Exercise as First-Line Care and Educating the Patient

The 2014 OARSI guidelines list land-based exercise, strength training, water-based exercise, weight management, self-management and education as core treatments for everyone with knee osteoarthritis. More than 50 randomized trials support exercise, yet a 2015 review found only 36% of patients received appropriate non-drug care. Aquatic exercise, tai chi, walking programs, cycling, land-based exercise and strength training all show benefit, with no clear winner. Anthony's message is to move more and sit less, choosing activities the patient enjoys and can progress. Education is as important as the exercise itself, because without it patients will not exercise. It should explain the condition, address fear avoidance, cover diet and weight, reassure that pain does not equal tissue damage, and set realistic timelines, since programs in studies ran 8 to 12 weeks or longer. Mild, tolerable pain is acceptable if it settles within 24 hours. A simple drawing of minimum and maximum load lines shows patients how to dose activity so the knee adapts.