Exercise as a treatment for osteoarthritis

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Abstract
This review highlights recent important research, future directions, and clinical applications for exercise and osteoarthritis. It focuses on knee osteoarthritis because of its prevalence and the dearth of research involving other joint osteoarthritis. The review covers exercise prescription for symptomatic relief, and its potential role in reducing development and slowing progression of osteoarthritis. Meta-analyses support recommendations that exercise is important in osteoarthritis management. Benefits appear to be additive when exercise is delivered with other interventions such as weight loss. Mode of exercise delivery has cost implications and may influence overall outcome. It appears that supervised exercise sessions are superior to home exercises for pain reduction. The challenge remains to increase the proportion of patients exercising. Areas of emerging interest are exercise to prevent disease or slow its progression and recognition of patient subgroups that may respond differently to treatment. Based on studies showing a relation between weaker quadriceps strength and increased risk of developing knee osteoarthritis, particularly in women, strength training may be able to prevent knee osteoarthritis. Novel exercise programs that strengthen hip muscles or alter impairments in knee neuromuscular control may also influence disease progression. Future studies must identify cost-effective exercise modes, strategies to maximize exercise compliance and optimal treatment combinations. The role of muscle strength and altered neuromuscular control in the prevention and development of osteoarthritis must be evaluated with the view to devising and testing novel exercise interventions.