Osteoarthritis is a condition characterised by degeneration of cartilage in joints. I commonly affects joints such as the hips and knees, and when it does, it can make walking (and other movements) difficult and painful. Those with osteoarthritis are often recommended to engage in exercise which, in theory, does not put the joints as further risk of damage and cartilage degeneration. Walking is generally viewed as an appropriate exercise here (though other potentially appropriate exercises include non-weight-bearing exercises such as swimming and cycling).
Another approach to osteoarthritis that I favour is the nutritional agent glucosamine. There is a fair amount of evidence which shows this has the potential to improve osteoarthritis. Certainly, I’ve found glucosamine to be very useful clinically, with the great majority of people who use it seem to get significant benefit from doing so. I am aware that some (or perhaps all) of the improvement these individuals see may be due to the placebo effect, but I don’t care (and neither, as it happens, do they).
So, what happens when you use glucosamine in combination with walking in individuals with osteoarthritis? This was essentially the question being asked by a study published recently in the journal Arthritis Research and Therapy [1]. In it, individuals aged 42-73 with mid-to-moderate osteoarthritis of the hip and/or knees were each treated with glucosamine sulphate (1500 mg per day) for six weeks.
After this, these study participants embarked on an 18-week walking programme. About half of individuals were encouraged to exercise on three days a week. The other half were instructed to exercise on five days each week.
In the first 6 weeks, individuals were encouraged to walk 1500 steps a day (about 15 minutes of walking) in addition to their normal activity on ‘exercise’ days. The target was subsequently increased to 3000 steps for the next six weeks. For the final six weeks, the target was upped again to 6000 steps per day.
Over the course of the study, significant benefits were found in both groups (those requested to walk three times per week and those requested to walk five times a week) in terms of physical function and scores assessing osteoarthritis. Even before the walking programme started, glucosamine supplementation (alone) was found to benefit stiffness and function, though pain was not improved.
There was no significant difference between the groups in terms of outcome, which might have had something to do with the fact that individuals instructed to exercise five times a week actually, on average, managed less than four days a week, while the other group managed a little over three days a week. Average number of minutes walked per week did not differ significantly between the two groups.
The most prominent benefits came when walking was increased to an additional 3000 steps per day. This was associated with improvement in both physical function and pain scores. 6000 steps on walking days improved physical function still more but pain was not further improved.
This study is somewhat hampered by the fact that it lacked a control group (i.e. there was no group taking placebo and not engaged in the walking programme). Nonetheless, what it shows is that glucosamine plus moderate levels if walking leads to significant benefits for sufferers of osteoarthritis. As in real life, some of the benefits may be due to the placebo effect. But I don’t suppose that, as with my patients, the study participants will mind much about that.
References:
1. Ng NT, et al. Efficacy of a progressive walking program and glucosamine sulphate supplementation on osteoarthritic symptoms of the hip and knee: a feasibility trial. Arthritis Research and Therapy. 12th February 2010 [epub before print publication]
Interesting to see that a combo of appropriate prescription and exercise can be so helpful.
Do you have any suggestions for exercising the hands: fingers, thumbs and wrists?
My hip and back pain was eliminated by wearing MBT shoes.
If you have a shellfish or seafood allergy, be sure to check the ingredients and source material on the label of any glucosamine supplement.
Increasingly, these supplements are made from crab or similar ingredients.
There is a vegetarian glucosamine supplement available, which is about the only one I found which avoided this allergy hazard.
My doctor recommended taking glucosamine. I decided to try the Dr Max Powers Joint Support with Vitamin B12 because it was the highest dose capsule I could find. It has worked very well.
I am generally impressed by your analysis of published papers but to suggest we use treatments based on the placebo effect because patients don’t mind is not good practice and deceiving them. Glucosamine is very expensive. You’ll be suggesting plain water next. Has anyone thought of that before?! Oh yes , homeopathy.