What activities are recommended for a 65-year-old male patient with osteoarthritis (OA) of the right knee, experiencing 7/10 pain, and having a past medical history of osteoarthritis (OA), acute medial meniscal tear, Chronic Kidney Disease (CKD) stage 2, hypothyroidism, Benign Prostatic Hyperplasia (BPH), and generalized chronic pain, who is Non-Known Drug Allergic (NKDA)?

From the Guidelines

For a 65-year-old male with osteoarthritis of the right knee causing 7/10 pain, I would recommend low-impact aerobic activities such as swimming, water aerobics, stationary cycling, or walking on level surfaces, as supported by the 2020 American College of Rheumatology guideline 1 and the 2021 US Department of Veterans Affairs/US Department of Defense clinical practice guideline 1. These exercises should be performed 3-5 times weekly for 20-30 minutes per session, gradually increasing duration as tolerated. Strength training focusing on quadriceps, hamstrings, and hip muscles twice weekly would also be beneficial, using light resistance with 10-15 repetitions per set, as recommended by the EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis 1. Before exercise, the patient should apply heat to the knee for 15-20 minutes to improve flexibility, and afterward use ice for 15-20 minutes to reduce inflammation. Daily gentle range-of-motion exercises are important to maintain joint mobility. These activities are recommended because they strengthen supporting muscles around the knee joint without excessive impact, potentially reducing pain and improving function. The patient should stop any activity that significantly increases pain and consult his healthcare provider about appropriate pain management strategies, which might include acetaminophen or topical NSAIDs, considering his CKD stage 2 which may limit systemic NSAID use, as noted in the 2003 EULAR recommendations 1. Weight loss may also be beneficial for overweight or obese patients with knee OA, as it can help reduce cumulative loading to the lower extremity joints, as suggested by the 2020 American College of Rheumatology guideline 1 and the 2021 US Department of Veterans Affairs/US Department of Defense clinical practice guideline 1. It is essential to consider individual preferences, access, and affordability when recommending exercise programs, as emphasized by the 2020 American College of Rheumatology guideline 1 and the 2019 American College of Rheumatology/Arthritis Foundation guideline 1. Overall, a comprehensive approach to managing osteoarthritis of the knee should include a combination of non-pharmacological and pharmacological treatments, as recommended by the EULAR recommendations for the management of knee osteoarthritis 1 and the 2003 EULAR recommendations 1.

From the Research

Recommended Activities for Osteoarthritis Management

For a 65-year-old male patient with osteoarthritis of the right knee causing 7/10 pain, and considering his past medical history, the following activities are recommended:

• Exercise therapy: This is a first-line management approach for osteoarthritis, as stated in 2 and 3. It can help improve joint function and reduce pain.
• Weight loss (if overweight): This can help reduce the strain on the knee joint and improve symptoms, as mentioned in 2 and 3.
• Education and self-management programs: These can empower patients to better manage their condition, as stated in 2 and 3.
• Physical exercise, such as hip and knee strengthening exercises: These can help improve joint function and reduce pain, as mentioned in 2.

Considerations for Activity Selection

When selecting activities for this patient, the following considerations should be taken into account:

• The patient's level of pain and disability: Activities should be tailored to the patient's individual needs and abilities, as stated in 4.
• The patient's past medical history: The patient's history of osteoarthritis, acute medial meniscal tear, CKD stage 2, hypothyroidism, BPH, and generalized chronic pain should be considered when selecting activities, as mentioned in the patient's profile.
• The potential risks and benefits of different activities: Activities that may exacerbate the patient's condition, such as high-impact exercises, should be avoided, as stated in 2 and 3.

Additional Recommendations

Additional recommendations for this patient include:

• Avoiding activities that may worsen the condition, such as high-impact exercises or activities that involve excessive knee bending, as mentioned in 4.
• Using assistive devices, such as canes or walkers, to reduce strain on the knee joint, as stated in 2.
• Considering alternative therapies, such as acupuncture or physical therapy, to help manage pain and improve function, as mentioned in 3.