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. Self-management strategies<\/a> (Standard 3)<\/a> 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.<\/p>\n [\/et_pb_text][et_pb_divider color=”#000000″ _builder_version=”4.16″ _module_preset=”default” custom_margin=”20px||||false|false” custom_padding=”20px||||false|false” global_colors_info=”{}”][\/et_pb_divider][et_pb_text _builder_version=”4.18.0″ _module_preset=”default” text_font_size=”18px” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n 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\u2019s expertise, they can refer to other clinicians<\/a>, 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.<\/p>\n It is important to use shared decision-making techniques<\/a> 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:4,6<\/sup>4<\/sup>Bowden 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. 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\u2019s socioeconomic status should be considered before selecting treatment options.<\/p>\n Over time, work with the individual with OA to safely and gradually progress the intensity<\/a>, 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.<\/p>\n With clinician approval for medical safety a target of 150 minutes of moderate to vigorous aerobic movement per week is recommended7,8<\/sup>7<\/sup>Canadian 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\/<\/a>]. [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ module_class=”mob” _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_row _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_accordion _builder_version=”4.18.0″ _module_preset=”7edfcb3f-f900-45e5-aca9-ee6492dc7b76″ hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″][et_pb_accordion_item _builder_version=”4.18.0″ _module_preset=”default” custom_css_main_element=”display:none;” global_colors_info=”{}” open=”on”][\/et_pb_accordion_item][et_pb_accordion_item title=”INTRODUCTION” _builder_version=”4.18.0″ _module_preset=”default” global_colors_info=”{}” open=”off”]\tIndividuals with osteoarthritis (OA) of the hip or knee often experience weakness in their lower extremities1,2<\/sup>1<\/sup>de Zwart AH, Dekker J, Lems WF, Roorda LD, Van Der Esch M, Van Der Leeden M.\u202fFactors associated with upper leg muscle strength in knee osteoarthritis: A scoping review. Journal of rehabilitation medicine. 2018;50(2):140-50. \tRegular 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<\/strong>.4,5<\/sup>4<\/sup>Bowden 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. \tSelf-management strategies<\/a> (Standard 3)<\/a> 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.<\/p>\n [\/et_pb_accordion_item][et_pb_accordion_item title=”PRESCRIBING MOVEMENT” _builder_version=”4.18.0″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” open=”off” sticky_enabled=”0″]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\u2019s expertise, they can refer to other clinicians<\/a>, 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.<\/p>\n\n
KEY RESOURCES<\/strong><\/span><\/span><\/h3>\n
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\n<\/span><\/li>\n<\/ul>\nINTRODUCTION<\/h1>\n
2<\/sup>\u00d8iestad 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. <\/span><\/span> 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.3<\/sup>3<\/sup>Musumeci 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.<\/span><\/span> Physical deconditioning due to inactivity not only exacerbates symptoms but can also negatively impact overall health.1,4<\/sup>1<\/sup>de Zwart AH, Dekker J, Lems WF, Roorda LD, Van Der Esch M, Van Der Leeden M.\u202fFactors associated with upper leg muscle strength in knee osteoarthritis: A scoping review. Journal of rehabilitation medicine. 2018;50(2):140-50.
4<\/sup>Bowden 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. <\/span><\/span><\/p>\n
5<\/sup>Rice 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. <\/span><\/span> Exercise and physical activity are related but not equal and have a variety of benefits and components (see below).<\/p>\nUnderstanding Prescribed Exercise vs. Physical Activity<\/h4>\n
Prescribed Exercise<\/h5>\n<\/div>\n
Physical Activity<\/h5>\n<\/div>\n<\/div>\n
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PRESCRIBING MOVEMENT<\/h1>\n
\n6<\/sup>Holden 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.<\/span><\/span><\/p>\n\n
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Movement Target<\/h4>\n
\n8<\/sup>World Health Organization. WHO guidelines on physical activity and sedentary behavior. Geneva; 2020. <\/span><\/span>.<\/p>\n
\n\t2<\/sup>\u00d8iestad 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. <\/span><\/span> 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.3<\/sup>3<\/sup>Musumeci 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.<\/span><\/span> Physical deconditioning due to inactivity not only exacerbates symptoms but can also negatively impact overall health.1,4<\/sup>1<\/sup>de Zwart AH, Dekker J, Lems WF, Roorda LD, Van Der Esch M, Van Der Leeden M.\u202fFactors associated with upper leg muscle strength in knee osteoarthritis: A scoping review. Journal of rehabilitation medicine. 2018;50(2):140-50.
\n\t4<\/sup>Bowden 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. <\/span><\/span><\/p>\n
\n\t5<\/sup>Rice 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. <\/span><\/span> Exercise and physical activity are related but not equal and have a variety of benefits and components (see below).<\/p>\nUnderstanding Prescribed Exercise vs. Physical Activity<\/h4>\n
Prescribed Exercise<\/h5>\n<\/p><\/div>\n
Physical Activity<\/h5>\n<\/p><\/div>\n<\/p><\/div>\n
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