Tag: neuromuscular exercise for osteoarthritis

A Complete Guide to the GLA:D® Canada Program for Knee and Hip Arthritis

If knee or hip arthritis has started making everyday activities harder, you are certainly not alone. The GLA:D® Canada Program for knee and hip osteoarthritis offers a structured approach that combines education, supervised exercise, and practical strategies to help people manage symptoms and stay active. At Sync Move Rehab Centre, the program is designed to help people understand their osteoarthritis, move with greater confidence, and build strength that can support everyday life.

Maybe stairs have become something you negotiate rather than simply climb. Perhaps getting out of a chair takes a little more effort than it used to. Or maybe a walk around the neighbourhood now comes with a mental calculation: “How far can I go before my knee starts complaining?”

Osteoarthritis can change the way people move, but it does not have to dictate everything they do.

The GLA:D® Canada Program takes a practical approach. Instead of treating movement as the enemy, it helps participants learn how to move more effectively, strengthen the muscles around the affected joint, and understand what they can do outside the clinic to manage their symptoms.

This guide explains what the GLA:D® Canada Program is, how it works, who may benefit from it, what the sessions involve, what the research says, and what you can expect if you are considering the program at Sync Move Rehab Centre in Thornhill, Ontario.

What Is the GLA:D® Canada Program?

GLA:D® stands for Good Life with osteoArthritis in Denmark. The program was originally developed in Denmark as an education and exercise program for people living with knee and hip osteoarthritis.

The Canadian version brings this approach to people across Canada through trained healthcare professionals.

According to GLA:D Canada, the program is built around three main components:

• Education about osteoarthritis and symptom management
• Supervised neuromuscular exercise
• Collection of outcome information to support quality monitoring and ongoing improvement

The current GLA:D Canada program guide describes two or three group education sessions followed by 12 tailored and supervised neuromuscular exercise sessions.

At Sync Move Rehab Centre, the program is delivered through physiotherapy care and includes an initial assessment, education, supervised exercise, strengthening, balance and movement training, and functional exercises that relate to everyday activities.

The idea is relatively simple:

Understand your condition. Learn how to move. Build strength. Practise those skills. Then use them in everyday life.

That sounds much more useful than simply being told, “Try to exercise more.”

Why Does Knee or Hip Osteoarthritis Make Movement Difficult?

Osteoarthritis is often described as a condition involving changes in the tissues within and around a joint.

But for someone living with it, the experience is much more personal.

It might mean:

• Pain when walking
• Stiffness after sitting
• Difficulty climbing stairs
• Trouble getting up from a chair
• Reduced confidence when moving
• Less participation in sports or hobbies
• Difficulty walking longer distances
• Avoiding activities because of fear that they will make the joint worse

And this can create an unfortunate cycle.

A person feels pain, so they move less.

They move less, so their muscles may become weaker.

The activity that once felt easy now feels harder.

Then they move even less.

It is almost as if the joint has hired a tiny security guard whose only job is to say, “Maybe don’t do that.”

The problem is that avoiding movement altogether is not usually the answer.

Appropriately selected exercise can be an important part of osteoarthritis management, and current evidence continues to support exercise for improving pain and physical function.

A major 2025 systematic review published in The BMJ analysed 217 randomized controlled trials involving 15,684 people with knee osteoarthritis. The researchers found that exercise interventions improved outcomes including pain, function, walking performance and quality of life, although the effectiveness varied between different types of exercise.

This is one reason structured programs such as GLA:D® Canada are receiving attention.

GLA:D® Canada Is Not Just an Exercise Class

One of the most important things to understand about the program is that it is not simply a group fitness class for people with sore knees.

The education component matters.

People with osteoarthritis often have questions such as:

“Am I damaging my knee when it hurts?”

“Should I stop exercising?”

“Why does my hip feel stiff in the morning?”

“Can exercise really help if my cartilage has changed?”

“Do I need surgery?”

“Is pain always a sign that I am making the condition worse?”

These questions are understandable.

Without clear information, it is easy to become afraid of movement.

The GLA:D® Canada approach gives participants information about osteoarthritis, treatment options, self-management, and the role of exercise. GLA:D Canada explains that its education sessions are designed to help people understand OA and remain as active as possible.

At Sync Move Rehab Centre, this education is combined with supervised physiotherapy so that information can be turned into practical action.

That combination is important.

Knowing that exercise is helpful is one thing.

Knowing which exercises to do, how to do them, how to progress them, and how to adapt them when symptoms change is something else entirely.

What Happens During the GLA:D® Canada Program?

The exact experience can vary depending on the individual, but the program at Sync Move follows the basic GLA:D® Canada structure.

Step 1: Your Initial Assessment

Before beginning the exercise portion, a physiotherapist assesses your condition and physical abilities.

This is not about deciding whether you are “fit enough.”

It is about understanding where you are starting.

The assessment can help the therapist determine whether the GLA:D® program is appropriate for you and how exercises should be adapted to your needs.

The GLA:D Canada program itself requires an assessment before participation so that a trained provider can determine whether the program is a suitable fit.

At Sync Move, the goal is also to understand what you want to improve.

Perhaps you want to walk farther.

Perhaps you want to climb stairs more easily.

Maybe you want to get back to recreational activities.

Or perhaps you simply want to be able to get up from your favourite chair without turning it into a small Olympic event.

Your goals matter.

Step 2: Education Sessions

Education sessions help participants understand osteoarthritis and how it can be managed.

Topics can include:

• What osteoarthritis is
• Common symptoms
• Factors that can influence symptoms
• The role of exercise
• Staying physically active
• Self-management strategies
• How to handle everyday activities
• Available treatment options

GLA:D Canada describes education as an important part of helping people understand OA and manage their symptoms while remaining active.

This information can also help replace fear with confidence.

Instead of thinking:

“My knee hurts, so I must stop.”

You may begin thinking:

“My knee hurts, so I need to understand what is happening and find the right way to keep moving.”

That is a very different mindset.

Step 3: Twelve Supervised Exercise Sessions

The standard GLA:D® Canada program includes 12 supervised neuromuscular exercise sessions.

At Sync Move Rehab Centre, these sessions are conducted twice a week over approximately six weeks, with each session lasting about 60 minutes.

The exercises are designed to improve things such as:

• Muscle strength
• Movement control
• Balance
• Joint stability
• Functional movement
• Confidence during physical activity

The exercises are not necessarily the same for every person.

That matters because two people can have the same diagnosis but very different abilities.

One person may comfortably walk several kilometres.

Another may struggle with stairs.

One person may have mild symptoms.

Another may have advanced osteoarthritis.

The goal is not to make everyone perform identical exercises at identical intensity.

The goal is to provide appropriate exercise and progress it according to the individual’s abilities.

What Is Neuromuscular Exercise?

The term “neuromuscular exercise” may sound intimidating, but the basic idea is easier to understand than the name suggests.

It is about helping your muscles and nervous system work together so that you can control your movements more effectively.

Think of it like driving.

Having a powerful engine is useful.

But if the steering wheel does not work properly, the experience becomes rather stressful.

Your body also needs both strength and control.

For someone with knee or hip osteoarthritis, training may involve practising movement patterns, balance, controlled weight shifting, strengthening and functional movements.

GLA:D Canada specifically describes neuromuscular exercises as part of its approach to helping participants improve joint stability and apply movement strategies to daily life.

This is one reason the program is different from simply handing someone a list of exercises and saying, “Good luck!”

Supervision gives participants the opportunity to learn the movements and receive guidance as they progress.

What Does the Research Say About GLA:D® Canada?

This is where things become particularly interesting.

GLA:D® Canada has collected outcome information from participants to understand how people respond to the program.

An earlier Canadian annual report included data from 3,803 people with hip or knee osteoarthritis in the GLA:D outcomes registry.

The report found significant improvements in pain at both three and 12 months.

At three months, more than 30% improvement in pain and/or zero pain was reported by 40.4% of participants with hip OA and 48.7% of participants with knee OA.

At 12 months, the corresponding figures were 44.4% for hip participants and 47.6% for knee participants.

The same report also found significant improvements in functional measures such as the 30-second sit-to-stand test and 40-metre walk test.

That is meaningful because osteoarthritis management is not only about reducing a number on a pain scale.

It is also about being able to do more.

Can you walk more comfortably?

Can you stand from a chair?

Can you manage stairs?

Can you participate in activities that matter to you?

Those are the questions that affect daily life.

What About Fear of Movement?

Pain can make people cautious.

Very cautious.

Sometimes appropriately so. Sometimes excessively.

If every painful movement is interpreted as evidence of damage, a person may gradually stop doing activities that are actually important for maintaining physical function.

The Canadian GLA:D report found substantial reductions in the proportion of participants who were afraid of damaging their joints.

At three months, the reduction was reported as 47% among hip participants and 50% among knee participants.

That does not mean everyone suddenly becomes fearless.

Rather, education and guided exercise may help people develop a better understanding of their symptoms and become more confident in movement.

And confidence can change behaviour.

A person who trusts their body more may be more willing to walk, exercise, participate in social activities, or return to hobbies.

Does GLA:D® Canada Cure Osteoarthritis?

No.

It is important to be clear about this.

The GLA:D® Canada Program is not a cure for osteoarthritis.

Osteoarthritis involves structural and biological changes in a joint, and no exercise program should promise to magically restore a joint to how it looked decades earlier.

The purpose of the program is different.

It focuses on helping people manage symptoms, improve physical function, become more confident with movement, and maintain an active lifestyle.

That distinction matters.

A good osteoarthritis program should not promise miracles.

It should provide realistic tools.

Can GLA:D® Canada Help Delay Joint Replacement?

For some people, improving strength, mobility, confidence and symptom management may help them remain active and potentially postpone the need for joint replacement.

But this should never be interpreted as a guarantee.

Some people with osteoarthritis will eventually need surgery.

Others may manage their symptoms for many years without it.

The decision depends on symptoms, function, individual circumstances, treatment response, medical assessment and personal goals.

The current GLA:D Canada program is designed for people with symptoms ranging from mild to severe, and Sync Move notes that it can also be appropriate for individuals preparing for or hoping to delay joint replacement surgery.

The important point is that exercise and education can be part of the treatment journey whether surgery is far away, being considered, or already scheduled.

What New Research Says About Exercise for Knee Osteoarthritis

Research continues to evolve.

One particularly important recent study was published in The BMJ in 2025.

Researchers reviewed 217 randomized controlled trials involving 15,684 people with knee osteoarthritis.

They compared different types of exercise, including aerobic exercise, strengthening, flexibility, neuromotor exercise and mixed exercise.

The researchers concluded that exercise can improve pain, physical function, walking performance and quality of life.

Aerobic exercise showed particularly strong overall results across several outcomes, while strengthening and mixed exercise were also associated with meaningful improvements in function. Neuromotor exercise showed benefits for gait performance.

Why is this relevant to GLA:D® Canada?

Because GLA:D® is not built around the idea that there is only one magic exercise.

Instead, it combines different elements of movement, strengthening, neuromuscular control and education.

The broader research therefore supports an important principle behind the program:

The right kind of movement can be part of effective osteoarthritis management.

Is Exercise Safe When You Have Arthritis?

This is one of the most common concerns.

People sometimes imagine that an arthritic joint should be treated like fragile glass.

But osteoarthritis management generally does not mean avoiding all loading and movement.

The type, amount and intensity of exercise matter.

A qualified physiotherapist can help determine appropriate exercises and adjust them according to your symptoms and abilities.

The 2025 BMJ review found no clear evidence of differences in safety between exercise interventions and control groups, although safety reporting was limited in the included research.

That last point is important: “exercise is beneficial” does not mean “every exercise is appropriate for every person.”

If an activity causes concerning symptoms, severe pain, significant swelling, or another unusual response, you should discuss it with an appropriate healthcare professional.

Who May Benefit From GLA:D® Canada?

The program may be appropriate for people experiencing:

• Knee osteoarthritis
• Hip osteoarthritis
• Pain while walking
• Difficulty climbing stairs
• Morning stiffness
• Difficulty getting up from a chair
• Reduced balance
• Reduced mobility
• Fear of movement
• Mild to advanced osteoarthritis
• Difficulty participating in recreational activities

Sync Move Rehab Centre states that the program is designed for people with both mild and more advanced knee or hip osteoarthritis, with suitability determined through assessment.

You do not have to be an athlete.

In fact, you do not need to be particularly athletic at all.

GLA:D® is designed for people who want to improve how they manage osteoarthritis.

Do You Need an X-Ray or Doctor’s Referral?

Requirements can vary by clinic and situation.

According to the information provided by Sync Move Rehab Centre, a doctor’s referral or X-ray is often not required to begin the program.

GLA:D Canada also notes that people interested in participating should contact their local clinic to confirm scheduling, pricing and referral requirements.

If you are considering the program at Sync Move, it is best to contact the centre directly so the current requirements can be confirmed for your individual situation.

What Makes the Program Different From Exercising at Home?

You could reasonably ask:

“Why can’t I just look up some knee exercises online?”

You can certainly find exercises online.

The problem is that information is not the same thing as individual guidance.

A generic video does not know:

• Your current strength
• Your movement pattern
• Your balance
• Your pain level
• Your goals
• Your previous injuries
• How you respond to exercise
• When an exercise should be progressed
• When it should be modified

Supervised exercise provides feedback.

It also creates structure.

And structure can be surprisingly powerful.

Most people know that exercise is good for them.

Knowing it and actually doing it twice a week are two very different things.

The Importance of Staying Active After the Program

Six weeks can be an excellent starting point.

But osteoarthritis does not disappear when the final supervised session ends.

The real goal is to develop skills and habits that continue beyond the formal program.

GLA:D Canada’s current guide describes the program as an approach that aims to improve movement, reduce symptoms and enhance quality of life, while encouraging continued physical activity.

Think of the program as learning to drive rather than taking a taxi.

You are not simply being transported somewhere.

You are learning skills you can use yourself.

What About Weight and Osteoarthritis?

Weight can be a sensitive topic, and it should be discussed respectfully.

For people who are overweight or living with obesity, weight management may be one part of a broader osteoarthritis strategy.

But it should not be framed as:

“Lose weight and your problem is solved.”

It is much more complicated than that.

Pain can make exercise difficult.

Limited movement can make weight management difficult.

And frustration can make both harder.

A good rehabilitation approach considers the whole person rather than reducing everything to a number on a scale.

GLA:D Canada includes weight management among the broader educational topics relevant to people living with hip and knee osteoarthritis.

GLA:D® Canada and Quality of Life

Pain matters.

But pain is not the only thing that matters.

Imagine two people who both report a knee pain score of 5 out of 10.

One can still walk to the shops, climb stairs, garden and play with their grandchildren.

The other has stopped doing nearly all of those activities.

Their pain score may be similar, but their lives are very different.

This is why functional outcomes and quality of life are important.

Canadian GLA:D data have shown improvements in functional performance alongside improvements in pain. Participants also reported high levels of satisfaction with the program. In the Canadian annual report, 84% of hip participants and 87% of knee participants described the program as beneficial, while 81% of hip participants and 86% of knee participants reported being satisfied.

These numbers do not mean every participant gets the same result.

They do, however, show why structured rehabilitation deserves consideration.

What Can You Expect at Sync Move Rehab Centre?

At Sync Move Rehab Centre, the GLA:D® Canada journey starts with an assessment.

The team then combines education and supervised exercise to help you understand your condition and develop better movement strategies.

According to Sync Move’s program information, participants receive:

• A comprehensive initial physiotherapy assessment
• Education about osteoarthritis
• Supervised neuromuscular exercise
• Progressive strengthening
• Balance and movement training
• Functional exercises
• Progress monitoring

Exercises are modified according to individual ability, fitness level and symptoms.

Sync Move serves people in Thornhill and surrounding communities including Markham, Richmond Hill, Vaughan and North York.

If you are interested in learning whether the program is appropriate for you, you can explore the GLA:D® Canada Program at Sync Move Rehab Centre.

What Should You Ask Before Starting?

It is perfectly reasonable to have questions.

Before beginning a program, you might want to ask:

1. Is GLA:D® Canada appropriate for my symptoms?
2. Do I need a referral?
3. How often are sessions held?
4. What does the program cost?
5. Does my extended health insurance cover the physiotherapy component?
6. Can exercises be modified if I have difficulty with certain movements?
7. What should I do if my symptoms increase?
8. What should I continue doing after the program ends?

According to Sync Move, many extended health insurance plans may cover physiotherapy services associated with GLA:D®, although coverage depends on the individual’s policy.

It is always worth checking directly with your insurer.

GLA:D® Canada: A Practical Approach to Living With Osteoarthritis

Perhaps the biggest strength of the GLA:D® Canada approach is that it does not treat osteoarthritis as a problem that can be solved by one single intervention.

Instead, it combines several useful pieces.

Education helps you understand what is happening.

Exercise helps you build physical capacity.

Neuromuscular training helps you practise controlled movement.

Physiotherapy guidance helps make the exercises appropriate for you.

Ongoing self-management helps you take those skills into everyday life.

And that last part may be the most important.

Your life does not happen inside a physiotherapy clinic.

It happens on sidewalks, stairs, grocery-store aisles, kitchens, parks, offices, gardens and living rooms.

The best rehabilitation program is therefore one that helps you function better in the real world.

Frequently Asked Questions About GLA:D® Canada

Is GLA:D® Canada only for older adults?

No. Osteoarthritis can affect people at different ages, and the program is not restricted to one age group. Suitability depends on the individual’s symptoms and assessment.

Can people with severe knee osteoarthritis participate?

The program can be appropriate for people with mild, moderate or severe knee or hip osteoarthritis. A trained clinician should assess whether it is suitable for you.

Does GLA:D® Canada replace surgery?

No. It is a non-surgical management program. Some people may use rehabilitation to manage symptoms and function, while others may participate before or after joint replacement.

Does GLA:D® Canada cure arthritis?

No. The goal is symptom management, improved function, movement confidence and long-term physical activity.

How long does the program take?

At Sync Move Rehab Centre, the program typically includes education sessions and 12 supervised exercise sessions over approximately six weeks.

Do I have to be physically fit before joining?

No. The exercises can be adapted to your abilities and symptoms.

Is the program suitable for hip osteoarthritis?

Yes. GLA:D® Canada is specifically designed for people with hip and knee osteoarthritis.

Can exercise make arthritis worse?

The appropriate amount and type of exercise should be selected according to your condition. A physiotherapist can help you understand how to exercise safely and modify movements when necessary.

Where can I learn more about GLA:D® Canada?

You can read more about the program through the official GLA:D Canada website and learn about the local program through Sync Move Rehab Centre.

Final Thoughts

Living with knee or hip osteoarthritis does not mean you have to put your favourite activities into a museum and admire them from a distance. The right approach can help you stay involved in the things that make everyday life enjoyable.

The GLA:D® Canada Program for knee and hip osteoarthritis combines education, supervised exercise, movement training and self-management rather than relying on one solution. Research from Canada has reported improvements in pain and function among participants, while newer international research continues to support exercise as an important part of knee osteoarthritis management.

If knee or hip osteoarthritis is affecting your walking, stairs, balance, strength or confidence, Sync Move Rehab Centre can help you explore whether GLA:D® Canada is appropriate for your situation. Visit the GLA:D® Canada Program page at Sync Move Rehab Centre to learn more and take the next step toward moving with greater confidence.

References

1. GLA:D Canada. What is GLA:D™ Canada?
   https://gladcanada.ca/what-is-glad-canada/
2. GLA:D Canada. Education and Exercise.
   https://gladcanada.ca/what-is-glad-canada-2/
3. GLA:D Canada. How to Participate in GLA:D™ Canada.
   https://gladcanada.ca/how-to-participate-in-glad-canada/
4. GLA:D Canada. Managing Hip and Knee Osteoarthritis.
   https://gladcanada.ca/
5. GLA:D Canada. Getting Started with the GLA:D™ Canada Program Guide, 2026.
   https://gladcanada.ca/wp-content/uploads/2026/01/Getting_Started_with_GLAD_v12Jan2026_FINAL.pdf
6. GLA:D Canada. 2019 Annual Report – Implementation and Outcomes.
   https://gladcanada.ca/wp-content/uploads/2020/06/2019-GLAD-Canada-Annual-Report_Implementation-and-Outcomes_June-2020-Final.pdf
7. GLA:D Canada. Accessing Database.
   https://gladcanada.ca/data/
8. GLA:D Canada. Learning About Osteoarthritis.
   https://gladcanada.ca/learning-network/
9. Yan L, et al. Comparative efficacy and safety of exercise modalities in knee osteoarthritis: systematic review and network meta-analysis. The BMJ. 2025.
   https://www.bmj.com/content/391/bmj-2025-085242
10. PubMed. Comparative efficacy and safety of exercise modalities in knee osteoarthritis.
    https://pubmed.ncbi.nlm.nih.gov/41093618/
11. The BMJ. Exercise for people living with knee osteoarthritis. 2025.
    https://www.bmj.com/content/391/bmj.r2281
12. Sync Move Rehab Centre. GLA:D® Canada Program for Knee & Hip Osteoarthritis.
    https://syncmove.ca/services/glad-canada-program/