Restrictions and contraindications for exercise therapy in patients with hip and knee osteoarthritis and comorbidity

Abstract

Background: Osteoarthritis (OA) has a very high rate of comorbidity. Exercise therapy is recommended in current guidelines on the management of OA of the hip and knee. Unfortunately, current protocols and guidelines for exercise therapy in OA of the hip and knee do not offer advice concerning comorbidity-associated adaptations for exercise therapy in OA patients. Because of the high prevalence of comorbidity in OA, it is important to establish when exercise therapy for OA of the hip and knee should be adapted when patients have one or more comorbidities.

Objective: To identify restrictions and contraindications for exercise therapy for common comorbidities (cardiac diseases, hypertension, type 2 diabetes, obesity, chronic obstructive pulmonary disease (COPD), depression, chronic pain, low back pain (LBP), visual or hearing impairments, and chronic cystitis) in hip and knee OA patients.

Major findings: Cardiac diseases, hypertension, type 2 diabetes, COPD, and chronic cystitis are associated with restrictions resulting from physiological impairments. Conversely, LBP, chronic pain syndromes, and depression are associated with psychological and behavioural restrictions to exercise therapy. Visual and hearing impairments result predominantly in environmental restrictions to exercise. Obesity is associated with restrictions resulting from physiological and psychological impairments and behavioural barriers. Several absolute contraindications exist and patient safety cannot be guaranteed when these are not taken into account during exercise therapy.

Conclusion: Restrictions and contraindications for exercise in patients with OA of the hip and knee and comorbidity have been identified. This overview is helpful in decisions on the treatment of patients and will be instrumental in the development of a protocol for comorbidity related adaptations in exercise therapy for OA patients.

Keywords:

• Exercise therapy
• Knee osteoarthritis
• Comorbidity

The authors would like to thank MS Terbraak, DG de Rooij, PhD and J van Andel for advice and critical reading of the manuscript and M Groenewold for her contribution to the search of literature.

This study was financially supported by the Royal Dutch Society for Physical Therapy.