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Guideline for the management of knee and hip osteoarthritis

Summary of recommendations

Strong recommendations for the intervention

Land-based exercise – Knee

Recommendation

We strongly recommend offering land-based exercise for all people with knee OA to improve pain and function, regardless of their age, structural disease severity, functional status or pain levels.

Exercise has also been found to be beneficial for other comorbidities and overall health

We strongly recommend walking, muscle-strengthening exercise, and specifically, Tai Chi Clinicians should prescribe an individualised exercise program, taking into account the person’s preference, capability, and the availability of resources and local facilities. Realistic goals should be set. Dosage should be progressed with full consideration given to the frequency, duration and intensity of exercise sessions, number of sessions, and the period over which sessions should occur.

Attention should be paid to strategies to optimise adherence. Referral to an exercise professional to assist with exercise prescription and provide supervision either in person or remotely may be appropriate for some people.

Strength of recommendation

Strong for recommendation
(all land-based exercise, walking, muscle-strengthening exercise, Tai Chi)

Quality of evidence

Low (all landbased, Tai Chi)
Very low (walking, musclestrengthening exercise)

Refer to full recommendation 

Land-based exercise – Hip

Recommendation

We strongly recommend offering land-based exercise for all people with hip OA to improve pain and function, regardless of their age, structural disease severity, functional status or pain levels.

Exercise has also been found to be beneficial for other comorbidities and overall health. The type of exercise that is most beneficial is not yet known.

Clinicians should prescribe an individualised progressive exercise program, taking into account the person’s preference, capability and the availability of local facilities. Realistic goals should be set. Dosage should be progressed with full consideration given to the frequency, duration and intensity of exercise sessions, number of sessions, and the period over which sessions should occur.

The clinician should monitor the person’s response to the exercise program, and could try a different form of land-based exercise if improvements are not evident. Attention should be paid to strategies to optimise adherence. Referral to an exercise professional to assist with exercise prescription and provide supervision either in person or remotely may be useful for some people.

Strength of recommendation

Strong for recommendation
(when combining all studies of land-based exercise)

Quality of evidence

Moderate (land-based)

Refer to full recommendation 

Weight management – Knee and/ or hip

Recommendation

We strongly recommend weight management for people with knee and/or hip OA. For those who are overweight (BMI ≥25 kg/m2 ) or obese (BMI ≥30 kg/m2 ), a minimum weight loss target of 5–7.5% of body weight is recommended. It is beneficial to achieve a greater amount of weight loss given that a relationship exists between weight loss and symptomatic benefits. Weight loss should be combined with exercise for greater benefits. For people of healthy body weight, education about the importance of maintaining healthy body weight is essential.

Strength of recommendation

Strong for recommendation

Quality of evidence

This event attracts CPD points and can be self recorded

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