Exercise should be considered as a core treatment for those suffering from arthritis caused by wear and tear.

Draft guidelines, published for the UK’s National Health Service (NHS) by the National Institute for Health and Care Excellence (NICE), state that physical activity can ease pain and help individuals with osteoarthritis stay healthy.

The guidance recommends offering tailored therapeutic exercise to all people with osteoarthritis, specifically identifying local muscle strengthening and general aerobic fitness exercises as being particularly effective.

Reasons for success
A key to the success of physical activity was not only getting people – and joints – moving, but also the positive effect that exercise can have on arthritis sufferers who are overweight.

According to NICE, evidence generally shows that, for people with knee osteoarthritis, as weight loss increases, the benefits in terms of quality of life, pain reduction and physical function increase.

NICE says people who are overweight should be advised that weight loss will improve their quality of life and physical function while also reducing pain. Healthcare professionals are advised to support them to choose a weight loss goal, explain that any amount of weight loss is likely to be beneficial, but that losing 10 per cent of their body weight is likely to be better than losing 5 per cent.

In its guidance to NHS healthcare workers and practitioners, NICE recommends that any prescribing of exercise should be accompanied by an explanation that physical activity might be painful at first – but that “it’s worth it”.

Managing expectations of pain
The guidance states: “Advise people with osteoarthritis that joint pain may increase when they start therapeutic exercise.

“Explain that doing regular and consistent exercise, even though this may initially cause discomfort, will be beneficial for their joints – and that long-term adherence to exercise increases its benefits.”

Exercise is favoured over the use of steroid injections, paracetamol and glucosamine, which are actively discouraged.