Exercise most benefits those with highest OA pain: Study

Osteoarthritis (OA) patients experiencing the most intense pain have the biggest reduction in depression symptoms when they engage in exercise, according to a new study.
 
The Victoria University research set out to explore the impact of pain on the relationship between physical activity and depression symptoms in those with OA, and whether pain levels mediate or moderate that relationship.
 
For the study, researchers examined people waiting for a consultation with an orthopaedic specialist at a public hospital in Melbourne. Their findings suggest pain ‘significantly moderates’ the association between physical activity levels and depression. Depression is known to be a common comorbidity with OA.
 
Professor of Physical Activity and Mental Health and Executive Director at Victoria University’s Institute for Health & Sport, Alexandra Parker is co-author of the study’s paper.
 
She told newsGP the study’s results help to reinforce using non-drug treatments as first-line OA management.
 
‘From the large sample of patients who are referred by their GP to see an orthopaedic specialist, while they’re on the waiting list, those who are engaging in some more physical activity, even if they had high pain, still had some benefit in terms of a reduction in depression symptoms – so some mood improvements,’ Professor Parker said.
 
‘This is reinforcing the current first line clinical guidance, which is emphasising non-surgical or non-drug treatment as the core of OA management.
 
‘And this data provides some reassurance to GPs when they do encourage their patients to engage in activities that might help with weight loss or recommending exercise, that even those who have high pain, if they were moving, they actually did experience mood benefits, which of course would be relevant to their overall quality of life.’
 
The RACGP’s Handbook of Non-Drug Interventions (HANDI) recommends physical activity for managing OA, while use of the Guideline for the management of knee and hip osteoarthritis aims to reduce over reliance on treatment such as medication and surgery.
 
With the authors highlighting that ‘little is known’ about the mediating role pain plays in the relationship between physical activity and depression in people with OA, they found that people with high levels of pain, and who may be the least likely to engage in physical activity, may also have the most to gain from exercising.
 
In Australia, OA is the most common form of arthritis, impacting an estimated 8.3% of the population (2.1 million people) in 2022.
 
Last year, OA accounted for 2.5% of total disease burden and 20% of the total burden of disease due to musculoskeletal conditions. Globally, the health burden of OA is rising.
 
For the Victoria University study, 552 participants with an average participant age of 62.6 years were tracked. The most common joint affected by OA was the knee (44%), followed by the hip (15.5%), shoulder (14.4%), and foot (13%).
 
Overall, 33.9% of participants had ‘moderate’ or higher depression scores, with 18.8% reporting a major depressive disorder and 10.8% another depressive syndrome.
 
On average, participants reported engaging in 5.19 hours of total physical activity per week, and almost half (47.8%) were ‘sufficiently active’ based on the Australian Physical Activity Guidelines, 36.9% were ‘insufficiently active’, and 15.4% were sedentary.
 
Depression-like symptoms were measured using the Patient Health Questionnaire. Self-reported pain intensity scores were determined according to the 4-item pain intensity measurement, with participants reporting an average level of pain of 27.7 on a scale of 0–40.
 
According to the authors, the mediation results confirm that participating in physical activity is ‘indirectly and inversely’ associated with symptoms of depression through lower levels of pain.
 
The highest levels of pain are linked to the most potential benefit in terms of reduction in symptoms of depression from engaging in physical activity.
 
And while the physical and mental benefits of exercise are well evidenced, Professor Parker says GPs are best placed to encourage physical activity as part of routine lifestyle advice.
 
‘It always is beneficial … but the data is just reinforcing that high pain perception should not be a barrier, and that there’s still a range of benefits that a patient could experience if they do move more,’ she said.
 
‘Because we know that patients and medical staff do show some caution about recommending exercise if there is significant pain with the concern that it might make the pain worse.
 
‘But particularly knowing that there might be a mood benefit and encouraging a patient to perhaps track or monitor their mood if they were engaging in more physical activity, then that might also help to reinforce it as being beneficial.’
 
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depression mood non-drug treatments osteoarthritis pain management physical activity