Anatomy of osteoarthritis and why exercise is so important
Osteoarthritis is characterised by the breakdown of cartilage from natural or injury-induced wear and tear. As we age, the cartilage tissue that cushions our joints and enables smooth movement slowly degrades, becoming thinner and rougher. In later stages, osteoarthritis causes bone-on-bone contact, leading to a lot of pain. Even in the early stages, you may experience aches, changes in mobility, and stiffness.
OA can also develop after injury, in which case it’s referred to as post-traumatic arthritis. If the injury causes changes to the natural movement of your joint (for example, through muscle stiffness), this can make cartilage degrade faster.
While many with the condition may be inclined not to move their painful joints and keep weight off them, exercise is actually an essential intervention. It improves muscle strength, reduces stiffness, and even stops extracellular matrix (ECM) degradation, allowing for better tissue growth. On top of that, cartilage is avascular - meaning it doesn’t get its nutrients from blood circulation. Instead, cartilage is supplied by synovial fluid, which lubricates the joints during movement.
However, the benefits of exercise very heavily depend on your condition and the type of exercise you do. So, let’s get into some of the best physical activities for osteoarthritis and what you can do to make them easier on your joints.
The best exercises for OA
Clinical research suggests 30-60 minutes of low-impact, moderate-intensity activity at least 3 times a week, preferably every day. The best ones include but aren’t necessarily limited to:
Swimming
Swimming is an excellent aerobic activity for arthritis. It loosens and stretches the muscles while strengthening them. Since the buoyancy created by water removes impact stress, swimming is especially good if you have osteoarthritis in the knee or ankle, where common moderate-intensity activities like hiking and walking can cause discomfort.
The one downside of swimming is that it can be a very seasonal activity. If you don’t like swimming in frigid waters and don’t have access to an indoor pool, you’ll need to supplement with other activities in this list.
Brisk walking/hiking
Walking and hiking can be done at pretty much any time of the year, though summer heat can make them unpleasant. They are great activities for toning the legs, boosting circulation to relieve stiffness, and getting nutrients into knee cartilage.
Weight training
Working out using dumbbells, resistance bands, or even your own body weight will help build up muscle so it can more effectively support your joints.
The key things to consider are starting with low resistance and rep count to acclimate yourself. You should also keep an eye on your pain levels and how they and muscle stiffness may affect your form. Poor form may not only affect your gains but also exacerbate pain and even lead to tissue damage.
Cycling
Cycling is another great low-impact aerobic option, especially for those with lower body OA. While certain joint changes and pain levels may make the activity uncomfortable, cycling is highly adjustable according to your needs. Granny gears, recumbent bikes, flatter routes or even a stationary bike can take the edge off and keep you active.
Yoga, Pilates, Tai Chi
These activities focus heavily on movement and balance, making them excellent options for working on impacted proprioception. They’ll also help you improve muscle strength and flexibility. Some research also shows that participants with knee osteoarthritis experienced less pain after their sessions - though further research with stricter protocols is needed.
How to make exercising with arthritis more comfortable
Warm up
Taking 5-10 minutes to stretch and walk around will help prepare your body for physical activity. Warming up is crucial for more physically demanding activities like weightlifting and hiking.
Wear a brace!
Braces can be an excellent addition to your exercise routine. Whether your osteoarthritis is mild or severe or in the wrist or ankle, we’ve got you covered.
Grade 1-2- early to mild OA
EpiTrain
For milder OA cases, we generally recommend compression supports like the EpiTrain, ManuTrain, and GenuTrain A3. These do not restrict movement. Instead, they use a combination of compression knit and gel padding to stimulate the muscles, boost circulation, and relieve pain.
Compression supports are also great for improving joint mechanics and proprioception, which can be negatively affected by pain and degenerative changes.
Grade 3
If your arthritis progresses into stage 3, you will likely experience worsening symptoms. X-rays and MRI scans typically show a narrowed joint space and less cartilage. In such cases, semi-rigid or rigid supports are best.
For unilateral (one-sided) knee arthritis, the GenuTrain OA or SecuTec OA are best. They have unique mechanisms that offload pressure from the damaged side of the knee. The external support they offer will also make moving and exercising easier as the knee needs to support less weight.
For other areas like the wrists and ankles, Braces like the ManuLoc and MalleoLoc support the joint while limiting damaging movements.
GenuTrain OA
Grade 4
Unfortunately, conservative interventions like bracing and exercise may no longer be effective at this stage. Stage 4 OA is characterised by little to no remaining cartilage, limited synovial fluid to serve as lubricant, and large bone spurs that make moving very difficult. Surgery is often the only option to reduce pain and improve quality of life. Speak to your clinician about your options.
Do some conditioning
If your arthritis has progressed, you are just starting out, or you feel worsening pain during any of the above activities, you may need to do some preparation. Gentle exercises like the single-leg balance, mini-squats, banded shoulder abductions, and weighted wrist extensions will help improve strength and mobility and prepare your arthritic joint for other types of physical activity.
Note: While such exercises are a good starting point (depending on the severity and location of your arthritis), it’s best to speak to your clinician for a tailored plan. They can recommend exercises specific to your case and any modifications, additions, or substitutions to ensure comfort and maximum effectiveness.
Start low and go slow
30-60 minutes 5-7 days a week is a good goal to work toward, but it may be best to start with fewer minutes or fewer days. Even activities deemed ‘safe’ for osteoarthritis can be hard on underworked and underprepared joints. With walking, cycling, and swimming, you can try a leisurely pace for the first few days and see how you progress. With yoga, tai chi, and pilates, let your instructor know about your condition so they can help you make some modifications. Lastly, for weight training, start with just your body weight or very light resistance. Focus on your form first.
To sum up
Exercise is an essential step to slow osteoarthritis progression and can improve symptoms of stiffness and pain. When exercising, make sure to opt for low-impact options that work to improve flexibility, strength, and cardiovascular fitness. To avoid unnecessary discomfort, start slow, wear a brace, warm up, and keep your physio up to date on your fitness routine and pain levels.
