1. Running head: EXERCISE AS TREATMENT FOR OSTEOARTHRITIS REVIEW OA 1
Exercise as Treatment for Osteoarthritis (OA) Review
Julia Poynter
Florida Gulf Coast University
Submitted to:
Dr. Czech
IHS 4504 Research Methods in Health Care
October 14, 2015

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Abstract
The most common form of arthritis is osteoarthritis (OA) which currently affects more
than 27 million adults in the United States (Lawrence et al., 2008). According to the Center for
Disease Control (2014), the primary cause of this disease is still unknown; however, prolonged
joint trauma has been known to cause OA later in life. In addition, metabolic factors and genetics
may be other factors that may contribute to the onset of OA (Stevens- Lapsley & Kohrt, 2010).
This review will be focused on the identification of early onset OA, preventative methods, the
benefits of exercise as an effective treatment, and what barriers may prevent the patient from
completing treatment. There is currently no cure for OA; however, in the research that has been
conducted in the area of exercise, regular exercise for the early detection and treatment of OA
has proved to have positive results with symptom management and improve the overall quality
of life for the patients. More research and an improved model of treatment would be beneficial
for the patient and also for the healthcare worker to determine impending factors hindering the
patient’s progress and how to prevent the early onset of OA.
Keywords: hands, osteoarthritis, exercises, arthritis

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Exercise as Treatment for Osteoarthritis (OA) Review
The most common form of arthritis in the United States is osteoarthritis (OA) with
symptoms progressing over time (Lawrence et al., 2008). A patient with OA may have persistent
joint pain, difficulty with gripping, crepitus, or a mild form of synovitis with symptoms typically
peaking after periods of inactivity (Walker, 2011). As these symptoms may be present in any
synovial joint of the human body, it often affects the patient’s quality of life as they would find
difficulty with completing daily living tasks, driving, and leisure activities. No cure for OA has
been found; however, with early detection, supportive treatment and symptom management
therapies with an exercise element has been proven to benefit patients (Hennig et all., 2014).
Current treatment options are often pharmaceutical or may include thermal treatments which
provide a temporary relief to the pain caused by OA. In severe cases, surgical intervention may
be necessary as the bone forms osteophytes which cause painful bone crystal formations in the
degrading cartilage of the affected joint (Walker, 2011). With these being a temporary relief of
pain, a long-term treatment plan is necessary for managing this disease.
Prevention of Osteoarthritis
Identification of predisposing factors can help prevent the onset or progression of OA:
factors including genetic predisposition, joint malalignment, ligament laxity, excess stress and
trauma, and metabolic factors in women have been identified as causations for OA. Many
studies have observed the metabolic risks of developing OA but there continues to be conflicting
evidence of the mechanical onset of OA (Cotofana et al., 2010). In addition, radiological testing
can predict the onset of OA before the patient becomes symptomatic (Walker, 2011).
Most, if not all, studies agree that women have a much higher prevalence rate of OA,
especially after menopause, than men which is another important factor in identifying potential

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OA prevalence in patients (Stukstette et al., 2012) (Walker, 2011) (Stevens-Lapsley & Kohrt,
2010). In addition, Stevens-Lapsley (2010) notes that women tend to report having increased
severity of symptoms with stiffness and pain compared to men.
Joint malalignment and ligament laxity has been identified as another factor that may
cause osteoarthritis as the reduced surface area of the joint causes uneven friction (O’Brien &
Giveans, 2013)(Cotofana et al., 2010)(Stevens-Lapsley & Kohrt, 2010). Ligament laxity by 1-
2mm can cause significant damage to the joint (O’Brien & Giveans, 2013). These factors can be
tested using magnetic resonance imaging (MRI) evaluations to measure the density of cartilage,
to identify which ligament is too loose, and to identify the point of most impact and friction
within the synovial joint. Cotofana et al. (2010) notes that in healthy joints, regular load bearing
mechanical stimulation has been known to increase cartilage thickness as the joints adapts to the
increased stress.
Benefits of an Exercise Regimen for Hand Osteoarthritis
By definition, it would be thought that patients with OA should reduce movement in their
joints since the disease is due to the destruction of hyaline cartilage in the synovial joints.
However, there are benefits of maintaining a regular exercise regimen, specifically of the hands,
that can reduce the symptoms of OA. In longitudinal, randomized studies that compared two
groups of women with OA, with one group performing hand exercises and the control group not
doing any exercises, the experimental group showed improved grip strength (Hennig et al.,
2014)( Stukstette et al., 2012).
With emphasis on joint stability rehabilitation during an exercise regimen as a
preventative measure, patients can reduce the likelihood for the mechanical onset of OA due to
an untreated loose or injured ligament. If an exercise program focused on dynamic stability of
the affected ligament within the joint, then the patient would expect to be able to perform

5. EXERCISE AS TREATMENT FOR OSTEOARTHRITIS REVIEW OA 5
physically demanding tasks without much pain or uncoordinated joint movement (O’Brian &
Giveans, 2013). The movement of the synovial joints during weight bearing activity enhances
the chondrocyte activity, thus, increasing flexibility and metabolic activity of the chondrocytes in
the fluid matrix of cartilage (Cotofana et al., 2010). In addition, the increased muscle strength of
the hand in the surrounding joint is also a contributing factor to increased thumb web space
(O’Brian & Giveans, 2013).
Barriers to Exercising With OA
Motivational barriers provide one of the largest barriers for patients receiving treatment
for osteoarthritis. In addition, there are two other barriers that patients face: environmental and
physical (Petursdottir, Arnadottir, & Halldorsdottir, 2010). Environmental aspects hindering the
ease of progression in a treatment plan include factors that are external to the patient whereas
physical barriers pertain to difficulties that the patient experiences as a result of health,
behavioral, or cognitive function (Petursdottir et al., 2010). Environmental barriers are often
factors that are outside of the patient’s control, but they can be prevented with awareness and
alternative plans should these factors arise. Physical barriers are caused by the physiological
symptoms affecting a patient’s ability to do an activity or to participate in exercise routines.
Though it is understood that these barriers do cause issues with implementation and compliance
with an exercise program, this crucial part a method of best practice is often overlooked.
Pain is the leading physical barrier that patients face. Walker (2011) noted that due to the
localized dull aching sensation that patients often experience from symptomatic OA, patients are
typically apprehensive about excess movement as this worsens symptoms. Because of the pain
experienced by OA, patients are often sedentary which makes surrounding muscle strength weak
(Walker, 2011). The strength of the patient needs to be taken into account and fully analyzed

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before proceeding with exercise plans to prevent further injury. Walker also notes that a way to
combat this is by alternating periods of inactivity with regular exercises.
Motivation is one of the leading barriers that hinder the success of patients in which the
motivation to comply and implement exercise routines depends on past experiences with exercise
results (Petursdottir et al, 2010). Patients with positive exercise outcomes in the past are more
likely to view future exercise treatments as a possibility. One of the reasons this is an issue is
because the patient lacks “goal ownership” and may not be improving in an area that they wish
to improve upon. However, there are ways to combat this issue. Walker (2011) suggests that the
patients maintain a more independent life style by learning how to self-manage their own health
goals and treatment. By establishing what areas the patient wants to improve in as opposed to
the therapist determining their goals for them, the patient is more likely to comply with the
treatment. A quasi-experiment allowed the experimental group to create their own goals and the
researchers measured how satisfied the patient was to comply with their goal by allowing the
experimental group to create and document their own goals versus a control group who’s goals
were set by the therapist (VanPuymbrouck, 2014). Improvement in overall quality of life (QOL)
is a goal sought out by patients. However, if the level of progress that they achieve through
therapy does not match the QOL that they expected by a particular time then this may discourage
the patient and could pose a motivational barrier issues. VanPuymbrouck (2014) concluded that
with the desire to complete a therapy program that was generated by the patient’s personal
aspirations, not only did it enhance the client- patient relationship, but it also helped the patient
comply with the therapy process.

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Summary
Osteoarthritis is a very common and treatable disease. It is imperative to understand the
effects of treatment and how best to implement it for the best treatment option of the patient.
Though the onset of symptomatic OA is not considered a high mortality risk to patients, the best
possible management of this often debilitating disease can provide the patient with greater
mobility, and may help the patient become less dependent on pharmaceutical treatments, thus,
assisting the patient to achieving a better quality of life. The compliance with an evidence-based
practice by the healthcare worker to gain a dynamic insight of the patient’s personal goals and
best treatment plan should be an addition to current or future health care professional practice
objectives. It would be beneficial to conduct an MRI to determine if any cartilage has been
strengthened or restored due to the implementation of a hand exercise therapy program. In
addition, research of the specific sex-related factors that predispose woman for having OA at a
much higher rate than men should be researched further. An ideal study should be a longitudinal
clinical trial or quasi- experiment with a strong barrier-reducing element involved and pre- and
post-testing for cartilage thickness. The patients would be periodically assessed for any cartilage
growth, increased grip strength, finger mobility, and an overall improved QOL survey
throughout the duration of the study. By understanding how to implement recommended
treatment regimens and how to combat inevitable barriers during treatment, the patient may have
a better treatment outcome.

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