Knee Osteoarthritis, Exercise Therapy and How Cartilage Works

Alessio opens with the question his PhD set out to answer, whether exercise wears the joint down. Osteoarthritis is the most common joint disease, affects women in particular, causes pain, disability and lower quality of life, and raises the risk of conditions such as cardiovascular disease, diabetes and depression. The NICE guidelines are used to make two points: pain and structural changes are poorly associated, so management should follow symptoms, and exercise therapy is first-line treatment alongside education and weight loss if needed. Exercise therapy is defined as physical activity designed and prescribed for specific therapeutic goals, first described in the British Medical Journal in 1943, and is set apart from exercise and general physical activity. Articular cartilage covers the bone ends, absorbs shock and lubricates the joint so it moves with low friction. Its key parts are the chondrocytes, aggrecan and collagen. Aggrecan and collagen decline as osteoarthritis progresses, which is part of why loading a thin, worn cartilage has long been seen as harmful.