Osteoarthritis (OA)

Osteoarthritis (OA) is a degenerative joint condition in which cartilage on weight-bearing joint surfaces deteriorates, the bone beneath it changes, and new bone grows at the joint margins.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 603.} The new bone, often forming spurs called osteophytes, can impair joint function and cause pain and limited range of motion.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 603.} The NSCA reports OA in 15% of adult women and 11% of adult men, and in some form in most people 55 and older.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 603.}

Fear that weight-bearing exercise will worsen the joints is a major barrier to exercise for clients with arthritis.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 735.} ACSM advises reassurance that exercise is safe and widely reported to reduce pain, fatigue and inflammation.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 735.}

In practice

• Low-resistance, high-repetition work limits loading of joint surfaces.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 603.} Loads as low as 30% of one-rep max can produce substantial strength and size gains when sets are performed with high effort.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 603.}
• Aquatic exercise reduces joint loading; biking, the elliptical and swimming provide cardio with limited weight bearing.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 603.}
• Hot, swollen, painful joints signal acute inflammation, during which ACSM contraindicates high-intensity exercise testing.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 734.} Avoid strenuous work during a flare, though gentle full-range movement and light activity are appropriate.^{4Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 738.}
• Mild discomfort after unfamiliar exercise doesn’t necessarily mean joint damage.^{4Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 738.} If an exercise aggravates joint pain, substitute one that works the same muscles.^{4Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 738.}

What about high-impact exercise?

The NSCA favors cardio with limited weight bearing to protect joint surfaces.^{1Schoenfeld and Snarr (eds.), NSCA’s Essentials of Personal Training, 3rd ed., p. 603.} ACSM finds no clear evidence for discouraging high-impact activity such as running in clients with arthritis unless they have obvious biomechanical or joint-stability problems.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 735.} It also notes that personal preferences for exercise mode and intensity affect adherence.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 735.}