Exercise better than relying on painkillers to improve quality of life long term, says guidance.
NHS guidance says people who are overweight should be told their pain can be reduced if they become active and shed the pounds. Aerobic exercise such as walking, as well as strength training, can ease symptoms and improve quality of life. Exercise programs may initially make the pain worse, but this will eventually settle down, the guidance suggests.
New evidence has shown there is little or no benefit to using painkillers. Quality of life, pain/psychological distress, and (particularly in the case of strong opioids) there was evidence that they can cause harm in the longer term - including addiction.
The guidelines say people should be offered tailored exercise programs (ie: The Fitness Doctor), with the explanation that “doing regular and consistent exercise, even though this may initially cause discomfort, will be beneficial for their joints”.
Exercising in the long-term also increases other health benefits. When it comes to weight loss any amount of weight loss is likely to be beneficial.
Dr Paul Chrisp, director for the center for guidelines said: “Osteoarthritis can cause discomfort and prevent people from undertaking some of their normal daily activities.“ However, there is evidence which shows muscle-strengthening and aerobic exercise can have an impact on not just managing the condition, but also providing people with an improved quality of life.
Beginning a fitness journey can be uncomfortable for some people at first, and they should be supported and provided with enough information to help them to manage their condition over a long period of time.
In the United States, 24% of all adults, or 58.5 million people, have arthritis. It is a leading cause of work disability, with annual costs for medical care and lost earnings of $303.5 billion. The most common form of arthritis is osteoarthritis. Other forms include gout, rheumatoid arthritis, and lupus.. The most affected areas are the knees, hips and small hand joints. (CDC.gov)
Over the years, I have personally witnessed the benefits that people with osteoarthritis can achieve by engaging in physical activity. Exercise can drastically improve a person’s mobility and help manage their pain.
Unfortunately, many healthcare professionals are reluctant to recommend physical activity to their patients.
Exercise is medicine - The knowledge gap
Research has shown that exercising regularly has enormous benefits for the prevention and treatment of a wide range of chronic conditions.
It’s been estimated that people who manage 150 minutes of moderate to vigorous activity per week cut their risk of major chronic disease by 25–50%. In fact, for the prevention of diabetes, treatment for heart failure, secondary prevention of coronary heart disease and stroke rehabilitation, exercise has been shown to be just as effective as conventional drug therapies at keeping patients alive and well.
Given the added advantages of exercise over drugs or surgery in terms of side effects or adverse events, the big question is why doctors don’t prescribe it more often?. This evidence–practice gap is the subject of a new perspective published in the Medical Journal of Australia, authored by three researchers from the University of Queensland.
They identify two key barriers to prescribing exercise. One is a lack of training at undergraduate level, and the other, perhaps surprisingly, is the level of physical activity of the doctors themselves.
“We know that many medical students and doctors don’t meet the guidelines for minimum physical activity. And we also know that the best advocates for exercise are people who believe it’s important in their own lives,” explains lead author, Dr Anita Green.
“It’s consistently been shown that the more active a clinician is, the more likely they are to think about exercise, to bring it up with the patient, and help the patient become more active. There were extraordinarily high rates of smoking up until the mid-1960s, but now it is well under 20% of the population. That’s an area where physicians have done extremely well, but prescribing exercise is a bit more nuanced. It’s hard to do in a brief consultation, and we need to be educating undergraduates and postgraduates so they feel confident in doing this.”
Furthermore, there is a lack of awareness of the evidence for the benefits of exercise. It’s not something that the medical schools teach. Then there’s the problem of knowing what to actually prescribe!
Just like you wouldn’t write a prescription for a drug without saying which one, you can’t just write a prescription for exercise. You have to tailor it to a condition. It has to be the right kind of exercise for the right amount of time. This knowledge-practice gap is reinforced because exercise doesn’t have well funded bodies advocating for it. There are no Medicare Benefits Schedule or pharmaceutical reimbursements for prescribing exercise... but the research doesn't lie.
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