Lifestyle Medicine and Osteoarthritis in Viet Nam: Therapeutic Exercise, Weight Management, and When Medical Treatment Is Needed

Lifestyle Medicine and Osteoarthritis in Viet Nam: Therapeutic Exercise, Weight Management, and When Medical Treatment Is Needed

Primary category: Evidence & Clinical Practice

Secondary category: Lifestyle Medicine in Viet Nam

Article type: VLMA Perspective

Last reviewed: October 30, 2026

A person with knee osteoarthritis may find that getting up from a chair, climbing stairs, or walking for longer periods has become increasingly difficult. Their healthcare professional may recommend exercise, weight management, and avoiding activities that aggravate symptoms. The advice may be appropriate, but putting it into practice can be challenging when movement itself causes pain.

Another person may have considerable changes on an X-ray yet remain physically active with relatively little discomfort. Someone else may experience persistent pain and difficulty with everyday activities despite less extensive changes on imaging. These differences illustrate why osteoarthritis cannot be understood simply as worn-out cartilage or managed according to an X-ray result alone.

Pain, muscle strength, physical function, associated medical conditions, and personal circumstances all influence how people experience the disease. Treatment therefore needs to address more than the structural changes occurring within a joint.

Evidence-based Lifestyle Medicine can contribute to osteoarthritis care through appropriate physical activity, weight management when indicated, behavior-change support, and attention to factors that influence symptoms and everyday functioning. However, these approaches are not substitutes for individualized rehabilitation or medical treatment.

Some patients need medication to control pain and participate in exercise. Others may benefit from assistive devices, supervised rehabilitation, or specialist assessment. When symptoms remain severe despite appropriate non-surgical care, surgery may become an important option.

The challenge is to understand how these interventions work together without suggesting that lifestyle changes can reverse established joint degeneration or that everyone with osteoarthritis should follow the same treatment plan.

For the Vietnam Lifestyle Medicine Alliance (VLMA), osteoarthritis provides a useful opportunity to examine how evidence-based Lifestyle Medicine can support comprehensive care while recognizing the importance of clinical assessment, rehabilitation, appropriate medical treatment, and shared decision-making.

Osteoarthritis Is More Than Joint Wear and Tear

Osteoarthritis is often described as an inevitable consequence of aging and joint wear. Although aging and mechanical loading contribute to the condition, this explanation does not fully reflect its biological complexity.

Osteoarthritis involves changes in multiple joint tissues, including cartilage, subchondral bone, synovium, ligaments, and surrounding structures. Its development and progression may be influenced by previous injury, excess body weight, joint alignment, genetics, occupational exposures, muscle function, and other individual factors.

The knees, hips, and hands are commonly affected, but symptoms and functional limitations vary considerably. One person may struggle to rise from a chair, while another has difficulty gripping objects or performing tasks requiring fine hand movements.

Structural changes visible on imaging do not always correspond closely to the intensity of pain or the degree of disability. Treatment decisions should therefore consider the patient's clinical presentation rather than rely on imaging findings alone.

The National Institute for Health and Care Excellence guideline NG226, published in October 2022, recommends diagnosing osteoarthritis clinically without routine imaging in people aged 45 years or older who have activity-related joint pain and either no morning stiffness or stiffness lasting no longer than 30 minutes.

This recommendation applies to typical clinical presentations. Imaging or further investigation may still be appropriate when symptoms are atypical, another condition is suspected, or additional information is needed for clinical decisions.

Not every painful joint has osteoarthritis. Inflammatory arthritis, infection, fracture, crystal-associated arthritis, and other conditions may present with overlapping symptoms. A suddenly hot or swollen joint, fever, significant trauma, inability to bear weight, or rapid deterioration requires appropriate medical assessment rather than routine lifestyle advice.

Once osteoarthritis has been diagnosed, understanding its effects on the person's daily life becomes central to treatment planning.

For someone who works on their feet, improvement may mean completing a working day with less discomfort. An older adult may want to walk safely, climb stairs, or remain independent at home. A person with hand osteoarthritis may be more concerned about preparing meals, writing, or handling everyday objects.

These goals help determine what successful treatment should achieve and whether the proposed interventions are making a meaningful difference.

Therapeutic Exercise as a Foundation of Treatment

Therapeutic exercise is consistently recommended as a core intervention for osteoarthritis, particularly when selected and adapted to individual needs.

The American College of Rheumatology's September 2026 guideline update continues to emphasize exercise, self-management, appropriate weight management, and shared decision-making as central components of care for osteoarthritis of the knee, hip, and hand.

The National Institute for Health and Care Excellence similarly recommends offering individualized therapeutic exercise, including local muscle strengthening and general aerobic fitness.

The European Alliance of Associations for Rheumatology reinforced the importance of physical activity in its 2025 update, published in April 2026. These recommendations emphasize promoting appropriate physical activity, reducing sedentary behavior, and considering individual capabilities, preferences, and circumstances.

Therapeutic exercise, however, is not simply another way of telling patients to exercise more.

An individualized program considers which joints are affected, the person's symptoms, muscle strength, mobility, balance, functional limitations, associated medical conditions, and treatment goals. Activities are selected and progressed according to clinical needs and the patient's response.

For knee osteoarthritis, strengthening the muscles supporting the joint may improve functional performance during walking, stair climbing, and rising from a chair. People with hip osteoarthritis may benefit from exercises addressing hip muscle strength, mobility, and functional movement.

Hand osteoarthritis requires different considerations because pain and stiffness can affect grip strength, dexterity, and everyday hand use. Exercise and rehabilitation strategies should reflect the affected joints and the activities the person wants to maintain.

Programs may combine resistance training, aerobic activity, balance exercises, mobility work, and functional movements. No single combination is appropriate for every patient, and different approaches may be needed as symptoms and physical capacity change.

Some people benefit from supervised rehabilitation, particularly when pain, weakness, disability, or uncertainty makes independent exercise difficult. Others may be able to follow a suitable home-based program after receiving appropriate assessment and instruction.

The choice depends on clinical needs, safety, feasibility, and the level of professional support required.

Exercise can improve pain and function even when structural changes in the joint remain. Patients should therefore understand that meaningful improvement does not necessarily involve cartilage regeneration or reversal of established joint abnormalities.

Lifestyle Medicine shares an emphasis on physical activity and sustained behavior change, while therapeutic rehabilitation remains a clinical intervention requiring appropriate professional competence and supervision when indicated.

When Exercise Causes Pain

One of the most common concerns among people with osteoarthritis is whether exercise will make their joints worse.

Pain during movement can understandably create fear of additional damage. Someone who experiences knee pain while walking may begin avoiding stairs, longer distances, or activities involving repeated knee bending.

Over time, reduced activity can contribute to muscle weakness and poorer physical conditioning, making everyday activities increasingly difficult.

The National Institute for Health and Care Excellence acknowledges that pain or discomfort may initially increase when therapeutic exercise begins. Its guidance also emphasizes that regular, consistent exercise can improve pain, physical function, and quality of life over time.

This does not mean that patients should ignore pain or continue exercising regardless of symptoms.

Temporary, familiar discomfort during an appropriately selected activity does not necessarily indicate further joint damage. However, substantial or persistent worsening of pain, marked swelling, new instability, inability to bear weight, or other concerning changes should prompt reassessment.

The appropriate response may involve adjusting exercise intensity, duration, movement selection, or progression. During a symptomatic flare, modifying activities and addressing pain may be more suitable than maintaining the same exercise schedule.

A person with significant knee pain may initially tolerate shorter walking sessions or carefully selected strengthening exercises more comfortably than prolonged walking or repeated stair climbing.

The objective is neither to avoid all discomfort nor to encourage patients to push through severe pain. It is to identify an appropriate level of activity that can be maintained and gradually progressed.

Clear communication can make an important difference. Telling someone simply to exercise despite pain may increase anxiety or discourage participation. Explaining why particular movements are recommended, which symptoms may be expected, and when adjustments or reassessment are necessary can help build confidence.

Behavior-change support becomes especially relevant when someone has avoided activity for a prolonged period. Knowing that exercise is beneficial is not always enough. Patients also need a plan that feels manageable, addresses their concerns, and fits their daily lives.

For healthcare professionals, this means considering not only which exercises are appropriate, but also what will help the patient begin, continue, and adapt the program safely over time.

Weight Management Without Compromising Muscle Health

Weight management is an important consideration for people with knee or hip osteoarthritis who are living with overweight or obesity.

Excess body weight increases mechanical demands on weight-bearing joints. Adipose tissue may also contribute through metabolic and inflammatory pathways relevant to osteoarthritis.

For appropriately selected patients, weight reduction can improve pain, physical functioning, and quality of life.

The National Institute for Health and Care Excellence recommends supporting weight loss in people with osteoarthritis who have overweight or obesity. Its guidance explains that any amount of weight reduction is likely to be beneficial, while losing approximately 10% of initial body weight is likely to provide greater benefits than losing 5%.

These figures are useful reference points for shared decision-making, not mandatory targets for every patient.

Age, nutritional status, muscle mass, associated medical conditions, treatment preferences, and the ability to sustain changes all influence the appropriate approach.

Weight loss should not be recommended automatically to everyone with osteoarthritis. Patients who are underweight, nutritionally depleted, or experiencing muscle wasting may require a different nutritional strategy.

This is particularly important for older adults. Excessive dietary restriction without attention to adequate nutrition and muscle-strengthening activity may contribute to loss of lean tissue and declining physical capacity.

A patient who loses weight but becomes weaker may not achieve the functional improvement that treatment was intended to produce.

Weight management and therapeutic exercise should therefore be considered complementary rather than interchangeable. Reducing excess weight may help relieve symptoms, while preserving muscle strength remains important for mobility, balance, and independence.

In Viet Nam, dietary counseling should also reflect familiar foods, family eating patterns, affordability, and individual medical needs. Effective nutritional care does not necessarily require replacing Vietnamese meals with an imported dietary pattern.

The goal is to support appropriate weight-related improvements while maintaining nutritional adequacy, muscle function, and sustainable habits.

New Evidence on Weight-Loss Medicines and Knee Osteoarthritis

An important development in osteoarthritis management concerns the potential role of medicines used to treat obesity.

On September 14, 2026, the American College of Rheumatology announced updated recommendations for osteoarthritis of the knee, hip, and hand. Among the changes was a conditional recommendation concerning glucagon-like peptide-1 receptor agonists for people with knee osteoarthritis and obesity.

The recommendation supports considering these medicines, when clinically appropriate, to help achieve an optimal weight in combination with diet and exercise.

A conditional recommendation does not mean that treatment should be prescribed routinely to everyone with knee osteoarthritis. It indicates that the potential benefits and harms need to be considered in the context of the patient's clinical circumstances, preferences, contraindications, treatment burden, cost, and access.

An important contribution to the evidence came from the STEP 9 randomized clinical trial, published in The New England Journal of Medicine on October 30, 2024.

The trial enrolled 407 adults with obesity and clinically and radiologically confirmed knee osteoarthritis associated with moderate-to-severe pain. Participants received once-weekly semaglutide or placebo over 68 weeks, alongside counseling on physical activity and a reduced-calorie diet.

The average reduction in body weight was 13.7% in the semaglutide group compared with 3.2% in the placebo group.

Knee pain also improved more in the semaglutide group. The average reduction in the Western Ontario and McMaster Universities Osteoarthritis Index pain score was 41.7 points compared with 27.5 points in the placebo group. Physical functioning, assessed using a general health survey, also improved more among participants receiving semaglutide.

These findings suggest that effective obesity treatment may provide meaningful benefits for selected patients with symptomatic knee osteoarthritis.

Both treatment groups, however, experienced improvements in pain. The trial does not establish that semaglutide regenerates cartilage, directly reverses the underlying joint pathology, or cures osteoarthritis. It also does not determine how much of the observed improvement resulted from weight loss rather than other potential mechanisms.

The study population deserves attention. Participants had a mean body mass index of approximately 40, and more than 80% were women. The findings should not automatically be generalized to people without obesity, those with hip or hand osteoarthritis, or patients with substantially different clinical characteristics.

Adverse effects and treatment discontinuation are also relevant. Gastrointestinal problems were among the most common reasons for stopping treatment. Longer-term decisions require consideration of individual benefits, risks, costs, and the potential need for continued obesity management.

For healthcare professionals in Viet Nam, international trial findings and professional recommendations do not independently establish an approved indication, product registration, reimbursement entitlement, or legal prescribing authorization.

Any use of prescription weight-management medicines must reflect appropriate clinical assessment, the current regulatory status and approved information of the specific product, and the responsibilities of the prescribing healthcare professional.

Lifestyle Medicine can contribute through nutritional care, physical activity, and behavior-change support, but these interventions should complement rather than replace appropriately indicated medical obesity treatment.

Pain Relief and Medical Treatment Remain Important

A common misunderstanding is that evidence-based Lifestyle Medicine requires patients to avoid medication whenever possible.

That is not the objective of comprehensive osteoarthritis care. Pain can interfere with sleep, movement, rehabilitation, employment, and daily functioning. When symptoms prevent someone from participating in appropriate exercise, effective pain management may help the person engage in a broader treatment plan.

The American College of Rheumatology's 2026 guidance continues to recognize pharmacological and nonpharmacological interventions as complementary components of individualized care.

Topical nonsteroidal anti-inflammatory medicines are an established option for knee osteoarthritis and may also be considered for selected patients with hand osteoarthritis.

Oral nonsteroidal anti-inflammatory medicines can provide symptom relief, but their use requires careful consideration of gastrointestinal, kidney, cardiovascular, and other risks.

These concerns are particularly relevant for older adults and patients with chronic kidney disease, hypertension, cardiovascular disease, previous gastrointestinal bleeding, or multiple medications.

The appropriate medicine, dose, duration, gastroprotective treatment when indicated, and monitoring requirements should be determined through clinical assessment.

Intra-articular corticosteroid injections may provide short-term symptom relief for selected patients, particularly when other treatments are ineffective or unsuitable. Their benefits are generally time-limited, and decisions about injections should consider the diagnosis, affected joint, clinical risks, procedural requirements, and treatment goals.

For hip osteoarthritis, image-guided injection may be appropriate when an intra-articular corticosteroid injection is indicated. Such procedures require the relevant professional expertise and clinical arrangements.

Injections should not be described as permanently reversing joint degeneration.

Medication can help control symptoms, but it does not remove the need for reassessment when the clinical picture changes. A suddenly swollen, hot, or severely painful joint may indicate infection, inflammatory disease, crystal-associated arthritis, or another condition requiring specific treatment.

Pain management should support physical function and rehabilitation while minimizing avoidable adverse effects and unnecessary treatment burden.

The appropriate balance between medication and nonpharmacological care will differ between patients and may change over time.

Supplements and Regenerative Treatment Claims Require Caution

People living with osteoarthritis frequently encounter advertisements for supplements, injections, and other products described as rebuilding cartilage, lubricating joints, or reversing degeneration.

Such claims may involve glucosamine, chondroitin, collagen preparations, herbal products, or interventions promoted as regenerative medicine.

The evidence supporting these approaches varies, and professional guidelines do not always reach identical conclusions.

The American College of Rheumatology's September 2026 update strongly recommends against glucosamine, chondroitin, and their combination for osteoarthritis of the knee, hip, and hand.

This represents a change from its 2019 guideline, which had conditionally supported chondroitin sulfate for hand osteoarthritis while recommending against its use for knee and hip osteoarthritis.

The National Institute for Health and Care Excellence also recommends against offering glucosamine for osteoarthritis management.

The 2026 United States Department of Veterans Affairs and Department of Defense guideline takes a different approach. After reviewing available evidence, it concluded that there was insufficient evidence to recommend either for or against several dietary supplements and nutraceuticals, including glucosamine, chondroitin, collagen, and selected other preparations, for hip and knee osteoarthritis.

This does not mean that these products have demonstrated reliable clinical benefits. It reflects limitations in the available evidence and uncertainty about the balance of potential benefits and harms.

The distinction matters. A recommendation against an intervention and a conclusion that evidence is insufficient are not identical, but neither justifies broad claims of effectiveness.

Healthcare professionals should also consider product variability, potential adverse effects, interactions with prescribed medicines, and treatment costs.

Similar caution is necessary when discussing intra-articular hyaluronic acid, platelet-rich plasma, cell-based interventions, and other procedures promoted as regenerative therapies.

Some of these approaches have been investigated in clinical studies, but their evidence base, indications, expected benefits, and professional recommendations differ.

For example, the National Institute for Health and Care Excellence recommends against intra-articular hyaluronan injections for osteoarthritis. In contrast, the 2026 United States Department of Veterans Affairs and Department of Defense guideline concluded that the evidence was insufficient to recommend either for or against viscosupplementation injections for persistent knee osteoarthritis pain when other interventions have not provided adequate relief.

The same guideline found insufficient evidence to recommend either for or against platelet-rich plasma injections for knee or hip osteoarthritis.

These differences demonstrate why recommendations should be interpreted according to the specific intervention, joint, patient population, and evidence reviewed.

The existence of a clinical study or commercial product does not, by itself, establish that an intervention is effective, appropriate for routine care, or authorized for a particular use in Viet Nam.

Claims of reliable cartilage regeneration, permanent reversal of osteoarthritis, or guaranteed avoidance of joint replacement require particularly strong evidence.

For professional education, the priority should be helping healthcare workers distinguish established treatments from interventions with uncertain benefits, limited evidence, or unresolved safety questions.

Knowing When Specialist Assessment or Surgery Is Appropriate

Not everyone with osteoarthritis achieves satisfactory symptom relief through exercise, weight management, assistive devices, and medication.

Some patients continue to experience substantial pain, progressive functional limitation, deformity, or significant difficulty performing everyday activities despite appropriate non-surgical care.

In these circumstances, specialist assessment may be necessary.

The National Institute for Health and Care Excellence recommends considering referral for joint replacement when osteoarthritis symptoms substantially affect quality of life and non-surgical management has been ineffective or unsuitable.

Referral decisions should be based on clinical assessment rather than imaging findings or numerical severity scores alone.

The guideline also advises against excluding patients from referral solely because of age, sex or gender, smoking status, comorbidities, or body mass index.

These factors may still influence surgical risk, preparation, and the suitability of a particular procedure. However, they should not automatically prevent a person from receiving appropriate specialist evaluation.

Someone with severe knee osteoarthritis who continues to experience substantial pain and loss of function despite appropriate treatment should not be expected to continue ineffective lifestyle interventions indefinitely before specialist assessment.

At the same time, extensive radiographic changes do not automatically mean that joint replacement is necessary.

The decision should consider symptoms, functional limitations, medical conditions, previous treatment, patient preferences, expected outcomes, and potential complications.

Lifestyle Medicine can remain relevant before and after surgery through appropriate physical activity, nutrition, smoking cessation, and management of associated conditions.

These approaches should complement the assessment, treatment, and rehabilitation provided by appropriately authorized surgical and rehabilitation teams.

Surgery should not be viewed as a failure of Lifestyle Medicine. For selected patients, it is an appropriate part of comprehensive osteoarthritis care.

Treatment Must Reflect the Affected Joint and the Individual Patient

Although osteoarthritis is often discussed as one condition, treatment needs differ between the knee, hip, and hand.

Knee osteoarthritis may limit walking, stair climbing, squatting, or standing for prolonged periods. Hip osteoarthritis may interfere with mobility, dressing, and activities requiring hip movement. Hand osteoarthritis can make gripping, writing, opening containers, and other fine motor tasks difficult.

These differences influence which exercises, assistive devices, rehabilitation strategies, and medical treatments may be suitable.

A person with knee osteoarthritis may benefit from a walking aid or appropriately selected knee brace in certain circumstances. Someone with hand osteoarthritis may require joint protection strategies, ergonomic adjustments, or a suitable hand orthosis.

The American College of Rheumatology's September 2026 update also introduced a conditional recommendation concerning methotrexate for selected patients with erosive hand osteoarthritis.

This recommendation is relevant to a distinct clinical presentation and represents a change from the organization's 2019 guidance. It should not be generalized to routine knee, hip, or non-erosive hand osteoarthritis.

Methotrexate has important potential adverse effects and monitoring requirements. Its use in this context requires specialist clinical judgment, discussion of the benefits and uncertainties, and consideration of the medicine's regulatory status and applicable prescribing requirements in Viet Nam.

The recommendation also illustrates how rapidly evidence and professional guidance can evolve. It does not mean that all forms of osteoarthritis should be managed with disease-modifying medicines.

Associated medical conditions further influence treatment decisions.

A patient with chronic kidney disease may have limited options for certain pain medicines. Someone with cardiovascular disease may require additional precautions. An older person with frailty or a history of falls may need rehabilitation emphasizing strength, balance, and safe mobility.

These factors are reasons to individualize treatment, not necessarily reasons to avoid exercise or other potentially beneficial interventions.

Care may involve primary care physicians, rheumatologists, orthopedic surgeons, physical medicine and rehabilitation specialists, physiotherapists, occupational therapists, clinical nutrition professionals, nurses, pharmacists, and other qualified practitioners according to the patient's needs.

Their involvement should reflect their professional competence and legally authorized responsibilities.

A coordinated approach helps clarify which problems require medical treatment, which interventions need professional supervision, and how patients can participate safely in their care.

Making Osteoarthritis Care Practical in Viet Nam

International clinical guidelines provide important scientific evidence, but implementing their recommendations depends on the realities of healthcare delivery and the circumstances of individual patients.

Someone may be advised to attend supervised rehabilitation but struggle to make regular appointments because of travel distance, transportation costs, work commitments, or the availability of suitable services.

An older patient may avoid exercise because of previous falls or concern that movement will worsen joint damage. Another person may understand the benefits of weight management but find that recommended dietary changes do not fit household meals or available resources.

These difficulties do not necessarily mean that patients are unwilling to improve their health. They may indicate that the treatment plan needs to be adapted.

In Viet Nam, rehabilitation services, specialist availability, equipment, and referral arrangements may differ between healthcare facilities and localities. The extent and consequences of these differences should be assessed using local evidence rather than assumed.

Some patients may benefit from supervised rehabilitation, while others may be able to follow an appropriate home-based program with suitable instruction and follow-up.

Healthcare professionals should consider what the person can realistically do and what support is available.

For someone who has avoided walking because of pain, a carefully explained starting plan may be more useful than a recommendation to achieve a fixed daily step target immediately.

For a patient whose work involves prolonged standing, heavy lifting, or repetitive joint loading, occupational adjustments may deserve attention alongside exercise and medication.

The European Alliance of Associations for Rheumatology's updated recommendations for nonpharmacological management of hip and knee osteoarthritis emphasize individualized care that considers daily activities, employment, personal circumstances, and the social environment.

This approach is relevant to Viet Nam because treatment needs to be both clinically appropriate and realistically achievable.

A recommendation that is scientifically sound but unaffordable, inaccessible, or incompatible with the patient's circumstances may require adaptation.

For Lifestyle Medicine, the distinction between recommending a healthier behavior and helping someone adopt it is especially important.

This does not mean compromising the clinical standards needed for safe care. It means recognizing the practical barriers that affect participation and working with patients to identify appropriate alternatives.

Measuring Outcomes That Matter to Patients

Pain reduction is an important outcome in osteoarthritis management, but it is not the only measure of successful care.

A patient may report modest improvement in pain while becoming more confident walking or participating in daily activities. Another may experience less pain but continue to struggle with stairs or rising from a chair because of muscle weakness.

These differences should influence treatment review.

Relevant outcomes may include pain intensity, physical function, walking ability, mobility, participation in daily activities, quality of life, treatment burden, and adverse effects.

For one person, meaningful improvement may be returning to work without frequent interruptions from pain. For another, it may be preparing meals independently, sleeping with less discomfort, or being able to take part in family activities again.

Validated patient-reported outcome measures can help clinicians assess changes more consistently.

The Western Ontario and McMaster Universities Osteoarthritis Index is widely used in osteoarthritis research to evaluate pain, stiffness, and physical function. Other validated instruments or functional assessments may also be appropriate depending on the affected joint and clinical setting.

When standardized questionnaires are used in Viet Nam, their language versions, validity, practicality, and suitability for the relevant population should be considered.

Routine care does not necessarily require numerous questionnaires. Consistent documentation of symptoms, physical function, treatment goals, and adverse effects may provide useful information for follow-up.

Repeated imaging is not always necessary to assess treatment progress. The National Institute for Health and Care Excellence advises against routine imaging solely for follow-up or to guide non-surgical osteoarthritis management.

For healthcare organizations, evaluation should also extend beyond counting exercise sessions, rehabilitation referrals, or completed appointments.

These figures describe service activity but do not independently demonstrate better patient outcomes.

A more meaningful approach examines whether patients receive appropriate assessment, understand their treatment, can access indicated interventions, and experience improvements in symptoms and function without avoidable harm.

Such evaluation can help connect evidence-based recommendations with the actual quality and effectiveness of care.

The Professional and Legal Context in Viet Nam

Osteoarthritis care in Viet Nam must remain consistent with applicable professional guidance, healthcare legislation, and the authorized activities of practitioners and healthcare facilities.

The Ministry of Health issued Decision No. 361/QĐ-BYT on January 25, 2014, promulgating the professional document Guidelines for Diagnosis and Treatment of Musculoskeletal Diseases.

This publicly available national reference includes guidance relevant to osteoarthritis, including knee osteoarthritis.

However, the document predates several developments in the international evidence base, including more recent recommendations on therapeutic exercise, weight management, and selected pharmacological treatments.

Healthcare professionals should distinguish between applicable Vietnamese professional requirements and international guidance that may offer additional or more recent scientific evidence.

Relevant international references include the American College of Rheumatology's September 2026 update, the 2026 United States Department of Veterans Affairs and Department of Defense guideline on non-surgical management of hip and knee osteoarthritis, recommendations from the European Alliance of Associations for Rheumatology, the National Institute for Health and Care Excellence guideline, and the Singapore Agency for Care Effectiveness guideline issued in April 2026.

These documents differ in their intended populations, healthcare systems, scope, treatment options, and methods for evaluating evidence.

An international clinical recommendation does not automatically replace Vietnamese professional guidance or authorize the use of a medicine, procedure, or treatment within Viet Nam.

The Law on Medical Examination and Treatment No. 15/2023/QH15, as amended and reflected in Consolidated Document No. 26/VBHN-VPQH dated February 26, 2026, provides the principal legal framework governing medical examination and treatment, healthcare professional licensing, and healthcare facility responsibilities.

Circular No. 32/2023/TT-BYT, as amended, including relevant changes introduced by Circular No. 25/2026/TT-BYT effective August 15, 2026, also forms part of the applicable regulatory framework.

Clinical assessment, medication prescribing, therapeutic rehabilitation, injections, surgical procedures, and other regulated activities must remain within the lawful professional scopes and responsibilities of appropriately qualified practitioners and authorized healthcare facilities.

Education in Lifestyle Medicine does not independently authorize participants to diagnose osteoarthritis, prescribe medicines, perform injections, or provide specialized rehabilitation beyond their existing professional authorization.

Similarly, international professional membership, training, or certification does not automatically expand an individual's legal scope of practice in Viet Nam.

These considerations are particularly important when discussing new treatments whose evidence base may be developing faster than local clinical guidance or regulatory arrangements.

A medicine recommended internationally may have different approved indications, availability, or prescribing restrictions in Viet Nam. An intervention discussed in research may also require specific professional expertise, facility authorization, or additional clinical governance before it can be appropriately provided.

For VLMA, maintaining these distinctions is essential. Professional education and scientific knowledge exchange can support healthcare professionals in understanding evolving evidence, but they cannot replace the responsibilities of authorized clinical services.

Implications for the Vietnam Lifestyle Medicine Alliance

Osteoarthritis illustrates why evidence-based Lifestyle Medicine should be understood as a contribution to established healthcare rather than a separate solution to chronic disease.

Therapeutic exercise can improve symptoms and physical function, but it needs to be selected and progressed appropriately. Weight management may provide additional benefits for some patients, while adequate nutrition and muscle preservation remain important. Behavioral support can help people participate in treatment, although motivation alone cannot overcome every clinical, financial, or environmental barrier.

Medication, assistive devices, supervised rehabilitation, specialist assessment, and surgery also have important roles when clinically indicated.

For VLMA, the opportunity lies in helping healthcare professionals understand how these approaches relate to one another, what the evidence supports, and where uncertainty remains.

Professional educational resources could examine osteoarthritis-specific exercise recommendations, fear of movement, weight management, clinical safety, functional assessment, rehabilitation referral, and the critical interpretation of emerging treatments.

Such work would benefit from appropriate collaboration with qualified specialists in rheumatology, orthopedics, rehabilitation, clinical nutrition, and related fields.

It should also remain consistent with Vietnamese professional and legal requirements.

VLMA is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. Its activities focus on evidence-based professional education, capability development, scientific knowledge exchange, and collaboration.

VLMA does not independently provide osteoarthritis diagnosis, medication prescribing, joint injections, orthopedic procedures, or individualized clinical rehabilitation services.

Its intended contribution is to strengthen professional understanding and support the responsible interpretation and application of scientific evidence within authorized healthcare services.

Supporting Movement Without Overpromising

For someone living with osteoarthritis, meaningful improvement may mean walking more comfortably, returning to a valued activity, sleeping with less pain, or maintaining independence.

These outcomes matter even when structural changes in the joint remain.

Therapeutic exercise, appropriate weight management, behavioral support, and other lifestyle-related interventions can contribute to better symptoms and function. Their benefits depend on individualized care, realistic expectations, and the patient's ability to participate safely.

Lifestyle Medicine cannot promise cartilage regeneration, permanent freedom from pain, or avoidance of all medical and surgical treatment.

Good osteoarthritis care requires attention to the whole clinical picture, including symptoms, physical capacity, associated conditions, treatment risks, patient preferences, and the circumstances affecting everyday life.

It also requires recognizing when an intervention is not working and when further medical or specialist assessment is appropriate.

For healthcare professionals in Viet Nam, the challenge is to use the available evidence thoughtfully, adapt care to individual needs, and avoid leaving patients to manage persistent pain and disability through general lifestyle advice alone.

The contribution of Lifestyle Medicine is not to replace osteoarthritis treatment, but to help people remain active, preserve function, and improve their quality of life through safe, evidence-based care alongside the medical and rehabilitation services they need.

Selected References

1. Ministry of Health of Viet Nam. Decision No. 361/QĐ-BYT Issuing the Guidelines for Diagnosis and Treatment of Musculoskeletal Diseases. January 25, 2014.

2. American College of Rheumatology. American College of Rheumatology Updates Osteoarthritis Guidance, Reinforcing Personalized, Comprehensive Care. Official guideline update announcement. September 14, 2026.

3. United States Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for the Non-Surgical Management of Hip and Knee Osteoarthritis. Version 3.0. June 2026.

4. Rausch Osthoff AK, Vliet Vlieland TPM, Ferreira RJO, et al. EULAR Recommendations for Physical Activity in People With Inflammatory Arthritis and Osteoarthritis: 2025 Update. Annals of the Rheumatic Diseases. 2026;85(6):1026–1038. DOI: 10.1016/j.ard.2026.03.006.

5. Moseng T, Vliet Vlieland TPM, Battista S, et al. EULAR Recommendations for the Non-Pharmacological Core Management of Hip and Knee Osteoarthritis: 2023 Update. Annals of the Rheumatic Diseases. 2024;83(6):730–740. DOI: 10.1136/ard-2023-225041.

6. National Institute for Health and Care Excellence. Osteoarthritis in Over 16s: Diagnosis and Management. NICE Guideline NG226. October 19, 2022.

7. Agency for Care Effectiveness, Ministry of Health Singapore. Management of Knee Osteoarthritis: A Joint Effort With Patients. ACE Clinical Guideline. April 24, 2026.

8. Bliddal H, Bays H, Czernichow S, et al. Once-Weekly Semaglutide in Persons With Obesity and Knee Osteoarthritis. New England Journal of Medicine. 2024;391:1573–1583. DOI: 10.1056/NEJMoa2403664.

9. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research. 2020;72(2):149–162. DOI: 10.1002/acr.24131.

10. National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. January 9, 2023, as amended. Consolidated Document No. 26/VBHN-VPQH, February 26, 2026.

11. Ministry of Health of Viet Nam. Circular No. 32/2023/TT-BYT Detailing Selected Provisions of the Law on Medical Examination and Treatment, as amended.

12. Ministry of Health of Viet Nam. Circular No. 25/2026/TT-BYT Amending Selected Provisions of Circular No. 32/2023/TT-BYT and Other Ministry of Health Regulations. June 30, 2026. Effective August 15, 2026.

13. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443–451. First published online October 28, 2025. DOI: 10.1177/15598276251379821.

Editorial and Professional Scope Note

This article presents the educational and professional perspective of the Vietnam Lifestyle Medicine Alliance on the contribution and limitations of evidence-based Lifestyle Medicine in osteoarthritis care, based on information reviewed through October 30, 2026.

It is intended for professional information, education, and scientific knowledge exchange. It does not constitute a clinical practice guideline, individualized medical advice, an osteoarthritis diagnostic or treatment protocol, a therapeutic exercise prescription, a medication recommendation, a rehabilitation treatment plan, a surgical referral protocol, or an authoritative interpretation of Vietnamese law.

Vietnam Lifestyle Medicine Alliance (VLMA) is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. VLMA is not a licensed medical examination or treatment facility, rheumatology or orthopedic care provider, rehabilitation service provider, medical licensing authority, or healthcare accreditation organization. It does not independently diagnose osteoarthritis, prescribe medication, administer joint injections, perform orthopedic procedures, or deliver individualized clinical rehabilitation.

Clinical assessment, prescribing, rehabilitation, injections, surgery, and follow-up must be undertaken by appropriately qualified and authorized healthcare professionals and facilities within their applicable scopes of practice and in accordance with relevant Vietnamese requirements.

Lifestyle-related interventions should not delay or replace necessary diagnostic assessment, pain management, specialist evaluation, rehabilitation, or surgical treatment when indicated. Decisions concerning exercise, weight management, medication, procedures, and rehabilitation require appropriate clinical assessment and consideration of individual risks, functional capacity, associated conditions, and treatment goals.

International clinical guidelines, research findings, and professional frameworks are cited for educational purposes. Their inclusion does not imply that their recommendations automatically have regulatory force in Viet Nam or that VLMA has independently adopted, clinically implemented, validated, endorsed, or certified any osteoarthritis management, rehabilitation, weight-management, or treatment program discussed in this article.

The hypothetical patient situations are illustrative and do not describe actual VLMA clinical activities or identifiable patients.