Most people pay little attention to the physical movements that power their daily activities, whether they’re walking the dog or climbing the stairs. But for the patients participating in a study on osteoarthritis and exercise led by the Krembil Research Institute and Bone and Joint Canada, these everyday actions have become important tools for managing their disease.
Through the GLA:D Canada program – the Canadian version of a groundbreaking education, exercise and research program called Good Life with Osteoarthritis in Denmark – participants are learning to move in ways that lessen their pain, strengthen their muscles, and improve the stability in their joints.
“People with osteoarthritis will often say, ‘I know I’m supposed to be exercising, so I started walking, and now my knee hurts even more,’” says Dr. Aileen Davis, a physiotherapist and senior scientist at the Krembil Research Institute, the research arm of Toronto Western Hospital. “An important part of this program is teaching people exercises with proper joint position and movement patterns as part of their daily activities. This then allows them to be more active, so they can do other things such as walking, cycling or swimming.”
That’s welcome news for the more than five million Canadians living with osteoarthritis, a degenerative joint disease – and the most common type of arthritis – that usually affects the knees, hips, hands and spine. While it is often seen among those aged 65 years or older, osteoarthritis also affects many Canadians between the ages of 30 and 45.
Dr. Davis says the international model of care for osteoarthritis calls for education and exercise as the first line of treatment. When this fails to control symptoms, medication, and in some cases an orthotic device such as a brace, is typically added to a care plan. Surgery is considered the last line of treatment.
“So the guidelines exist, but the challenge is getting care that follows the guidelines,” says Dr. Davis.
Dr. Davis and her GLA:D Canada collaborators at Krembil and other healthcare sites are working to improve the gap in osteoarthritis care. The program, which includes two education sessions where participants learn about the disease, how to exercise with acceptable pain levels and improve their physical activity, also takes participants through six weeks of individualized exercise instruction in a group setting. This program uses a novel approach by incorporating muscle-building movements into daily activities to sustain improvements.
“These are functional exercises,” says Rhona McGlasson, Executive Director at Bone and Joint Canada, a national agency that promotes education and best practices for managing musculoskeletal diseases. “We know from the research that if you just give people exercises to do following a rehabilitation program, they don’t continue to do them long term. But if you incorporate the new muscle movements into the tasks a person does every day, then you have a better chance of keeping the muscles activated to support the joint which will reduce the pain.”
The exercises are always customized to each patient, she adds. For instance, patients who limp learn how to strengthen the muscles that cause that limp. Common activities are also modified initially to ensure proper performance as people build muscle strength.
“For example, when people get up from a chair, their knees typically collapse inward, and they push up using their arms,” explains Mark Anunciacion, a Toronto physiotherapist. “In the GLA:D program, we educate patients to execute this activity by having their hip, knee and foot in alignment with one another. We’ll also look at other factors that might be throwing them out of alignment, like maybe the seat is too low, and they need to look for chairs that are at the correct height.”
Participants in GLA:D come in for exercise training twice a week for six weeks. While some sites offer the option for one-on-one training, most attend group sessions led by a physiotherapist.
“The evidence suggests that people in supervised exercise do better,” says Dr. Davis.
“We run it as a group because people support and encourage each other in a group.”
Whether they exercise in a group or, for few, on their own, most people with arthritis stand to benefit from the functional exercises taught in GLA:D. Davis says the results in the initial pilot study with 59 participants were similar to those from the Danish program participants, and were really encouraging. “People reported a 40 per cent reduction in pain,” she says. Those who participated in the program also reported improved functional ability and 24 per cent reported increased levels of physical activity.
The GLA:D program launched in 2016 in Ontario. Dr. Davis says she hopes to see similar results for many more people as the number of sites offering the program continues to grow.
“We are committed to national implementation of the program. The program in now offered in 46 sites across four provinces, 27 in Ontario, 13 in British Columbia, five in Alberta, and one in New Brunswick,” says Dr. Davis. “We are getting so much demand for this program and we are continuing to train healthcare professionals across the country to deliver GLA:D Canada.”
This content was produced by The Globe and Mail's Globe Edge Content Studio, in consultation with an advertiser. The Globe's editorial department was not involved in its creation.