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Background
Exercise was once viewed as having a deleterious effect on joint pain and function in those with rheumatic diseases. Positive evidence, both related to exercises at specific joints and for exercise in the management of comorbidities and for general illness prevention, is now well established.
Objective
The aim of this article is to provide an update on the role of therapeutic exercise at individual joints and the utility of general exercise programs in the management of comorbidities and prevention of chronic disease in those with rheumatic disease.
Discussion
Major international rheumatology bodies now recommend multiple forms of exercise as part of the non-pharmacological management of both osteoarthritis and the more classically inflammatory rheumatic disorders.
IN THE PAST, ARTHRITIS was thought to be simply a process caused by joint overuse 'wear and tear', injury or complex inflammatory processes. As articular cartilage and associated joint structures were damaged, significant further exercise involving affected joints was not recommended. Indeed, currently accepted advice is to avoid exercise that involves an acutely inflamed joint, and caution is advised in prescribing exercise to patients who already have significant joint damage, especially of weight-bearing joints. In these cases, high-impact exercise is relatively contraindicated; if exercise is prescribed, it should involve modalities that do not excessively load the joint, such as water walking, swimming, cycling, walking or strengthening.1 Exercise on an apparently quiescent joint should be modified if exercise exacerbates the patient's usual degree of pain or initiates a painful episode. Otherwise, current evidence indicates that both local exercise around individual joints and general exercise for its systemic benefits should be encouraged.2
The focus of this article will be on data related to osteoarthritis (OA) and, as an exemplar of inflammatory joint diseases, rheumatoid arthritis (RA).
Osteoarthritis
OA is no longer thought to be a non-inflammatory 'wear and tear' process. It is now thought to be an active response to injury associated with failure of the 'synovial joint organ', which comprises structures in and around the joint. These include muscles, ligaments, entheses, synovial tissue and subchondral bone. There is good evidence that OA is a low-grade inflammatory disease associated with obesity, metabolic syndrome, innate immunity and age-related inflammation.3'4 A number of the aforementioned chronic diseases are associated with chronic low-grade inflammation....