Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial

EDITOR – Thomas et al 1 provided an overview of the benefits of a
home based exercise programme for sufferers of the common musculoskeletal
conditions, knee pain and knee osteoarthritis. In our experience, the
prudent use of exercise is beneficial for the health and well-being of all
such patients. Additional benefits may be derived when an individualised
prescription of exercise is the platform of treatment and management.

Today, osteoarthritis and other chronic diseases are seen in younger
individuals rather than being limited to older adults. We believe that
this phenomenon is related to overweight and obesity, one of the common
denominators for many individuals who experience knee pain and knee
osteoarthritis. Obesity significantly increases the risk of developing an
ensemble of medical conditions including hypertension, stroke, respiratory
disease, type 2 diabetes, certain cancers, gout, osteoarthritis, and other
musculoskeletal disorders.2-3 Physical inactivity tends to exacerbate
these health problems. The flip-side of this is that regular physical
activity and appropriate exercise is one of the critical elements in the
prevention, treatment and management of these chronic diseases. In support
of this contention, van Mechelen 4 has purported that physical activity is
‘public health’s best buy’.

According to standard BMI cut-offs, subjects in the study by Thomas
et al 1 were overweight. Devoid of other movement limitations (as defined
in the selection criteria for the study), the reported improvements are
not unexpected. What additional benefits might be derived if the graded
introduction to physical activity was followed by an individualised
prescription of exercise?

Despite the recent recognition of the importance of physical activity
and exercise there is still a generally poor understanding of how best to
promote activity and prescribe exercise, particularly in the context of
chronic disease management. To enable a greater number of patients to
benefit from exercise and to maximise the exposure for those who already
‘exercise’, a multi-disciplinary approach is required. As the traditional
gate-keepers of patient care, general practitioners would benefit from an
enhanced knowledge and understanding of the mechanisms of exercise and the
specialist skills of exercise science professionals. Exercise scientists
are best placed to contribute to the functional restoration of patients
with musculoskeletal problems such as knee pain. As such, exercise
scientists should be an important part of the rehabilitation process
working alongside medical practitioners and physiotherapists. While the
findings of Thomas et al 1 are both interesting and encouraging, it is of
interest to speculate on the magnitude of improvement that may have been
possible with an individualised program of exercise.

Andrew P Hills, associate professor.

a.hills@qut.edu.au

Nuala M Byrne, lecturer.

School of Human Movement Studies, Queensland University of Technology,
Victoria Park Road, Kelvin Grove, Qld, Australia, 4059

1. Thomas KS, Muir KR, Doherty M, Jones AC, O’Reilly SC, Bassey EJ.
Home based exercise programme for knee pain and knee osteoarthritis:
randomised controlled trial. BMJ 2002; 325: 752-756.

2. Hills AP, Hennig E, Byrne NM, Steele JR. The biomechanics of
adiposity - structural and functional limitations of obesity and
implications for movement. Obesity Reviews 2002; 3: 35-43.

3. James WPT. A public health approach to the problem of obesity. Int
J Obes 1995; 19 (Suppl 3): S37-S45.

4. Van Mechelen W. A physically active lifestyle – public health’s
best buy? Br J Sports Med 1997; 31(4): 264-265.

Competing interests:  
None declared