Osteoarthritis and GLA:D® Australia

Osteoarthritis (OA) is defined as a degenerative disorder of a joint in the human body; most commonly the knee, hip and hand. Formerly OA was thought to just involve the wearing of cartilage and changes to the underlying bony surface, however more recent research has led to the new definition of OA encompassing the whole joint and considers the interactions between all structures. (Practitioners TRACoG 2018).

OA has also now been recognised to be influenced by a multitude of other factors outside of those physiological degenerative changes. These factors include co-morbidities (e.g. obesity, fatigue), lifestyle (sleep, physical activity level), social factors (stress, isolation, depression), pain-related fear avoidance, muscle weakness, physical loading as well as negative beliefs and poor coping strategies.

In Australia, 1 in 11 people are clinically diagnosed with OA – that equates to 2.1 million people! (ABS 2018). It is also the most common lifestyle disease in people aged 65 years and over – more than both high blood pressure and diabetes!

Most commonly, these individuals visit their doctor when their pain gets too much and they are subsequently referred to an orthopaedic surgeon for consultation before undergoing a joint replacement. Whilst the outcomes of said surgery can be very successful, the economic burden placed both on the health care system (cost of surgery and hospitalisation) and the welfare system (due to time unable to work due to pain associated with OA) makes this option a very expensive one!

Surely there is something else we can be doing?

There is now irrefutable evidence that exercise can not only assist in managing Osteoarthritis in terms of pain reduction, but also delay, and in some cases, remove the need for joint replacement surgery altogether. (Skou ST, Roos EM 2017)

Exercise is important for Osteoarthritis because:

• cartilage needs appropriate loading to be healthy,

• it improves the range of motion in your joint,

• it improves stability and joint function,

• it decreases pain,

• it helps you move better,

• it improves joint confidence.

(GLA:D Australia, 2021)

So what exercises do you need to do to gain this benefit?

The physical activity guidelines in Australia recommend everyone should aim to complete 150 minutes of moderate or 75 minutes of vigorous physical activity per week (ACSM 2018). The benefit is increased if this amount is doubled. This may seem daunting, but can be completed in a number of short bouts of 10 minutes across the day to make it more achievable. This physical activity can be land or water based exercise, but should be in addition to your usual activities of daily living.

For people with Osteoarthritis it is recommended to undertake more specific therapeutic exercise:

• Neuromuscular,

• functional,

• endurance,

• strength,

• power,

• flexibility and

• aerobic.

This needs to be carried out with a specific purpose and can be guided by a health professional. This is where Physiotherapy comes to the fore. More specifically a consultation with a Physiotherapist can provide you with a better understanding of your condition and a tailored strengthening exercise program to assist with your OA. Our unique set of expertise can provide you with the tools necessary to manage pain flares common during exercise with OA and to guide you as to which exercises are suitable for your situation. Pain DOES NOT equal damage!

As mentioned earlier OA is multifactorial in nature and exercising as suggested can also address these elements by assisting in improving cardiovascular health, decreasing stress, weight loss, increasing muscular strength and endurance, improving mood and overall well-being.

What is GLA:D Australia?

GLA:D®, Good Life with osteoArthritis: Denmark, is an education and exercise program developed by researchers in Denmark for people with hip or knee osteoarthritis symptoms.

Research from the GLA:D® program in Australia shows an average pain reduction of 36%, reduced analgesic consumption, reduction in perceived need for surgery, and clinically meaningful improvement in joint confidence.

Education and exercises provided can be applied to everyday activities, ensuring participants develop skills to self-manage their osteoarthritis. By strengthening and improving confidence with exercise, participants develop better capacity to become or stay active, prevent symptom progression and reduce pain.

(GLA:D Australia, 2021)

GLA:D Australia program is run by trained Physiotherapists in clinic. It consists of 2x 1 hour education sessions followed by 2x 60 minute exercise sessions per week for 6 weeks. Each participant is then followed up at 3 and 12 months.

Origin Physiotherapists Ethan Ashley and Robert Ho have both completed the GLA:D program training for health professionals. If you would like to learn more about managing OA they can help you.

References

The Physical Activity Guidelines for Americans 2018, 2nd Edition.

Australian Bureau of Statistics 2018, Arthritis and osteoporosis, <Arthritis and osteoporosis, 2017-18 financial year | Australian Bureau of Statistics (abs.gov.au)>.

Practitioners TRACoG. Guideline for the management of knee and hip osteoarthritis. 2nd edn. East Melbourne: RACGP; 2018.

Skou ST, Roos EM. Good Life with osteoArthritis in Denmark (GLA:D): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskelet Disord. 2017;18(1):72.