Sunday, February 24, 2008

Exercising With Arthritis: Should I Exercise and Why

The more sedentary a person is the more stiff they will become. Along with that stiffness will be increased pain and increased fatigue. The old adage use it or lose it also applies to people who have arthritis.

Many people who have arthritis hesitate to exercise for one reason or another. Some of these reasons may include pain, stiffness, swelling, coordination and fear. To ask someone who is already in daily pain to go out and exercise that painful limb, in their mind, is asking them to cause themselves more pain. Because of this many people who have arthritis never get started on an exercise program. In this article I am going to discuss some of the reasons for that and why people suffering from arthritis should get started on a properly designed exercise program.

Up until about ten years ago exercise was not routinely included in treatment programs for people who have arthritis. There hadn't been much research done to prove the importance of exercise in reducing pain, improving function and flexibility, and keeping connective tissue strong to support weakened joints. The thought back then was that exercise might possibly accelerate the joint destruction and be the cause of reduced function over time. Most treatment programs were centered on treating the symptoms with various kinds of medication and using heat and cold to help control stiffness and pain.

Fortunately many researchers have began investigating the feasibility of using exercise programs to help control pain, restore function, increase connective tissue strength and regain range of motion. The result of this research has been overwhelmingly positive for the use of exercise for people who have arthritis. At the New England Medical Center in Boston, Massachusetts, researchers subjected people with rheumatoid arthritis to a progressive resistance-training program for 12 weeks. At the end of that time they had no change in the number of painful or swollen joints, but had significant reductions in the self-reported pain score and fatigue score. They also improved their strength by 57 percent, improved 50-foot walking time, and had improved balance and gait scores. This is only one of many research studies that have similar results. Most physicians would agree that exercise is now accepted as a very important part of the treatment plan.

Since pain is one of the most often used reasons for not engaging in an exercise program, let's look at some of the reasons exercise can actually reduce pain. Just as with the person who is disease free, people with any form of arthritis will begin to lose strength and become stiff with inactivity. The more sedentary a person is the more stiff they will become. Along with that stiffness will be increased pain and increased fatigue. The old adage use it or lose it also applies to people who have arthritis. One of the key benefits that can result from exercising is the increased production of endorphins. These endorphins are natural substances produced in the body that help reduce pain. This pain reduction benefit can last for a number of hours following the exercise session depending on the length and intensity of that exercise program. So, in most cases, once the mild muscle soreness associated with any new exercise program has subsided, the pain associated with arthritis can be greatly reduced.

People who have arthritis lose function over time. Because there is no cure for many forms of arthritis, the joint destruction continues even when the person is on medical therapy. As the deterioration progresses the whole joint capsule is involved. First the cartilage is affected, then the bony surfaces and then eventually the connective tissue stabilizing the joint. With each phase of this deterioration process function is being reduced. As stated above, the disease progression can only be slowed at best, so through an exercise program good nutrients are supplied to the cartilage by weight bearing activity and by strengthening the connective tissue (muscles, ligaments, tendons) it helps support and stabilize the joint. If this can be achieved through an exercise program, a person can stay very functional even though the disease is progressing. Maintaining function not only keeps people mobile and independent, it also adds quality to their lives. It keeps them out enjoying social activities, which can boost their sense of well being.

Another important function exercise can serve is maintaining range of motion in the affected joints. As the joint capsule deteriorates, changes in the joint occur. It may become misaligned, fused or perhaps bone on bone. When these situations occur, joint range of motion is also changed. So along with strengthening connective tissue, they must also keep those structures flexible. This can be achieved by including range of motion or flexibility exercises into a daily exercise routine. Range of motion exercises, when done properly, can be done two to three times daily for best results. Joints affected by arthritis must be moved often or the end result could be complete disuse. If the person with arthritis has not been exercising for a long time, range of motion exercises must be started and progressed slowly to avoid flares and increased discomfort. Again the client who has arthritis must be told this might cause some discomfort at the beginning, just as it would with someone without disease. But in time, the ease of movement achieved through increased range of motion will decrease pain, improve function and lessen fatigue. Ranges of motion exercises are essential for a person to continue to perform daily living activities and remain independent.

When exercise was first recommended for people with arthritis it was just to include range of motion and aerobic exercise. Strength training was not part of the prescription. Doctors felt that the stress and intensity often used in strength training would actually harm the joint rather than help. So people were walking and doing range of motion exercise, but continued to get weaker and lose the stability in their joints. So, research was done to find out the efficacy of strength training. First of all they wanted to dispel the idea that strength training would increase swelling and cause further deterioration. Most, if not all, the research that has been done up until now has proven that strength training does not increase disease symptoms or activity. What they have found is that even a person with an active disease process can safely and effectively engage in strength training exercises. In fact the results have been dramatic. People with arthritis have been able to increase their strength by 50 percent or more without any noticeable increase in disease symptoms or activity. These results are the same for people of the senior population also. By increasing strength in the muscles, tendons and ligaments, those supporting structures can help stabilize a joint that may be deteriorating. Therefore strength training is essential to continued mobility and to perform daily activities.

Another important factor about strength training is its importance before and after a total joint replacement. For example when a total hip replacement is preformed, many muscles along the upper, lateral thigh and buttocks area are cut to expose the hip joint for replacement. The stronger the muscles are in that region the faster the recovery and the better the outcome of that surgery. Those muscles they cut through to expose the hip are the very muscles that stabilize the hip as a person takes a step forward and puts weight on the foot. Without some muscle strength in that area the person would develop a limp that would affect their gate and the other joints of the body, which could end up permanent without proper physical therapy. And using the hip as an example again, when those muscles are cut, so are some nerves. With reduced nerve conduction you have reduced muscle stimulation and fewer muscles being recruited to stabilize the joint. So, the ones that are there might have to perform double duty. Therefore, strength training is a very important component of all exercise programs used with people who have arthritis.

So, in conclusion, when your arthritic client is hesitating to begin an exercise program you can now tell them it is probably one of the more important components of their treatment plan. It can help reduce their pain, decrease their fatigue, improve their joint stability, quality of life, range of motion, and improve or maintain their function. There might be some discomfort in the beginning, just as with someone without disease, but that will diminish in a very short time. They will have to start slow and progress very slow to minimize the possibility of a flare up. They will need to be very consistent in their effort to continue with the exercise program. And to maintain the improvements gained through an exercise program, they must continue on a program for the rest of their lives.

Living with rheumatoid arthritis for the last 47 years I can personally attest to the benefits of a well-planned exercise program. Even after seven major surgeries due to the progression of my disease I have maintained a very high level of function and mobility. Exercise has also helped control my weight, reduce my pain and increase my endurance. Without the inclusion of exercise in my own treatment program I know I would not nearly be as functional as I am today.

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