Exercise, Pain Relief, and Mobility in Osteoarthritis Patients

Introduction and Research Objectives

Most experts would likely agree with the general statement that individuals who exercise, or who implement an exercise regime, are much more likely to lose weight and alleviate pain experienced from a variety of diseases and conditions. Much of the current literature provides evidence for this hypothesis. This specific study, however, seeks to do more than simply ascertain results from such a general question. This study seeks to determine whether initiating an exercise regime for patients experiencing osteoarthritis can lower their level of pain and increase their mobility through adherence to that regime.

This study takes a two-pronged approach. The first is to determine whether patients suffering from osteoarthritis can lower the level and incidence of pain by implementing a basic exercise regime — and if so, by how much. The second approach examines patient mobility and asks whether mobility increases with a certain amount of exercise. It is hypothesized that, overall, patients in the study will find relief from pain through exercise as well as increased mobility.

A recent study determined that "quality of life is generally considered the state of physical, mental and social well-being" (Barile, Reeve, Smith, Zack, Mitchell, Kobau, Cella, Luncheon, & Thompson, 2013, p. 1202). In other words, most people desire to be physically healthy, mentally alert, and socially engaged. More specifically, as the Barile et al. study determined, "health-related quality of life is measured by the aspects of overall quality of life that can be clearly shown to affect physical and mental health" (Barile et al., p. 1202).

Obesity, Quality of Life, and Osteoarthritis

Current literature contains a myriad of studies concerning quality of life as it relates to individuals experiencing osteoarthritis, including studies on exercise, weight loss, and mobility. One study determined that between the years 2002 and 2010, "there was no change in the proportion of adults with doctor-diagnosed arthritis who had ever taken a self-management education class (approximately 11%) or who had been counseled to engage in physical activity (approximately 52%)" (Do, Hootman, Helmick, & Brady, 2011, p. 136). What is interesting about the Do et al. study is not that there was relatively little change in either approach, but that 52% of patients had already been counseled to engage in physical activity. Ironically, the study concerned arthritic patients who were obese or overweight, yet physicians who diagnosed these patients recommended losing weight as an approach to alleviating pain and suffering only 41% of the time. Comparing the 41% of doctors who recommended weight loss to the 52% who recommended physical activity suggests that incorporating physical activity into patients' lives may be prioritized over weight loss alone. Another interpretation, of course, is that weight loss is a natural result of a regular exercise regime, particularly for individuals who are overweight or obese. Other studies have echoed this sentiment; a 2007 study found that arthritis development and progression are affected by obesity and that "weight loss can provide symptomatic benefit for adults with arthritis" (Fontaine, Haaz, & Bartlett, 2007, p. 12).

That obesity and arthritis are ongoing concerns in the health community is well established. A 2003 study noted that "obesity has reached epidemic proportions in the United States" (McInnis, Franklin, & Rippe, 2003, p. 1249). While that characterization may appear strong, it is undeniable that many Americans need to reduce caloric intake and increase physical activity. A particular challenge for arthritic individuals is that exercising — especially at the beginning of a regime — may cause pain. That prospect likely dampens enthusiasm, leading many to procrastinate; and while procrastinating, they may gain weight, which compounds problems such as obesity.

According to McInnis et al., such problems make vulnerable "more than 97 million Americans to a host of chronic diseases and conditions" (p. 13). The same study reports that of those 97 million individuals, "approximately 300,000 deaths each year are attributed to a combination of dietary factors and physical inactivity" (p. 13). Physical activity is therefore a key factor in the health of Americans, and it should be relatively straightforward for physicians and other medical professionals to incorporate physical activity guidance into the information and recommendations they provide to patients. This point is especially relevant because obesity is one of the major factors affecting osteoarthritis.

One study states plainly: "Excess weight is the major risk factor associated with various diseases, such as type 2 diabetes mellitus, hypertension, dyslipidemia and osteometabolic diseases, including osteoporosis and osteoarthritis" (Sartori-Cintra, Aikawa, & Cintra, 2014). Even more significantly, the same study notes that "osteoarthritis is the most prevalent rheumatic disease and the leading cause of physical disability and reduced quality of life of the population over 65 years" (Sartori-Cintra et al., 2014). What the proposed study seeks to determine is whether physical activity can benefit these individuals by reducing pain, improving quality of life, and increasing mobility. As the current literature demonstrates, achieving that goal would help a great many people in the United States and around the world.

Current literature establishes strong links between obesity and poor health outcomes. Given the strength of these links, it follows that physicians and medical professionals who actively address excess weight are doing their patients a significant service. Just how significant is a question this study will help answer.

Physical Activity Recommendations and Public Health Data

Based on the discussions above concerning obesity and health, it is generally assumed that losing weight through exercise is beneficial to most obese and overweight individuals. A link has also been established between obesity and osteoarthritis. A recent study determined that "the frequency of knee osteoarthritis continues to accelerate, likely because of the increasing proliferation of obesity" (Sowers & Karvonen-Guiterrez, 2010, p. 533). Addressing obesity, therefore, is likely to benefit osteoarthritic patients in the long term — at least that is what the current literature leads researchers to believe.

It has also been established that evidence-based practices assist medical professionals in how they diagnose and treat patients. A 2010 study found that "evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values" (Stillwell, Fineout-Overholt, Melnyk, & Williamson, 2010, p. 58). Additional studies have shown that several groups develop additional health problems if they do not exercise, do not monitor their weight, and do not consistently adopt healthy practices.

One study found that "epidemiological patterns suggest that risk for overweight in the U.S. varies across social, economic, and racial/ethnic groups" (Cushing & Steele, 2014). The same study noted that "individuals with lower household incomes, those from rural communities, and those who are African-American or Latino are at risk for obesity and overweight problems" (Cushing & Steele, 2014). All of this data presents further opportunities for the study proposed here.

Conclusion and Implications for Future Research

It is hoped that results from the proposed study either confirm or deny the benefits of using exercise as a component to address osteoarthritis in a variety of body areas. The study wishes to determine that exercise will lower the pain of the patient, and at the same time increase the mobility of the patient in regards to overcoming the debilitating effects of osteoarthritis. It is also hoped that the results will influence future studies and clinical practices in the field of osteoarthritis management.

If patients suffering from this disease are offered a method for reducing their incidences of pain, the study will have achieved its desired effect. According to many of the studies discussed herein — as well as many not included — exercise appears to be one means of countering the debilitating effects of osteoarthritis. It is hoped that this study confirms or challenges current literature but, at the very least, contributes to it in a meaningful way.