For Adults with Osteoarthritis
In the absence of a cure, joint-friendly exercise is the single most important weapon in the fight against osteoarthritis.
Exercise is good for everyone—so important that the U.S. Department of Health and Human Services has established physical activity guidelines to help all Americans harness the healthful power of exercise. The guidelines are for people of all ages – including those who are older or have arthritis or other chronic conditions. The recommendations specify the types and amounts of physical activity per week that can produce long-term health benefits.
The physical activity guidelines for adults (below) are considered to be particularly relevant for people with osteoarthritis (OA), because the evidence of benefits for OA is so strong. The recommendations are also considered to be safe as long as people with OA choose activities within their capabilities and according to their needs. Ask your doctor if you are unsure which types of activity are best for you.
Check
Every week:
- Doing something active is better than doing nothing. Getting any amount of physical activity is better than getting none. People who participate in any amount of physical activity gain some health benefits.
- If you are able, get the recommended amount of activity. To reap substantial health benefits, every week get at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity or 75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity—or an equivalent mix of moderate- and vigorous-intensity activity.* Aerobic activity should be performed in episodes of at least 10 minutes and should be spread throughout the week.
- If you can, do more than that. For additional and more extensive health benefits, increase your aerobic physical activity. Every week aim for 300 minutes (5 hours) of moderate-intensity or 150 minutes of vigorous-intensity aerobic physical activity, or an equivalent mix of moderate- and vigorous-intensity activity.
- Do muscle-strengthening workouts, too. In addition, do muscle-strengthening activities on two or more days. Muscle-strengthening exercise should require a moderate or high level of effort and should involve all major muscle groups – legs, hips, back, abdomen, shoulders and arms.
Additional considerations for people with osteoarthritis:
- Younger adults with mild-to-moderate OA. Match the type and amount of physical activity to your abilities and the severity of your symptoms. If you are unsure about what types or amounts of activity are appropriate, consult your health care provider.
- Older adults with other chronic conditions or moderate-to-severe OA. Your level of fitness should guide your level of physical activity. If you cannot do 150 minutes of moderate-intensity aerobic activity each week because of other health conditions, you should still be as physically active as your abilities and conditions allow. If you are unsure about what types or amounts of activity are appropriate, consult your health care provider.
*1 hour of moderate-intensity aerobic activity = 30 minutes of vigorous-intensity aerobic activity.
Aerobic activity: It's essential
The guidelines encourage people with OA to be as physically active as possible. This is good advice, as research in people with knee OA shows that physical function benefits improve with greater amounts of activity. Do just a little, if that's all you can do right now. When you can, do more. If you are already active, increase your activity, if you are able. It's simple: The more you do, the better!
Aerobic activity: what is "intensity"?
The guidelines recommend getting exercise of moderate intensity, vigorous (high) intensity, or a combination of moderate and high intensity. What's the difference?
Intensity refers to the amount of energy or effort needed to perform the activity. People breathe faster and their heart pumps more quickly as intensity increases. During moderate-intensity activity, a person can usually talk but not sing. During high-intensity activity, a person can usually say only a few words before needing to take a breath.
Someone who is "out of shape," will experience an activity as higher intensity than someone who is more aerobically fit. The good news is that everyone's fitness level increases with regular exercise.
Examples of moderate- and high-intensity activities:
| Type of Activity |
Moderate-Intensity |
High-Intensity |
| Exercise and leisure |
Walking 3 mph or faster (not race-walking), walking carrying a 15-lb child |
Race-walking, jogging, running, backpacking, hiking, climbing hills, stair climbing |
| Biking: cycling outdoors on level ground, stationary bike |
Biking: cycling at less than 10 mph, mountain biking, spin bike class |
| Gym, other: Pilates, yoga; circuit training, stationary rowing (moderate effort) |
Gym: rope skipping, ski or elliptical machine, circuit training (vigorous pace, with minimal rest) |
| Dancing: ballet, modern, jazz, tap, ballroom (waltz, foxtrot, cha cha), Caribbean dance (all moderate effort, as in standard dance, rehearsal, class) |
Dancing: ballet, modern, jazz aerobic/fitness dancing, step, dancing, polka, contra, country (all vigorous effort, competition level) |
| Water activities: sailing; snorkeling, swimming laps, water walking or aquatic aerobics (all moderate effort) |
Water activities: water skiing; scuba diving, swimming laps, canoeing/rowing/kayaking; and water walking/jogging windsurfing (all vigorous effort) |
| Cold-weather fun: downhill skiing, snow shoeing (all moderate effort) |
Cold-weather fun: ice skating or dancing, cross-country skiing, sledding (all vigorous effort) |
| Sports |
Games/sports: badminton (non-competitive), bowling, children's games (hopscotch, tag, dodge ball), bowling, cricket, croquet, golf, horseback riding (no jumps or gallops), tai chi, softball, tennis (doubles, modified), volleyball (non-competitive) |
Games/sports: basketball, boxing, football, handball, hockey, horseback riding (jumps, gallops), martial arts (karate, judo, kick boxing), racquetball, rock or mountain climbing, skipping rope, skating/rollerblading, soccer, squash, tennis (singles), volleyball (competitive) |
| Lawn and garden |
Firewood: carrying/loading/stacking wood or lumber |
Firewood: chopping wood/splitting logs |
| Yard: clearing light brush, weeding garden, digging with a spade, raking leaves, manually trimming shrubs or trees, mowing lawn with a walk-behind power mower |
Yard: hauling brush and branches, wheelbarrow chores, shoveling dirt, hoeing, mowing with a hand/push mower, shoveling snow by hand |
| Home activities and repairs |
Home care: general cleaning (sweeping, mopping, vacuuming, washing windows), painting, washing and waxing car |
Home care: vigorous scrubbing (floors, bathtub), outdoor repairs (installing gutters, carpentry, using a hand saw) |
Source: Adapted from 2011 Compendium of Physical Activities: a second update of codes and MET values. Medicine and Science in Sports and Exercise, 2011;43(8):1575-1581.
What types of aerobic activities are best?
The types of aerobic activities that are "best" are different for each person and depend on the person's overall health and fitness level, the joints involved and severity of OA. Of course, personal preference, location, time and overall convenience all matter a great deal, too, particularly when it comes to finding an activity you will stick with.
Be sure each episode of activity is at least 10 minutes long is of at least moderate intense. This means that biking to work, walking to a store, raking leaves or even playing in the snow would all count. The possibilities for physical activity are endless.
Muscle strengthening—just as important!
Muscle-strengthening exercise (also called resistance training) is essential to achieve overall fitness, and also is a critical component of OA management. Like shock absorbers, muscles help to absorb the force directed to a joint during movement and activity. Muscles also stabilize and support joints. Your joints will appreciate the improved muscle strength that comes from doing aerobic activity, but for specific OA benefits, targeted strengthening exercises are best.
To increase strength, you need to progressively increase the resistance/weight, increase the number of repetitions or sets of repetitions, or decreasing the rest time between exercises.
As a general recommendation, a full routine of moderate- to high-level intensity muscle-strengthening exercises should be performed at least two times per week (but not more than four times) and should work all major muscle groups (legs, hips, back, chest, abdomen, shoulders, and arms). Each session should begin with a warm-up (10 minute of aerobic activity, such as brisk walk or walking in place).
There are countless ways to strengthen muscles, the most common being the use of hand-held weights, resistance bands, weight machines, isometric exercises, or the weight of your own body (for example, push-ups, pull-ups). The specific type of muscle-strengthening activity is less important than knowing how to do the exercises properly to avoid injury.
Flexibility exercises
Daily, gentle stretching helps keep joints and muscles limber, improving joint range of motion. Increase flexibility with by doing a stretching routine or even yoga and tai chi. Stretching should be done after muscles are warmed up by a 10-minute walk or walking in place.
Check out the Arthritis Foundation's step-by-step exercise video featuring strengthening and stretching moves.
Next: Plan for Success
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