Plenary Session “Rehabilitation through exercise” at ECSS Barcelona 2013

Exercise as prevention and treatment of knee osteoarthritis
Roos, E.
University of Southern Denmark

The two most common questions from patients with osteoarthritis are if it is OK that it hurts when exercising, and if exercise will wear
the joint down. Recent research suggest that it is OK if it hurts when exercising, and exercise therapy seem not to wear the joint
down, if anything small pilot studies suggest the opposite. Our joints need mechanical load to work well, and the cartilage needs
mechanical stimuli to produce the building blocks needed. Because of joint pain and varying structural changes of the joint exercise
must be adapted to suit this patient group.

Systematic reviews of data from randomized controlled trials from many thousands of patients show that both aerobic exercise and
strength training are associated with substantial pain relief and improved physical function. Therefore exercise is recommended as
first line treatment, together with education and weight loss, for patients with knee osteoarthritis. In many countries initiatives are
taken to offer educational classes, exercise and weight loss programs for patients with knee osteoarthritis. Less is however known
about the optimal exercise program, but 12 or more supervised sessions are associated with twice the effect compared to less than
12 sessions.

The role of exercise in OA prevention in groups at increased risk of knee OA is currently under study. Patients having had treatment
because of an injury to the anterior cruciate ligament or to the menisci constitute such easily identified highrisk groups where
preventive measures may be possible. Neuromuscular exercise programs have been developed for these groups to improve their
symptoms and function and dynamically stabilize the joint. Time will show if these strategies are able to reduce or slow OA
development.

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