SPECIAL ARTICLE

JAGS 49:808–823, 2001

© 2001 by the American Geriatrics Society

0002-8614/01/$15.00

Exercise Prescription for Older Adults With Osteoarthritis Pain:

Consensus Practice Recommendations

A Supplement to the AGS Clinical Practice Guidelines on the Management of Chronic Pain in

Older Adults

American Geriatrics Society Panel on Exercise and Osteoarthritis

INTRODUCTION

In response to mounting evidence that a program of in-

creased physical activity is a useful component in the man-

agement of osteoarthritis (OA) in older adults, the Board of

Directors of the American Geriatrics Society (AGS), along

with a multidisciplinary panel of experts, recommended that

the AGS take the lead in promoting exercise prescription for

OA patients in the primary care setting. This project, culmi-

nating in the publication of these practice recommendations,

parallels the Society’s clinical practice guidelines on the man-

agement of chronic pain in older persons.

1

The purpose of this document is to provide an evi-

denced-based review that explains why a physically active

life style benefits older adults with OA and to provide

practical strategies and exercise guidelines for this expand-

ing patient population. These practice recommendations

are derived from the existing literature and by consensus

among a panel of experts from many disciplines: geriat-

rics, internal medicine, orthopedics, physical therapy and

rehabilitation, exercise physiology, nursing, and pharmacy.

A literature search involving a full-text computer search of

Index Medicus

and MEDLINE using the terms

osteoarthri-

tis

,

exercise

, and

aging

was first conducted. An extensive

manual search using the bibliographies of the publications

located through the computer search was also undertaken.

A study was included in this review if the publication

made an implicit or explicit claim regarding osteoarthritis

or research designed to evaluate the effects of exercise on

physiologic or functional parameters in older adults. Mem-

bers of the multidisciplinary panel reviewed successive drafts

of the report summarizing their findings, and the final

draft was submitted for review and comment by experts

routinely involved in the care of older adults.

Americans 65 years or older represent an expanding

proportion of the United States (U.S.) population, and

their numbers will increase rapidly as the baby-boom gen-

eration ages.

2,3

Although the majority of older people in

the U.S. are healthy and physically active, others suffer

with chronic illnesses and require some assistance (family,

friends, and public support systems) to manage their ev-

eryday lives.

4,5

Approximately one quarter of all patients

seen by primary care physicians present with musculoskel-

etal conditions

6

and, among those age 65 years and older,

the most prevalent articular disease is OA.

7

Addressing the

health care needs of this rapidly expanding population is a

national priority.

The conspicuous presence of OA in the older popula-

tion has many believing that chronic pain and functional

difficulties are immutable consequences of aging. OA, the

most common form of arthritis, is associated with consid-

erable disability.

8

Symptomatic OA causes pain, limits

daily activities, and reduces quality of life.

8,9

The majority

of those burdened with OA are elderly; in fact, about half

of all persons age 65 and over are affected by OA.

10

The

fallacy that undercuts the mistaken belief that symptom-

atic OA is caused by aging is revealed in the following an-

ecdote. An older man visits his doctor complaining of dif-

ficulty with getting out of a chair and walking because of

persistent pain in one of his knees. The doctor replies,

“Well you’re 75, this is just part of growing old.” The as-

tute patient replies, “My other knee is just as old and it

doesn’t hurt.”

11

An emerging body of evidence shows that light- to

moderate-intensity physical activity may play a preventive

and possibly a restorative role in combating declines in

health and functional capacity caused by chronic diseases

such as OA.

12–17

Regular physical activity modifies risk

factors for chronic diseases prevalent in the older popu-

lation,

18,19

improves psychologic health,

10

and promotes

functional independence.

20–33

Physical inactivity is recog-

nized as a risk factor for many diseases prevalent in the

older population (coronary artery disease, diabetes melli-

tus, and obesity), and increasing physical activity in seden-

tary OA patients may reduce morbidity and mortality.

34–38

Evidence indicates that quadriceps muscle weakness is a risk

factor for knee OA, which is often the consequence of inac-

tivity.

35

Furthermore, inactivity may contribute to the mor-

bidity associated with a variety of other chronic diseases,

most notably diabetes mellitus, cerebrovascular disease,

coronary artery disease, congestive heart failure, osteoporo-

sis, and depression. The superimposition of any of these

Reviewed and approved by the AGS Clinical Practice Committee and the

AGS Board of Directors, May 2001.

Address correspondence and reprint requests to Nancy Lundebjerg, Senior

Director, Professional Education and Publications, American Geriatrics

Society, 350 Fifth Avenue, New York, NY 10118.