Exercise prescription

When prescribing exercise for people with hip/knee osteoarthritis, a range of factors must be taken into consideration by the clinician, including the individual’s goals of therapy, the type(s) of exercises that may be (un)suitable and dosage parameters.  Prescribed programs should be monitored and adjusted as needed to ensure the program remains fit-for-purpose across time. It is important that a person is instructed in how to implement their exercises program correctly.

OARSI Rehabilitation Discussion Group expert recommendations state that clinicians should:

  • Determine goals of exercise therapy
    • Collaborate with the individual to establish meaningful and mutually agreeable goals.
    • Set functional goals that promote participation in daily activities. Create an exercise program that aligns with the individual’s goals.
    • Communicate exercise goals clearly to the individual in terms of the type, frequency, intensity, time/duration of exercise.
    • Set realistic expectations about the outcomes of exercise, including timeframes.
  • Choose the most suitable type of exercise
    • Consider various kinds of exercise including aerobic, strengthening, neuromuscular training, flexibility training and balance training.
    • Select exercises that will directly address the impairments or functional limitations of the individual.
    • Provide a simple exercise program that relies on inexpensive and readily obtainable equipment and can be easily reproduced at home.
    • Incorporate strategies to increase general physical activity levels for the individual if they are insufficiently physically active.
    • Consider patient preferences when deciding on the type of exercise
  • Set a clear exercise dosage
    • Determine an appropriate starting exercise dose for the individual.
    • Provide a sufficient dose of exercise (in terms of frequency, intensity, time/duration) to provide physiological benefits and clinically meaningful changes in line with the individual’s goals.
    • Encourage the individual to exercise two or more times per week.
    • Encourage a “long-term” rather than “episodic” approach to exercise participation.
  • Modify and progress the exercise program
    • Progress exercise appropriately for the individual, providing ways to incrementally increase or decrease the difficulty of the exercise.
    • Modify or progress exercises according to the individual’s response (e.g. in response to an increase in muscle strength, or when the exercise has become too easy).
    • Progress the exercise program gradually, as long as the individual does not experience significant increases in pain or discomfort.
    • Modify exercise in response to any problem that the individual encounters (e.g. provide alternative exercises).
    • Provide clear guidance on when and how to modify and progress exercises.
  • Individualise the exercise program
    • Ensure that the exercise program is tailored to the individual, taking into consideration any co-existing medical conditions, their level of pain, their physical and cognitive ability to participate in exercise, and their ability to perform the exercise on their own without supervision.
    • Tailor the exercise program to the individual based on assessment findings.
    • Focus on “the whole person” and not just the affected joint(s).
  • Ensure the person can implement the exercise program
    • Provide instructions that are easy to follow.
    • Ensure that the exercise program is well understood by the individual (e.g. ask them to give you a demonstration and provide feedback as necessary).
    • Ensure that the individual is confident in their ability to complete the exercise program.
    • Create a strong therapeutic alliance. Build trust with the individual.
    • Listen to the individual and encourage open dialogue. Allow the individual to ask questions at any time.

Resources and tools to help support exercise prescription

Below, you can find a useful selection of free resources and tools available to assist you with prescribing an exercise program for people with hip/knee osteoarthritis. Resources were assessed and selected based on their relevance for arthritis and the context of exercise, whether the information was factual and accurate, whether the source/author was reliable, the accessibility and clarity of the content, and whether the resource has been updated recently. Are you aware of other useful resources that aren’t listed here? Click here to let us know.

We would love to know how you are using this toolkit and its resources in your clinical practice. Click here to complete a quick one minute survey to let us know.

Education & information
Assessment & monitoring
Exercise prescription
Exercise adherence