If individuals are reluctant to join a class, videos that demonstrate safe exercises to do at home can be rented from local chapters of the Arthritis Foundation. Some individuals may benefit from a referral to a health care provider with expertise in exercise supervision and training.

Physical Therapists and Exercise Scientists with additional training in working with persons with arthritis may play an important role in helping these individuals become more physically active. Physical therapists PTs are optimally trained to develop and evaluate the appropriateness of physical activity programs in persons with arthritis.

PTs can carefully assess joint motion, muscle strength and endurance, and performance of activities of daily living. Education about energy conservation, modification of daily tasks, and joint protection is emphasized.

PTs can also develop an individualized therapeutic exercise program that individuals can perform at home. Frequently, health insurance programs will reimburse, in part, the services of physical therapists.

Recently, a new type of exercise specialist has emerged to bridge the gap for individuals who have completed a program of physical therapy or received clearance from their physician but lack the skills or confidence to continue exercising independently. Clinical Exercise Specialists can play an important role in helping individuals with arthritis become or remain more physically active.

While most exercise specialists have the training and skills to work with apparently healthy individuals, Clinical Exercise Specialists have additional training and experience that enable them to work with persons with arthritis and other chronic medical conditions.

This advanced training is broad in nature and includes an emphasis on exercise physiology, motivation, goal setting, biomechanics, exercise technique and the needs of individuals with chronic medical conditions.

Clinical Exercise Specialists can often be found in hospital-based wellness settings. Many provide services to clients in their own homes to make exercise more convenient and less burdensome.

Currently, several organizations certify exercise scientists who have undertaken additional training and experience working with individuals who have chronic medical conditions.

Two of the best are the American College of Sports Medicine Clinical Track Certifications and the American Council on Exercise Clinical Exercise Specialist. Both organizations maintain lists of individuals who are currently certified in your area.

Health Care Professional Yes No. All information contained within the Johns Hopkins Arthritis Center website is intended for educational purposes only. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site.

Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website. by Susan Bartlett, Ph. ref 1 In the short-term i. Physical Activity Recommendations The goals of an exercise program for individuals with arthritis are to: 1 preserve or restore range of motion and flexibility around affected joints, 2 increase muscle strength and endurance, and 3 increase aerobic conditioning to improve mood and decrease health risks associated with a sedentary lifestyle.

Assessing Readiness to Exercise Psychological readiness to begin exercising is also an important consideration. Water Aerobics Aquatic aerobic training programs that are offered in therapeutic pools have many advantages related to the warmth and buoyancy of the water.

ref 11 Additional evidence of the value of moderate intensity exercise comes from recent investigations that have shown that activity need not be undertaken in a single bout to be beneficial. Exercise Adaptations for People with Arthritis The ACSM has outlined several modifications for exercise for persons with arthritis.

ref 8 Begin slowly and progress gradually. The hallmark of a safe exercise program is gradual progression in exercise intensity, complexity of movements, and duration. Often patients with arthritis have lower levels of fitness due to pain, stiffness or biomechanical abnormalities.

Too much exercise during a flare may result in increased pain, inflammation and damage to the joint. Thus, beginning with a few minutes of activity, and alternating activity with rest should be the initial goals.

Avoid rapid or repetitive movements of affected joints. Special emphasis should be placed on joint protection strategies and avoidance of activities that require rapid repetitions of a movement or those that are highly percussive in nature. Because faster walking speeds increase joint stress, walking speed should be matched to biomechanical status.

Special attention must be paid to joints that are malaligned or unstable. Control of pronation and shock absorption through shoe selection or use of orthotics may be indicated.

Adapt physical activity to the needs of the individual. Affected joints may be unstable and restricted in range of motion by pain, stiffness, swelling, bone changes or fibrosis.

These joints are at higher risk for injury and care must be taken to ensure that appropriate joint protection measures are in place. Getting Started Apparently healthy or non-symptomatic people do not require maximal or diagnostic stress testing for participation in moderate intensity aerobic exercise.

asp Keeping It Going: Exercise Supervision and Training Some individuals may benefit from a referral to a health care provider with expertise in exercise supervision and training. Selected References Andersen RE, Blair SN, Cheskin LJ, Bartlett SJ.

Ann Int Med 5 , Minor MA. Exercise in the treatment of osteoarthritis. Rheum Dis Clin North Am 25 2 , Ytterberg SR, Mahowald ML, Krug HE. Exercise for arthritis. Baillieres Clin Rheumatol 8 , The effect of physician advice on exercise behavior.

Preventive Medicine 22 1 , Preventive Services Task Force. Clinical Guide to Preventive Services. Alexandria, VA. International Medical Publishing, Long BJ, Calfas KJ, Wooten W, Sallis JF, Patrick K, Goldstein M, et al.

A multisite field test of the acceptability of physical activity counseling in primary care: project PACE. Am J Prev Med 12 2 , Department of Health and Human Services. Physical Activity and Health : A Report of the Surgeon General.

Atlanta, GA: U. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, American College of Sports Medicine. Champaign, IL: Human Kinetics, Facebook Instagram Pinterest TikTok Twitter.

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In addition, families and communities are empowered and sensitized, in order to improve their capacity to recognize illnesses, follow up on treatments and refer to appropriate health structure when needed. Kaba-Guichard Neyaga, Representative of UNHCR in Burundi.

The joint planning is currently focusing on health centers in the most affected communes in 10 provinces where more than 10, returnees per province are expected over the year. However, the MoU lays the ground for a second phase including the consolidation of existing programs and an extension to the remaining provinces during All activities are conducted in support to the Government and in partnership with NGOs, which is essential for the success of this project.

Activities to prepare the effective implementation have been launched by the three agencies in accordance with their respective mandate. A complementary funding proposal was presented in the Consolidated Inter-agency Appeal for A part of the activities have been funded by the United Kingdom through its Department for International Development DFID and the European Commission Humanitarian Office ECHO , although increased resources need to be mobilized to ensure the planned activities.

UNICEF Burundi: Sara Johansson, Communication Officer, phone: 22 68 88 mobile: , sjohansson unicef. WHO Burundi: Marc Nkunzimana, phone: 23 17 02, mobile , nkunzimanam usan-bu.

For more information, please contact: UNHCR Burundi: Bernard Ntwari, phone 22 32 45, ntwari unhcr. You can use treats, toys, and praise to reward your dog when they do things you want them to repeat.

For example, when you say Sit and your dog sits, you offer a treat. Reactive behavior in dogs may be a sign of underlying health issues. In fact, lots of these dogs are in pain.

If your dog shows reactive behavior without an apparent trigger, consult a vet to rule out medical causes. Teach your dog Watch Me and Look at Me commands so they redirect their attention and make eye contact with you.

Reactive dogs will feel safe and calm in trigger-free places. For lots of dogs, that means dog parks, popular walking areas, high-traffic trails, and similar places are out. For example, private dog park rentals like Sniffspot are making it easier than ever for parents of these dogs to let their pups run free, play, and practice training.

Desensitizing your dog to triggers can help them get over their reactive behaviors. Start slow and work with people you know and trust.

For example, you could meet a friend with a dog at a quiet park. As you approach, encourage your pup to keep their attention on you and reward them with treats. Training a reactive dog takes a lot of time and patience. Training a reactive dog involves understanding their behavior, using positive reinforcement, and seeking professional help when needed.

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Additionally, autonomic function was measured by heart rate variability HRV measures, which were analyzed in the time and frequency domains. Polyvagal theory, proposed by Porges, suggests that the vagus nerve plays a crucial role in regulating the autonomic nervous system and influencing emotional states, stress responses, and social engagement.

Engaging in activities that stimulate the vagus nerve, such as the exercises described, may promote relaxation, reduce anxiety, and enhance emotional regulation. These outcomes could ultimately contribute to a reduction in perceived pain and an increase in quality of life in patients with knee osteoarthritis 9.

Vagus nerve stimulation has multifaceted mechanisms that could explain its potential benefits for individuals with knee osteoarthritis. It activates the parasympathetic nervous system, increasing vagal tone while reducing sympathetic activity, which might lead to pain reduction and enhanced well-being 9.

Moreover, vagal stimulation exhibits anti-inflammatory effects, regulating immune responses and potentially alleviating arthritic joint inflammation, thus contributing to pain relief Additionally, by influencing central pain mechanisms and neural pathways, VNS can modulate pain perception and processing, thereby potentially enhancing pain relief Finally, vagal stimulation's impact on neuroplasticity could lead to lasting improvements in pain and quality of life for those with knee osteoarthritis 5.

The WOMAC assessment for knee OA is a sensitive tool, well suited for detecting changes in symptoms and function over time or in response to interventions. This evaluation captures the patient's perspective, facilitating a comprehensive assessment of the impact of knee OA on daily life and functioning In the present study, both groups displayed effects as measured by WOMAC subscales; however, the group that performed VNS exercises demonstrated notable improvements in pain, stiffness and functional limitations.

Notably, the results indicated that Group 2 exhibited significantly greater reductions in joint pain, joint stiffness, and functional limitations than Group 1 after 6 weeks.

Group 2 also exhibited significant improvements in the WOMAC index scores, reflecting favorable overall outcomes. In terms of quality of life, Group 2 demonstrated marked enhancements in the psychological and social domains compared to Group 1.

However, there were no significant differences observed in the physical domain or the environmental domain. Muscle and skeletal problems constitute over a quarter of nonlethal health losses, with pain being the most significant contributor Chronic pain related to OA not only restricts social functioning but also heightens the risk of psychological issues 24 , depression 25 and diminished work capabilities The finding of this study underscores the favorable response observed with polyvagal exercises, which predominantly focus on relaxation.

As a nonpharmacological intervention, relaxation is increasingly employed to alleviate pain and enhance pain management Further reinforcement is derived from a study by Onivea-Zefra et al.

Through the utilization of visualizations and mental imagery techniques, this approach promotes relaxation and helps in alleviating pain perception Another study by Morone and Greco reinforces the findings that guided imagery and relaxation offer clinical pain management benefits for individuals with knee OA The reduction in pain, functional limitations and stiffness could also be attributed to the effects of strengthening exercises.

Strength training has been linked to potential disease-modifying impacts in OA. Regular exercise can promote joint health, stimulate cartilage metabolism, and improve muscle strength and joint stability In individuals with osteoarthritis, pain is the most prevalent complaint and a primary contributor to reduced health-related quality of life HRQoL.

In this study, both groups demonstrated significant improvements across various domains of quality of life, including overall quality; general health; and physical, psychological, social, and environmental aspects. Notably, Group 2 exhibited more substantial enhancements in overall quality of life, general health, psychological, social, and environmental domains than Group A, which underwent vagal nerve stimulation-based exercise.

The improvement in the physical domain is attributed to the 6-week exercise regimen, a sentiment that aligns with Smith et al. Various techniques, including deep breathing, meditation, relaxation exercises, and specific physical activities, can stimulate the vagus nerve and enhance its functionality.

These exercises may facilitate relaxation, stress reduction, and overall well-being. Goff et al. Our results are corroborated by Ebenezer et al.

The shared impact of yoga on emotional stability and quality of life, a factor pivotal in pain reduction and enhanced quality of life, is a significant highlight of their research Vagal stimulation, in line with the polyvagal theory, is also emphasized by Wang et al.

By stimulating parasympathetic pathways, yoga reduces perceived pain and improves QoL These outcomes imply that the combination of polyvagal exercises and knee-strengthening training yields a favorable impact on HRV, reflecting improved cardiovascular health.

Interestingly, a positive correlation exists between disability and cardiovascular health in patients with knee OA. This is underscored by Tsubio et al. This underscores the imperative for enhanced autonomic regulation in knee OA patients.

The observed changes in HRV parameters can be attributed to the stimulation of the vagal nerve. This emphasizes the contention of the polyvagal theory that the physiological state is not merely a correlate but a fundamental component of emotions and moods.

Within this theoretical framework, the autonomic state functions as an intermediary variable that influences our perception and evaluation of environmental stimuli. The reflexive assessment of cues as neutral, positive or threatening can vary based on an individual's physiological state.

Goldbeck et al. also emphasized the importance of yoga-based exercises in enhancing HRV parameters, consequently improving parasympathetic activity The study had a few limitations that should be noted.

It had a small sample size, exclusively female participants, and a lack of long-term follow-up. While generalization to the wider population should be approached with caution, the study's findings still contribute to a broader understanding of the potential benefits of the interventions within this specific subset of patients.

The decision to include female participants only was driven by the fact that knee osteoarthritis is more commonly observed in females than in males. Evaluating the sustainability and durability of the benefits conferred by polyvagal exercises in the long term could provide a more comprehensive understanding of their effects and guide clinical recommendations.

Furthermore, there was no control group, and blinding procedures were not implemented. The inability to implement blinding in this study is attributable to the nature of the interventions employed, which made it a practical challenge to blind participants and researchers to the group assignments, as the participants themselves needed to be aware of the specific exercises they were performing.

The study relied on self-reported measures and did not use objective measures. A total reliance on self-reported measures, without the use of objective assessments, introduces the potential for measurement bias due to participants' subjective perceptions and recall biases.

Integrating objective measures such as biomechanical assessments or biomarkers would offer a more comprehensive understanding of the interventions' effects.

The study highlights the potential benefits of combining strengthening exercises with exercises based on polyvagal theory in the management of grade II knee OA. Strengthening exercises can improve joint stability and reduce stress on the joint, while exercises based on polyvagal therapy may help regulate autonomic function, reduce pain perception, and promote relaxation and emotional well-being.

The combination of these interventions may lead to superior overall outcomes and improved quality of life for individuals with knee osteoarthritis. These results support the potential effectiveness of incorporating polyvagal exercise as an adjunctive intervention for osteoarthritis management.

The study opens up several potential avenues for future research. First, conducting a larger-scale study with a more diverse participant pool, including both genders, would help establish the generalizability of the findings. Long-term follow-up assessments could be incorporated to examine the sustainability and durability of the effects observed.

Additionally, incorporating a control group and implementing blinding procedures would enhance the study's internal validity. Objective measures, such as physiological recordings, could be used in conjunction with self-report measures to provide a more comprehensive understanding of the outcomes.

Exploring different stimulation parameters and investigating the mechanisms underlying vagal nerve stimulation could further elucidate its therapeutic potential. Overall, future research should build upon these limitations to strengthen the evidentiary base and better inform clinical applications of VNS.

All data generated or analyzed during this study are presented in the manuscript. Please contact the corresponding author for access to the data from this study. Grazio, S. Obesity: Risk factor and predictor of osteoarthritis. PubMed Google Scholar. Cui, A. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies.

Kaur, R. Prevalence of knee osteoarthritis and its determinants in 30—60 years old women of Gurdaspur, Punjab. Public Health 7 10 , — Article Google Scholar.

Taheri, M. The effect of water therapy and jogging exercises on the health-related factors of physical fitness of elderly women. Sport Stud. Alves, J. Quality of life and functional capacity of elderly women with knee osteoarthritis.

Einstein Sao Paulo. Article PubMed PubMed Central Google Scholar. Arslan D, ÜNAL ÇEVİK I. Interactions between the painful disorders and the autonomic nervous system.

Agri J. Mora, J. Knee osteoarthritis: Pathophysiology and current treatment modalities. Pain Res. Richebé, P. Persistent postsurgical pain: Pathophysiology and preventative pharmacologic considerations. Anesthesiology 3 , — Article PubMed Google Scholar. Porges, S. Farr, J.

et al. Progressive resistance training improves overall physical activity levels in patients with early osteoarthritis of the knee: A randomized controlled trial. Wang, S. Depression in osteoarthritis: Current understanding. Ruffoli, R. The chemical neuroanatomy of vagus nerve stimulation.

Article CAS PubMed Google Scholar. Kumar, H. Epidemiology of knee osteoarthritis using Kellgren and Lawrence scale in Indian population. Trauma 11 , S—S Dunlevy, C.

Procedural considerations for photographic-based joint angle measurements. Salaffi, F. Reliability and validity of the Western Ontario and McMaster Universities WOMAC Osteoarthritis Index in Italian patients with osteoarthritis of the knee. Article CAS Google Scholar. Pollard, B. Exploring differential item functioning in the Western Ontario and McMaster universities osteoarthritis index WOMAC.

BMC Musculoskelet. Snell, D. Evaluating quality of life outcomes following joint replacement: Psychometric evaluation of a short form of the WHOQOL-Bref. Life Res. Christofaro, D. Validation of the Omron HEM blood pressure monitoring device in adolescents. Garg, S. The cardiac comeback-beating stronger: Exploring the remarkable resilience of the heart in COVID recovery through cardiac autonomic analysis.

Medicina 59 8 , Abbott, J. Management of osteoarthritis: A guide to non-surgical intervention. Centre for Musculoskeletal Outcomes Research The polyvagal hypothesis: Common mechanisms mediating autonomic regulation, vocalizations and listening. In Handbook of Behavioral Neuroscience: — Elsevier, Google Scholar.

Bassi, G. Modulation of experimental arthritis by vagal sensory and central brain stimulation. Brain Behav. Agaliotis, M. Burden of reduced work productivity among people with chronic knee pain: A systematic review. Jank, R. Chronic pain and sleep disorders in primary care.

Bair, M. Depression and pain comorbidity: A literature review. Landmark, T. Chronic pain: One year prevalence and associated characteristics the HUNT pain study.

Pain 4 4 , — Bushnell, M. Cognitive and emotional control of pain and its disruption in chronic pain. Article CAS PubMed PubMed Central Google Scholar. Turk, D. The Pain Survival Guide: How to Reclaim Your Life. American Psychological Association Onieva-Zafra, M. Effectiveness of guided imagery relaxation on levels of pain and depression in patients diagnosed with fibromyalgia.

Morone, N. Mind—body interventions for chronic pain in older adults: A structured review. Pain Med. Bartels, E. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst. Smith, J. A scalable week exercise and education programme reduces symptoms and improves function and wellbeing in people with hip and knee osteoarthritis.

Goff, A. Patient education improves pain and function in people with knee osteoarthritis with better effects when combined with exercise therapy: A systematic review. Ebnezar, J. Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: A randomized control study.

Yoga 4 2 , 55 Wang, Y. Integrative effect of yoga practice in patients with knee arthritis: A PRISMA-compliant meta-analysis. Medicine 97 31 Tsuboi, M.

Do musculoskeletal degenerative diseases affect mortality and cause of death after 10 years in Japan?. Bone Miner. Groves, D.

Vagal nerve stimulation: A review of its applications and potential mechanisms that mediate its clinical effects. Goldbeck, F.

Relaxation or regulation: The acute effect of mind-body exercise on heart rate variability and subjective state in experienced Qi Gong practitioners. Download references.

The authors are grateful to the Researcher Support Project number RSPR , King Saud University, Riyadh, Saudi Arabia, for funding this research. This study was funded by the Researcher Support Project number RSPR , King Saud University, Riyadh, Saudi Arabia.

Department of Physiotherapy, School of Allied Health Science, Manav Rachna International Institute of Research and Studies, Faridabad, , India. Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, , Saudi Arabia.

Respiratory Care Department, College of Applied Sciences, Almaarefa University, Ad Diriyah, , Saudi Arabia. Department of Basic Sciences, College of Medicine, Majmaah University, Al-Majmaah, , Saudi Arabia.

Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P. You can also search for this author in PubMed Google Scholar. and M. proposed the study concept and design.

and A. planned the methodology. collected data. contributed to the data analysis. contributed to the data interpretation.

critically reviewed and edited the manuscript for intellectual content. Correspondence to Amir Iqbal. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution 4.

The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.

If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Rizvi, M. Exploring the impact of integrated polyvagal exercises and knee reinforcement in females with grade II knee osteoarthritis: a randomized controlled trial.

Sci Rep 13 , Download citation. Received : 12 June Accepted : 25 October Published : 03 November Second, the group offers support and opportunities to socialize. Many of these programs can be found in health clubs, community recreation centers or YMCAs.

The Arthritis Foundation maintains listings of a variety of week programs offered in your area. Programs include stretching and strengthening P. E: People with Arthritis Can Exercise , water aquatics, and others. If individuals are reluctant to join a class, videos that demonstrate safe exercises to do at home can be rented from local chapters of the Arthritis Foundation.

Some individuals may benefit from a referral to a health care provider with expertise in exercise supervision and training. Physical Therapists and Exercise Scientists with additional training in working with persons with arthritis may play an important role in helping these individuals become more physically active.

Physical therapists PTs are optimally trained to develop and evaluate the appropriateness of physical activity programs in persons with arthritis. PTs can carefully assess joint motion, muscle strength and endurance, and performance of activities of daily living.

Education about energy conservation, modification of daily tasks, and joint protection is emphasized. PTs can also develop an individualized therapeutic exercise program that individuals can perform at home. Frequently, health insurance programs will reimburse, in part, the services of physical therapists.

Recently, a new type of exercise specialist has emerged to bridge the gap for individuals who have completed a program of physical therapy or received clearance from their physician but lack the skills or confidence to continue exercising independently. Clinical Exercise Specialists can play an important role in helping individuals with arthritis become or remain more physically active.

While most exercise specialists have the training and skills to work with apparently healthy individuals, Clinical Exercise Specialists have additional training and experience that enable them to work with persons with arthritis and other chronic medical conditions.

This advanced training is broad in nature and includes an emphasis on exercise physiology, motivation, goal setting, biomechanics, exercise technique and the needs of individuals with chronic medical conditions. Clinical Exercise Specialists can often be found in hospital-based wellness settings.

Many provide services to clients in their own homes to make exercise more convenient and less burdensome. Currently, several organizations certify exercise scientists who have undertaken additional training and experience working with individuals who have chronic medical conditions.

Two of the best are the American College of Sports Medicine Clinical Track Certifications and the American Council on Exercise Clinical Exercise Specialist. Both organizations maintain lists of individuals who are currently certified in your area.

Health Care Professional Yes No. All information contained within the Johns Hopkins Arthritis Center website is intended for educational purposes only.

Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.

by Susan Bartlett, Ph. ref 1 In the short-term i. Physical Activity Recommendations The goals of an exercise program for individuals with arthritis are to: 1 preserve or restore range of motion and flexibility around affected joints, 2 increase muscle strength and endurance, and 3 increase aerobic conditioning to improve mood and decrease health risks associated with a sedentary lifestyle.

Assessing Readiness to Exercise Psychological readiness to begin exercising is also an important consideration. Water Aerobics Aquatic aerobic training programs that are offered in therapeutic pools have many advantages related to the warmth and buoyancy of the water.

ref 11 Additional evidence of the value of moderate intensity exercise comes from recent investigations that have shown that activity need not be undertaken in a single bout to be beneficial.

Exercise Adaptations for People with Arthritis The ACSM has outlined several modifications for exercise for persons with arthritis. ref 8 Begin slowly and progress gradually. The hallmark of a safe exercise program is gradual progression in exercise intensity, complexity of movements, and duration.

Often patients with arthritis have lower levels of fitness due to pain, stiffness or biomechanical abnormalities. Too much exercise during a flare may result in increased pain, inflammation and damage to the joint.

Thus, beginning with a few minutes of activity, and alternating activity with rest should be the initial goals. Avoid rapid or repetitive movements of affected joints.

Special emphasis should be placed on joint protection strategies and avoidance of activities that require rapid repetitions of a movement or those that are highly percussive in nature. Because faster walking speeds increase joint stress, walking speed should be matched to biomechanical status.

Special attention must be paid to joints that are malaligned or unstable. Control of pronation and shock absorption through shoe selection or use of orthotics may be indicated. Adapt physical activity to the needs of the individual. Affected joints may be unstable and restricted in range of motion by pain, stiffness, swelling, bone changes or fibrosis.

These joints are at higher risk for injury and care must be taken to ensure that appropriate joint protection measures are in place. Getting Started Apparently healthy or non-symptomatic people do not require maximal or diagnostic stress testing for participation in moderate intensity aerobic exercise.

asp Keeping It Going: Exercise Supervision and Training Some individuals may benefit from a referral to a health care provider with expertise in exercise supervision and training.

Selected References Andersen RE, Blair SN, Cheskin LJ, Bartlett SJ. Ann Int Med 5 , Minor MA. Exercise in the treatment of osteoarthritis.

Rheum Dis Clin North Am 25 2 , Ytterberg SR, Mahowald ML, Krug HE. Exercise for arthritis. Baillieres Clin Rheumatol 8 , The effect of physician advice on exercise behavior.

Preventive Medicine 22 1 , Preventive Services Task Force. Clinical Guide to Preventive Services. Alexandria, VA. International Medical Publishing, Long BJ, Calfas KJ, Wooten W, Sallis JF, Patrick K, Goldstein M, et al.

A multisite field test of the acceptability of physical activity counseling in primary care: project PACE. Am J Prev Med 12 2 , Department of Health and Human Services. Physical Activity and Health : A Report of the Surgeon General.

Atlanta, GA: U. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, American College of Sports Medicine. Champaign, IL: Human Kinetics, Ettinger WHJ , Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T et al.

A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial FAST. JAMA 1 , Minor MA, Hewett JE, Webel RR, Anderson SK, Kay DR.

Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum 32 11 , Pate RR, Pratt M, Blair SN. Physical activity and public health: A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine.

JAMA , DeBusk RF, Stenstrand U, Sheehan M, Haskell WL. Training effects of long versus short bouts of exercise in healthy subjects. Am J Cardiol 65 , Jakicic JM, Wing RR, Butler BA, Robertson RJ. Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence, cardiorespiratory fitness, and weight loss in overweight women.

Int J Obes 19 , van Baar ME, Dekker J, Oostendorp RA, Bijl D, Voorn TB, Lemmens JA et al. The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial.

J Rheumatol 25 12 , Bautch JC, Malone DG, Vailas AC. Effects of exercise on knee joints with osteoarthritis: A pilot study of biologic markers. Arthritis Care Res 10 , Lifestyle physical activity interventions.

History, short-term and long-term effects, and recommendations. Am J Prev Med 15 4 , Gordon NF, Kohl HW, Scott CB et al. Reassessment of the guidelines for exercise testing. Sports Med 13 ,

You should not feel any pain when doing these exercises. If you do, stop immediately and seek medical advice.

These exercises are not suitable for people with an existing knee injury. Tip: place an exercise ball between your back and the wall for smooth movement. Tip: keep your back straight and bend from the hips, you can do the move looking straight ahead or looking straight down.

Tip: do not bend forwards or stick your buttocks out. You should feel the stretch along your outer right thigh and hip.

Tip: if you can perform these confidently, you can progress on to the wide stance single leg squat. New to running? Couch to 5K gets you off the sofa and running in just 9 weeks. The One You Couch to 5K app gives you a choice of running coaches and helps you track your progress. As well as Laura, who features on the NHS Couch to 5K podcasts, you can also be coached by celebrities Jo Whiley, Sarah Millican, Sanjeev Kohli or Michael Johnson.

Page last reviewed: 13 January Next review due: 13 January Based on: Hoffman, DF Arthritis and Exercise Primary Care 20 , Physicians and other health care providers can play a key role in encouraging individuals with arthritis to become more physically active.

ref 4 Eighty percent of Americans view their physician as their primary source of health information. The U. Preventive Services Task Force recommends that physicians advise patients to engage in a program of regular physical activity tailored to their individual health status and lifestyle.

We must continue to stress the importance of physical activity to every patient we see and help to motivate them to choose the road to good health and long life.

Brief doctor-patient discussions about exercise do translate into behavior change among patients. In a major multi-site trial in primary care settings with diverse patient populations, the PACE Physician-Based Assessment and Counseling for Exercise Project found that minute counseling sessions increased physical activity among patients.

ref 4 Listed below are several key points that have been shown to enhance exercise counseling interventions. Patients with arthritis need clear messages about the benefits of exercise for people with arthritis. It is important to stress that physical activity of the type and amount recommended for health has not been shown to cause or worsen arthritis.

ref 7 While rest is important, especially during flare-ups, lack of physical activity is associated with increased muscle weakness, joint stiffness, reduced range of motion, fatigue and general deconditioning.

Hence, current recommendations now emphasize a balance of physical activity and rest. Also, exercise needs to be directed at the entire body, and not just the joints that are affected with arthritis. A simple but highly effective way of helping patients to determine the right balance is by asking them to keep records of their physical activity and arthritis symptoms between office visits.

Patterns often become clear within a couple of weeks. Regular discussions about physical activity at each office visit convey sincerity and interest in the importance of exercise. Among patients, the relationship between physical activity and arthritis is confusing. When joints hurt, a natural response to pain is to reduce physical activity.

Also, health care providers often advise patients to rest and avoid exercise during acute flares. Thus, it is easy to understand why some individuals with arthritis mistakenly perceive that all physical activity is undesirable, will only aggravate or worsen their arthritis and should be minimized.

It is important to explore with patients their beliefs about exercise , as well as to help them identify barriers and misinformation. Important considerations in tailoring the advice are: 1 level of readiness to be more active; 2 confidence to begin exercising; 3 expectations about the benefits the person will receive by being more active; 4 previous experience with physical activity; and 5 current lifestyle.

Discussions should focus first on encouraging physical activity and allaying fears, as well as helping patients to identify opportunities to become more physically active. Sedentary patients may benefit from receiving simple written directions that reflect a basic exercise prescription to enhance safety, boost confidence and guide them in gradually increasing their levels of physical activity.

Psychological readiness to begin exercising is also an important consideration. Theories of behavior change suggest that people vary widely in their readiness to adopt new behaviors. For these individuals, realistic goals for exercise counseling are to increase awareness of the importance of physical activity and to personalize information about the benefits that can be anticipated.

For those who express a willingness to be more active, a medical history and physical exam is advised. Specifically, the evaluation should assess the severity and extent of joint involvement, overall level of cardiovascular conditioning and presence of other comorbid conditions.

The Fitness Arthritis and Seniors Trial FAST is the largest clinical trial to evaluate the effects of exercise on osteoarthritis. ref 9 A total of adults aged 60 and older were randomized to either aerobic exercise, resistance exercise or a control group health education. Participants in the aerobic exercise group exercised for 40 minutes three times a week; those in the resistance training group completed three 40 minute sessions per week performing two sets of 12 repetitions of nine exercises.

The investigators concluded that both types of exercise were associated with similar significant improvements in symptoms of physical disability, improved physical performance and reduced pain. Aquatic aerobic training programs that are offered in therapeutic pools have many advantages related to the warmth and buoyancy of the water.

ref 10 Pools that are designed for persons with arthritis are often kept at much warmer temperatures e. Individuals with arthritis often have a limited range of motion, especially in lower extremity joints.

Decreased range of motion associated with knee and hip OA is associated with pain, loss of function, physical limitations and an increased risk of injury and falls. In addition, to receive adequate nutrition, cartilage requires regular compression and decompression to stimulate remodeling and repair.

ref 1 Minor notes that the optimal daily exercise plan to maintain cartilage health should include range of motion exercises.

Physical activity need not be strenuous to achieve health benefits. Older adults can obtain significant health benefits with moderate amounts of physical activity, preferably daily. A moderate amount of activity can be obtained in longer sessions of moderately intense activities such as walking or in accumulating shorter sessions of more vigorous activities such as fast walking or stair walking.

By the early s, epidemiological data were mounting on the dose-response gradient of physical activity and health outcomes. These findings were reinforced by recent investigations that demonstrated that health benefits of physical activity are obtained even with small amounts of moderate-intensity activity.

Thus, while improvements in fitness require strenuous and continuous activity on a regular basis, health benefits i. ref Additional evidence of the value of moderate intensity exercise comes from recent investigations that have shown that activity need not be undertaken in a single bout to be beneficial.

For instance, the benefits from three minute walks or one minute walk are similar. ref 12 , 13 Studies also suggest that moderate-intensity activity may improve pain, reduce disability, improve fitness and enhance psychological well being.

In , the Surgeon General released the first report on physical activity and health summarizing an exhaustive review of the research on physical activity. It recommended that people of all ages strive to accumulate 30 minutes of moderate intensity lifestyle activity throughout the day on most days of the week.

ref 16 Examples of moderate-intensity lifestyle activities include walking, raking leaves, and gardening. For persons with arthritis, lifestyle physical activity may be especially appropriate for several reasons.

Short bouts of exercise as opposed to one continuous session may reduce pain and prevent injury. Intermittent episodes of activity also allow individuals with arthritis more flexibility in alternating physical activity with rest.

The ACSM has outlined several modifications for exercise for persons with arthritis. ref 8. Apparently healthy or non-symptomatic people do not require maximal or diagnostic stress testing for participation in moderate intensity aerobic exercise.

A recent meta-analysis of exercise and osteoarthritis concluded beneficial effects are evident for various types of exercise therapy, but there is insufficient evidence in favor of one type of exercise program.

ref 18 Thus, the most important factor when counseling individuals with arthritis is to help them to select activities they are likely to stay with over time. Beginning exercisers should be encouraged to identify the type of physical activity they feel most comfortable with, and then begin this activity in short sessions.

If patients have had positive experiences with a particular mode of exercise in the past, they are likely to have higher exercise self-efficacy. Exercise self-efficacy is the belief or confidence people have in their ability to begin and maintain an exercise program and is one of the best predictors of long-term adherence.

For instance, among those who have enjoyed swimming in the past, water aerobics may be an ideal method to increase physical activity. On the other hand, if individuals are not fond of swimming, encouraging them to get into a pool regularly is less likely to be successful than encouraging them to begin a walking program.

A standing hamstring stretch is also an effective way to stretch the backs of the legs, and it is less strenuous for the lower back than toe touches. Exercise is a noninvasive and healthful way to help with minor knee pain due to overuse, arthritis, or other causes.

Knee-strengthening exercises are an effective way to help prevent injury and keep the legs strong. Stretching can also help keep the muscles flexible, which can prevent or alleviate pain. People with health conditions should speak with a healthcare professional before beginning any exercise program.

Squatting properly does not usually cause knee pain. However, if a person squats incorrectly or has a knee injury or knee condition, they may…. Learn about the causes of inner medial knee pain, treatments, and exercises you can do at home to strengthen the knee and relieve pain.

Knee exercise can strengthen the muscles that support the knee joint. This article lists eight stretches to try, plus tips for knee health. Learn about knee hyperextension, an injury caused when the knee joint bends too far backward.

We look at symptoms, treatment options, and recovery…. A sprained knee occurs when a person damages the ligaments. Learn more about the causes, symptoms, and treatment options for knee ligament sprains….

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Medical News Today. Health Conditions Health Products Discover Tools Connect. How to strengthen your knee. Medically reviewed by Micky Lal, MA, CSCS,RYT — By Jennifer Berry — Updated on December 15, Benefits Leg lifts Standing hamstring curls Leg extensions Step exercises Single-leg dip Wall squats Post-exercise stretching Summary Doctors may recommend exercises and stretches to help a person strengthen the muscles around the knee.

Benefits of knee strengthening exercises. Leg lifts. Share on Pinterest. Standing hamstring curls.