Moving more is good for you.

There is little argument there. The stats speak for themselves...

Being physically active for 150 minutes per week reduces the risk of: 

• Heart disease by 40%
• Type 2 diabetes by 40%
• Breast cancer by 25%
• Dementia by 30%
• Depression by 30% 
• Osteoporosis by 50%.  

All big and proven benefits.


If physical activity could be bottled as a drug everyone would be taking it.

Make time for 5x half hour exercise sessions a week and everyone can realise those benefits.

Remarkable figures for our general health... but what about our joints?

 
First of all, the best advice following an acute, first-time injury to a joint is to rest it.

The key word there is ‘acute’. 

Get help if it's bad or if you're unsure. However, there's now more and more evidence that, beyond an acute injury, our approach to chronic pain needs to change.

 
So far I've written a  story about my own dodgy right hip, and added the stories of 800 people followed before and after joint replacement.

All of those people do better when they move more. Their stories, when wrapped together in a clinical research paper, do sound convincing.

However, no one should rely on evidence from a single story (n = 1) or from a single group of stories (n = 800).

We need to look at the stories from a large number of people with pain and a diagnosis of hip or knee osteoarthritis. 

And we need to compare a group of people who are active with a group who are not. Done methodically, better evidence emerges that we can really believe in and trust.


The latest published evidence.
 
A quick search for the latest published evidence reveals three main papers that look at osteoarthritis and physical activity.

These papers are the best out there. That's because they group together and analyse the results from many other well-done trials. So, in date order: 


There's this 2013 British Medical Journal (BMJ) paper that includes 60 clinical trials of 8,218 patients (44 knee, 2 hip and 14 mixed trials):

The paper concludes that ‘as of 2002 sufficient evidence had accumulated to show significant benefit of exercise over no exercise in patients with osteoarthritis’.


A 2014 Cochrane review of 9 trials of 549 people with hip osteoarthritis:

...proved that ‘exercise programmes can reduce pain and improve physical function.’


And this 2015 Cochrane review of 44 trials of 3537 participants with knee osteoarthritis:

...proved that ‘high‐quality evidence indicating that exercise reduced pain’. 

 
'Benefit', 'reduce pain..  improve' and 'reduced pain'. Those are some strong conclusions.


Indeed, the first BMJ paper concludes with the sort of definitive statement that I’ve not seen written in this sort of research article before. The authors prove there's a ‘significant benefit of exercise’ and that ‘further trials are unlikely to overturn this result’.


Often, we're used to reading such reports that end with a statement like ‘more research needed’ ...but not this time.

The results are conclusive. 

The authors go on to conclude that ‘combining exercises to increase strength, flexibility and aerobic capacity is likely to be most effective’. 


Mixing it up is best.

The authors got to that point by combining the results of 60 randomised control trials in their analysis from a search of 3,796 papers. That is sixty of the best from nearly 4,000 studies.

Their paper, therefore, sits at the pinnacle of a large group of high-quality studies. We should pay attention.

Thank you to everyone who has helped grow this newsletter to over 150 subscribers...


I've told the stories of 1 (me), then 800 and now 12,000 people with hip and knee pain. And how they all do better moving more. 

I hope that by sharing the latest evidence in this newsletter that I can begin to help maybe 1, perhaps 800, and who knows 12,000 people with joint pain. I strongly believe that a deeper understanding can help us all to do more with less pain.


For example, at the end of this issue let's give a nod to new Mums and Dads out there. Perhaps they're getting a first twinge of hip pain lugging about their new 15kg bundle of joy! For me, that's a massive red flag...

A deeper understanding of their hip or knee pain can only help. Please forward this email and nudge them to hit the Subscribe button below.

And they can catch up on my first 8 newsletters at www.danhwilliams.com/#subscribe