A patient with osteoarthritis of the knee used Facebook to ask Duke Orthopaedics specialists what cardiovascular exercises are safe and appropriate for patients with OA.

David Attarian, MD, of Duke Total Joint Center, and Selene Parekh, MD, MBA, of North Carolina Orthopaedic Clinic, answer her question in this Q&A session.

What cardiovascular exercises are appropriate for patients who have osteoarthritis (OA) of the knee?

David E. Attarian, MDDavid Attarian, MD: Low impact activities are preferred in patients with knee OA. A patient may run but will pay a price in terms of pain, swelling, and, possibly, a more rapid progression of the knee OA.

Low-impact aerobic activities may include using an exercise bike, regular bike, elliptical trainer (and similar devices) or water exercises and swimming.

Also, walking, particularly on a treadmill, will be less stressful than running and jumping. Many times, a visit or two with one of our Sports Medicine physical therapists may assist in developing a suitable exercise program.

Selene G. Parekh, MD, MBASelene Parekh, MD, MBA: Knee arthritis is a common orthopaedic complaint. Patients will usually experience pain, loss of motion, and may have swelling of their knees. Anti-inflammatories and physical therapy are some of the first lines of treatment used for patients with knee arthritis.

Physical therapy will broadly target range of motion, strengthening, and endurance.

Range of motion

A variety of exercises are used to maximize range of motion. With arthritis, over time, patients will lose their motion and have pain with movement. Even still, the therapist will try to maximize the range of motion.

It's important to bend the knee (flexion) as much as possible. You can do this by lying on your stomach, placing a band or towel around the front of your ankle, and pulling the ankle towards the buttocks. The goal is to try and get the heel as close to the buttocks as possible.

Alternatively, you can sit on a chair with your buttocks as far back as possible. Plant your foot on the ground and, slowly, advance your buttock on the seat, moving it towards the edge of the seat. This will cause you to flex your knee.

Strengthening

The muscles around your joints can act as "shock absorbers" for the joint. In this case, the knee muscles need to be strengthened.

Knee extensions and leg lifts work the quadricep muscles. Knee curls, or flexion, works the hamstrings. Squats, leg presses, and balance balls can work the knees, hips, lower back, and core muscles. This can help reduce some of the stress on the knee.

Endurance

Non-impact activities such as swimming, walking, an elliptical machine, or biking can help to build the endurance of the muscles around the knee.

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