Editor's Note: When you see these three dots surrounded by a gray rectangle — 1 — you can click on it to get further information about the topic. Click a second time, and the message goes away.
Part I: Overview of Arthritis
Arthritis and other rheumatic conditions2 are among the most common chronic diseases. There are two common types:
Osteoarthritis (OA) — the most common form of arthritis — is a progressive joint disease. There is a gradual loss of cartilage from the joints and, for some, joint inflammation. The most common symptoms are pain, stiffness and loss of joint motion. It most often affects the hands, knees, hips, and spine.
Rheumatoid arthritis (RA) is a systemic autoimmune inflammatory disease; the immune system turns against the body, attacking the joints. The lining surfaces of the joints become inflamed; it can also affect the surface surrounding the heart and the lungs. It tends to occur on both sides of the body, usually involving multiple joints of the hands and feet, although any joint can be involved.
Part II: How to Manage Arthritis
Most adults have one or two chronic health conditions by the time they reach 60, but most people are able to manage their disease(s). Physical disuse and disability is, however, a major contributor to premature aging. Dr. Waneen Spirduso in her book, Physical Dimensions of Aging, identifies three dimensions which contribute to premature aging:
Dimension #1: Time. This is the normal aging process, which eventually drains energy and vitality.
Dimension #2: Disease. Genetic predispositions to diseases, or exposure to external agents, will damage one or more bodily systems and can lead to weakness, fatigue, and frailty.
Dimension #3: Disuse. Sitting for long periods of time, extended bed rest, or general inactivity will dramatically accelerate aging.
We obviously have little control over the first two dimensions, but the third one, disuse, is completely within our control.
The most common medications used to control pain and inflammation of arthritis are:
- analgesics for pain reduction;
- anti-inflammatory agents for inflammation reduction;
- immunosuppressants for immune system suppression; and
- antidepressants for helping reduce depression and anxiety.
In addition to medical intervention and therapies, there are some simple strategies that can help to control pain, improve independence and quality of life, and slow the progression of the disease. Here are four strategies that may help:
Weight reduction: Even modest weight loss (as little as 5 pounds) may be beneficial by putting less stress on the joints.
Rest: Deep breathing, visual imagery while listening to music, tensing and relaxing individual muscles, and meditation exercises — all can be helpful.
Joint protection: The basic principles of joint protection are: (1) respect pain; (2) distribute the load over stronger joints; (3) avoid sitting or standing for long periods of time; (4) reduce weight; (5) use good posture and body mechanics; (6) use the minimum amount of force necessary; (7) balance work with rest; and, (8) remain active.
Energy conservation: Conserving your energy overlaps with protecting your joints. Plan ahead, organize tasks, and take regular breaks.
Part III: Exercise Design
Regular, moderate physical activity has many benefits. Some level of physical activity is necessary to preserve joint function. A combination of aerobic exercise, strength training, stretch and flexibility — taught by a qualified instructor — is the most effective.
The primary goals of an exercise program for those suffering from arthritis are:
Restore or maintain joint range of motion so daily tasks can be completed.
Restore or maintain muscle strength which increases tone and functional strength of the muscles surrounding the joint.
Interrupt the Chronic Pain Cycle: When we hurt, we tend to stop moving; however, continued disuse of the joint will most likely cause stiffness and a shortening of the muscles and connective tissues around the joint.
Improve cardiorespiratory endurance with low-impact aerobic exercise; this contributes to overall fitness level and lubricates the joints.
Improve posture and body awareness through balance and coordination exercises.
Maximize pulmonary function with breathing and chest expansion exercises.
Promote relaxation through techniques that soothe the muscles and decrease stress.
Enhance quality of life by improving self-image and self-esteem.
Part IV: Exercise Guidelines and Considerations
If you have OA or RA, here are some guidelines to follow when exercising:
- Expect fatigue and some pain: Find a balance between exercise and rest, as you need both. Modifications need to be made based on your personal pain tolerance.
- Use the 2-Hour Pain Rule: If you experience more than typical joint pain two hours after exercise, it indicates that you have over-exerted and you need to adjust your workload the next time you exercise.
- Respect your limits: If the exercise is uncomfortable or hurts, you should stop, slow down, change weights, or rest — whatever seems right for you. Work at your own pace and don’t attempt to keep up with anyone else.
- Warm-ups should be long and slow: Begin with slow, range-of-motion exercises and gentle large muscle movements.
- Progress slowly: Modify whenever necessary. Decrease repetitions and speed of the movement when appropriate.
- Use isometric exercises which keep your joints in the most stable position. Some examples: Pressing the hands together, pressing down on a ball, squeezing the ball. They reduce joint movement yet strengthen muscles.
- Avoid quick, jarring changes as they can compromise joints and aggravate joint pain.
- Follow the tenets of joint protection (see Part II).
- Attempt complete range-of-motion movements, as much as can be tolerated: This might be accomplished by decreasing the speed of the movement, a slower tempo of music, warming up with range of motion activities, and flexibility stretching at the end.
- Increase chest expansion by doing deep-breathing exercises before and after exercise.
- Include relaxation — which reduces muscular tension and soothes muscles — at the end of every session.
- Avoid becoming chilled as cold drafts and/or becoming chilled while exercising increase muscle tension.
- Purchase footwear with plenty of room for your toes, a stable and comfortable sole, extra cushioning and space for orthotics.
- If possible, exercise at the best time of day: People with RA tend to be less stiff and sore later in the day. Those with OA may be better able to tolerate exercise in the morning.
- Use medication properly and let your doctor know how you are feeling; also explain what your exercise regimen entails.
Part V: Research on Arthritis and Exercise
Here are four studies about exercise and its benefits for those who suffer from arthritis:
In 2008, researchers in a Holland study searched the literature to find out if any studies had linked the value of dynamic exercise with rheumatoid arthritis. The researchers concluded that: (1) exercise should occur twice weekly for more than twenty minutes; (2) aerobic intensity had to be more than 55% of maximum heart rate and/or, and (3) the muscle strengthening exercises had to be at least one repetition.
Two other researchers independently concluded that aerobic exercise and muscle strength training for rheumatoid arthritis patients found “no harmful side effects” to exercise — whether on land or on water. The researchers concluded that “aerobic capacity training combined with muscle strength training is recommended as routine practice in patients with RA.” Look here for details of this research.
In 2009 at the New England Baptist Hospital in Boston, Dr. D.J. Hunter and F. Eckstein considered the risks involved for an osteoarthritis patient while exercising, but still concluded that “Despite the common misconception that exercise is deleterious to one’s joints, in the absence of joint injury there is no evidence to support this notion. Rather it would appear that exercise has positive...benefits for joint tissues....” For more information about this research go to Pub Med and type in #19207981.
- The Radiological Society of North America published an article by Linda Brooks and Maureen Morley that first states that high-impact activity, such as running, “more than one hour per day at least three times a week appears associated with more degenerated cartilage and potentially a higher risk for development of osteoarthritis.” So what is the amount of exercise one should undertake? MRI exams showed that light exercisers and minimal strength training exercisers had the healthier knee cartilage among all exercise levels and patients. What to avoid? “Frequent knee-bending (such as climbing 10 flights of stairs) or lifting objects weighing more than 25 pounds, or squatting, kneeling or deep knee bending for at least 30 minutes per day.” For more information about this, go to the study.
This article is part of a series about various health conditions and the benefits of exercise. The other articles are:
- Exercise and Allergies
- Exercise and Allergies
- Exercise and Asthma
- Exercise and Balance
- Exercise and Cancer
- Exercise and Chronic Pain
- Exercise and Circulation
- Exercise and COPD
- Exercise and Dementia
- Exercise and Diabetes
- Exercise and Heart Disease
- Exercise and Hypertension
- Exercise and Lifestyle and Older Adults: Recent Research
- Exercise and Mood
- Exercise and Osteoporosis
- Exercise and Our Brain
- Exercise and Pain vs. Burn: Will it ever stop hurting?
- Exercise and Parkinson's
- Exercise and Sleep
- Exercise and Stroke
- Exercise and Viruses: Exercise Immunology
Source for some of this article: Exercise and Arthritis by Stephanie Harris, MD, and Gwen Hyatt, MS
I am a BCRPA-certified fitness instructor in Vancouver, BC. I teach four classes at the West End Community Centre in Vancouver, BC, mostly designed for the older adult. The Inevitable Disclaimer: Everything published here expresses only my opinion, based on my training and research. What you do with the information is entirely your own responsibility. I am not liable for any injury you suffer that seems to be related to anything you read here. Always consult your doctor before beginning an exercise program. For other articles, return to the table of contents.
These three dots behave exactly like a footnote. Click on them and you will get more information about the topic. ↩
There are other types of rheumatic disease but they are not as common as OA and RA. These include: spondyloarthropathy, Reiter’s syndrome, gout, psoriatic arthritis, inflammatory bowel disease, juvenile arthritis, systemic lupus, scleroderma, and fibromyalgia. ↩