Exercise is effective for older people with knee pain, new study shows
Reproduced from Issue 139 of Arthritis Today
The second part part of our special feature highlighting three important new studies for osteoarthritis (see right-hand column for other two features in series).
Exercise, self-management and active coping strategies are effective in relieving knee pain in older adults, a new arc study has shown.
Results of the ESCAPE-knee pain (Enabling Self-management and Coping with Arthritic Knee Pain through Exercise) trial published in Arthritis Care and Research showed that, compared to the usual GP care, six weeks of simple exercises produced meaningful improvements in function for up to six months for the typical patient suffering with knee pain.
There were also improvements in pain, general quality of life, anxiety and depression in the five-year arc-funded study.
Principal investigator of ESCAPE-knee pain, Mike Hurley, Professor of Physiotherapy at King’s College, London, said: “From these results a vast and increasing number of people may not have to continue to suffer a very debilitating condition that is largely dismissed as the inevitable, untreatable consequence of old age. People do not have to suffer it and put up with it, they can learn to live with it, and help themselves.”
A total of 418 people aged over 50 who had knee pain for more than six months were recruited from 54 inner city GP practices in south London. They were randomised into different groups to compare the effectiveness of a rehabilitation programme offering exercise, self-management and active coping strategies compared to “usual GP care.”
Mike Hurley
Those in the exercise group took part in 12 weekly half-hour sessions individually or in groups. Exercises aimed to build up the quadriceps muscle which supports the knee and improves strength, endurance, flexibility, balance, coordination and cardiovascular fitness, using an exercise bike and wobble boards.
Those who took part in the exercise arms of the trial had better functioning for up to six months after completing the programme compared to those in the usual care group.
Professor Hurley commented: “The people taking part in ESCAPE were unusual in that they were the typical person who knocks on their GPs surgery door looking for help; participants were socio-economically and ethnically mixed and we had no upper age limit. They also often had co-morbidities such as diabetes and heart problems; again these problems are often screened out in other trials.”
As the prevalence of chronic ill health increased, so did the need for safe, effective, low tech affordable interventions promoting self-management that could be delivered to large numbers of individuals.
“The study also evaluated the costs of the intervention, which were shown to be relatively small and more cost-effective than usual care, so decision-makers can see that they can easily afford it,” said Professor Hurley.
The results of the study are being used to support the forthcoming NICE guidelines for the management of osteoarthritis.
Case study
Mary immediately started to notice the difference
Mary Watts, a retired vicar from south London, has never looked back since taking part in Professor Hurley’s exercise trial at King’s College, London.
She enjoyed the experience so much that she persuaded her husband to join too, set up an exercise class in her church hall, and made sure her local GP surgery started recruiting patients.
Mary, now 76, was still taking church services and helping in the church as a volunteer when she saw an article in her local paper about the exercise trial. “It was very cold in the church and I always felt cold, and I had really sore knees so I got in touch with Mike Hurley,” she says.
Mary Watts
“I can’t tell you the benefit I got from the exercise sessions. I did the individual sessions - a couple of warm up exercises and then a go on the bike. There were a variety of exercises: resistance work with an elastic band, wobble board, strengthening, up and down steps, twice a week for six weeks.”
Mary says she immediately started to notice the difference, and didn’t feel any pain in her knees for about six months. “I carried on doing the exercises after the trial ended – I’d go up and down stairs, taking the grandchildren to school and do as much walking as possible. When I get up I flex my knees before I start the day; I’ve developed some good habits and I’m always on the move. I haven’t felt pain in my knees for ages. When it’s bad I force myself to have a little walk, maybe have one paracetamol and I take glucosamine as well.
“I used to run a pop-in club for elderly people every Thursday in the church hall and the physio from King’s, Nicky Walsh, came along and gave talks and got them all doing things and talking about the benefits of exercise,” she adds.
“They assumed that if you have a bad knee the more you exercise the worse it was going to be, so she explained to them how it’s all about the importance of the quadriceps muscles being strong. The reason why people don’t walk about and do much is because the quad muscles are weak.”
Mary and husband John now live in retirement apartments in Bromley, and she still does her best to spread the word about the wonders of exercise to other residents. “They think I’m a bit potty, but some of the ladies who live near me are housebound and I’m sure they’d benefit from exercise. Exercises give me the confidence to move about – that’s the main thing. The trial has been wonderful for me. It has changed my life."
