Quality statement 4: Exercise

Quality statement

Adults with osteoarthritis are advised to participate in muscle strengthening and aerobic exercise.

Rationale

Exercise is a core treatment for osteoarthritis that will improve joint pain and function. It is important that people are advised to undertake specific exercise that is relevant for their condition, including muscle strengthening that targets affected joints and general aerobic exercise. Healthcare professionals will need to make a judgement about the best way to encourage participation in exercise, because this will vary for each person depending on their needs, circumstances and self‑motivation, and may change over time. It is important that support and encouragement to exercise is ongoing and reinforced at every opportunity.

Quality measures

Structure

Evidence of local arrangements to ensure that adults with osteoarthritis are advised to participate in muscle strengthening and aerobic exercise.

Data source: Local data collection.

Process

a) Proportion of adults diagnosed with osteoarthritis who receive advice on participating in muscle strengthening exercise.

Numerator – the number in the denominator who receive advice on participating in muscle strengthening exercise.

Denominator – the number of adults newly diagnosed with osteoarthritis.

Data source: Local data collection. Data on exercise advice are included in the 'care.data' extract from the Health and Social Care Information Centre (not specific to people with osteoarthritis). Data on exercise advice and referrals to physiotherapy are included in the Keele Primary Care Consortium Osteoarthritis (OA) e-template for primary care consultations (endorsed by NICE).

b) Proportion of adults diagnosed with osteoarthritis who receive advice on participating in aerobic exercise.

Numerator – the number in the denominator who receive advice on participating in aerobic exercise.

Denominator – the number of adults newly diagnosed with osteoarthritis.

Data source: Local data collection. Data on exercise advice are included in the 'care.data' extract from the Health and Social Care Information Centre (not specific to people with osteoarthritis) and also in the Keele Primary Care Consortium Osteoarthritis (OA) e-template for primary care consultations (endorsed by NICE).

c) Proportion of adults with osteoarthritis who receive advice on participating in muscle strengthening and aerobic exercise at their review.

Numerator – the number in the denominator who receive advice on participating in muscle strengthening and aerobic exercise.

Denominator – the number of adults with osteoarthritis attending for a scheduled review of care.

Data source: Local data collection. Data on exercise advice are included in the 'care.data' extract from the Health and Social Care Information Centre (not specific to people with osteoarthritis). Data on exercise advice and referrals to physiotherapy are included in the Keele Primary Care Consortium Osteoarthritis (OA) e-template for primary care consultations (endorsed by NICE).

Outcome

a) Physical activity in adults with osteoarthritis.

Data source: Local data collection.

b) Patient satisfaction with advice on exercise.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (GPs and community healthcare providers) ensure that processes and referral pathways are in place so that adults with osteoarthritis are advised and encouraged at both diagnosis and review to participate in muscle strengthening and aerobic exercise. It may be useful to compile information about local exercise classes, groups and facilities, so that people can be given information about any that are suitable.

Healthcare professionals ensure that they advise and encourage adults with osteoarthritis at both diagnosis and review to participate in muscle strengthening and aerobic exercise, and provide information about suitable local exercise classes, groups and facilities.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services in which adults with osteoarthritis are advised and encouraged at both diagnosis and review to participate in muscle strengthening and aerobic exercise. Commissioners also ensure that there is sufficient capacity in physiotherapy and exercise support resources to meet demand for adults with osteoarthritis.

What the quality statement means for patients, service users and carers

Adults with osteoarthritis are advised and encouraged by healthcare professionals to exercise, both for general fitness and to strengthen the muscles that support their affected joints, because this may help to improve their symptoms.

Source guidance

  • Osteoarthritis (2014) NICE guideline CG177, recommendations 1.2.5 and 1.4.1 (key priorities for implementation)

Definitions of terms used in this quality statement

Muscle strengthening exercise

Exercise to strengthen the muscles around the affected joint.

[Adapted from Osteoarthritis (NICE guideline CG177) full guideline section 8.1]

Aerobic exercise

Aerobic exercise aims to improve general mobility, function, cardiovascular fitness, wellbeing and self‑efficacy, and could include cycling, swimming or exercise at a gym.

[Adapted from Osteoarthritis (NICE guideline CG177) full guideline section 8.1, and expert opinion]

Equality and diversity considerations

Healthcare professionals should take into account cultural and communication needs (including any learning disabilities) when providing information and support for adults with osteoarthritis. This should include providing printed information for people who cannot access information online and providing information in accessible large print and easy read formats where needed.

All adults with osteoarthritis should be encouraged to exercise. If age, comorbidities, pain severity or disability are seen as a barrier, the person may need specific advice and support to encourage participation, and should be advised that exercise may improve their symptoms.