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Exercise Safety

Learn more about exercise tips for osteoarthritis for implementing the PEAK program.

In this article, you will learn more about exercise safety.

Bilateral knee symptoms

Many people with knee OA often have bilateral knee symptoms, thus many of the exercises in the PEAK program involve both knees simultaneously. Bilateral symptoms may be an indication for choosing such exercises over unilateral exercises.

Exercise Safety

We use the Exercise and Sports Science Australia stage 1 pre-exercise screening tool to screen our research participants to identify those who may be at increased risk of an adverse event during physical activity/exercise. You may wish to do this too. Irrespective of any screening processes you employ in your clinical practice, you should advise all patients to be on the lookout for any potential adverse symptoms of exercise and physical activity, such as chest pain, dizziness etc, and advise them what to do should such symptoms occur.

General points to remember:

  • Your patient should be advised that they may feel some knee pain/discomfort during the exercises and/or physical activity and that this is normal. There is information in the Exercise Booklet (available in the Resources section for learners who choose the course upgrade option) discussing this.
  • It is important that your patient understands that knee pain during exercise or, flare-ups afterward, are not an indication of worsening of OA.
  • If you consider that a specific exercise is aggravating your patient’s pain, then you may recommend a reduction in resistance, dosage, and/or level of exercise until the pain flare settles, or the aggravating exercise may be dropped from the program and replaced with an alternative less aggravating exercise.
  • If necessary, the entire strengthening exercise program may be ceased for a period of time if the pain flare or swelling is excessive. However, it is better for an individual exercise to be modified or ceased rather than the entire program stopped if possible.
  • Consider patient safety (in particular fall risk) when prescribing exercises, including the physical activity plan. Think about the furniture a patient may be using in their home (e.g. no chairs with wheels) as well as any floor coverings that may present trip hazards.
  • If an exercise involves an isometric component, your patient should be instructed on how to breathe through the exercise. Breath-holding must be avoided, as this may result in a significant increase in intra-thoracic and arterial blood pressures, increasing the strain on the heart.
  • Each movement should be done slowly and in a controlled manner.
  • It may be necessary to discuss appropriate footwear with any patient who is planning to increase walking or take up new activities.

Exercise and Video Consultations

To help you demonstrate the strengthening exercises to your patient, you can access a dedicated website This website contains a video demonstration of each of the PEAK strengthening exercises. You may wish to bookmark the exercise video website in your internet browser for quick access during video consultations. That way you can share your screen to play the video demonstration for your patient.

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Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis (PEAK)

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