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Title: Patients With Knee Osteoarthritis Must Exercise Despite Pain

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Arthritis & Rheumatism, July 2002; Vol. 46:7; pp. 1784-1788.
07/08/2002 08:02:00 AM
By Harvey McConnell

Clinicians need to combat the self-defeating action of many patients with osteoarthritis of the knee who limit their activity in order to avoid pain. A study among older Dutch patients shows that, despite the discomforts, maintenance of muscle strength plays a pivotal role in helping them cope with their disability. Dr Martin Steultjens. and colleagues at the Netherlands Institute of Health Services Research Center in Utrecht, said their study confirms the link between lack of activity and progressive physical deterioration in patients with osteoarthritis (OA) of the knee. They think their findings make a powerful case for the importance of routine exercise to sustain the muscle strength and mobility for all people with OA. Most of the patients tended to avoid physical activity because of a fear of, or an actual increase, in pain. This reduces pain in the short-term, but their physical condition deteriorates, with muscle weakness leading to joint weakness and reduction of ability to carry a load. Their condition comes full circle with increased disability leading to more avoidance. The researchers carried out their study among 107 patients, mean age 68.7, who had had osteoarthritis symptoms in the knee for at least 12 months. Muscle strength and level of disability was assessed with a series of physical exercises. Patients questioned about any avoidance behavior. from taking more frequent sitting breaks to ceasing activities altogether. Analysis found a clear connection between avoidance of activity and reduced muscle strength, as well as between reduced muscle strength and increased disability. Overall, avoidance of activity accounted for 21.5 percent variance in disability. After muscle strength was taken into account, the variance in disability accounted for by avoidance of activity was reduced from to 15.7 percent. The researchers said muscle strength could not completely account for the effect of avoidance of activity on disability. It is possible that inactive patients think they are less capable, which is demonstrated by not being able to carry out some normal everyday tasks, even though there are no clear physical reasons for this inability to do so.

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