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Arthritis and Exercise - Friend or Foe?

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Types of Arthritis

The physical pain caused by arthritis can render many patients sedentary for fear of injury and aggravation. It can especially be limiting with regards to exercise if joints like the knees, hips or anywhere in the spine is affected. Symptoms often include joint pain, stiffness, weakness, and joint instability. Arthritis is a condition that can affect almost any joint and can present in several different forms, the most well known being osteoarthritis. This type of joint pain is caused by ‘wear and tear’, which affects the cartilage that supports the joint. Swelling can also occur in the area. The risk of developing osteoarthritis increases with age, although an injury to a joint or repetitive use can predispose to the development of symptoms early in life. [1]

Arthritis

There is no doubt that osteoarthritis is common – by the age of 65 almost 50% of people report living with arthritis in either hips or knees or both in Canada. [2] Knee and hip replacements due to arthritis cost our healthcare system 1 billion dollars per year as of 2017. [3] Osteoarthritis in interestingly also increasing in prevalence in recent history. One study looked at human skeletons of people born before world war 2, and found that individuals born after this time were far more likely to have knee osteoarthritis regardless of body weight. In fact, the incidence doubled between pre and post war samples. The fact that there was no association with weight is important because a higher body weight is thought to apply more pressure and ‘wear and tear’ to joints, increasing the risk of osteoporosis. The combination of a longer lifespan and the prevalence of obesity is what may professionals attribute to the rising rates of arthritic joint pain. Rather, authors in this review suggest that the shift in physical activity of our daily lifestyles might be what has increased our incidence of osteoarthritis. Physical activity helps to force nutrients into the joints, which is delivered to the cartilage. With so many of us now leading sedentary lifestyles, our joints may be more prone to become weak with time. [4] Only about 12% of cases are thought to have osteoarthritis that developed after a joint injury. [5]

Another type of arthritis that can happen at a younger age is called rheumatoid arthritis. Onset can be anywhere between the age of 30 and 60. This type of arthritis develops when the immune system mistakes soft tissue in joints for a foreign protein, attacking it and causing inflammation and destroying joint tissue. One hallmark of rheumatoid arthritis compared to osteoarthritis is that rheumatoid tends to affect joints symmetrically (BOTH wrists or BOTH knees or hips will usually be affected) while osteoarthritis can be isolate to one. An important step to take if you are starting to experience joint pain is to visit to your healthcare practitioner to determine what kind of arthritis may be developing and how to start addressing the underlying cause to help prevent progression. Blood testing and x-rays of joints are used for diagnosis. [6]

Will Exercise Help Osteoarthrits?

Arthritis

The question of whether to exercise or not is a serious one for those who have already developed arthritis. Many patients may hear conflicting advice from family and friends, and the feedback from sore joints can be painful when exercising at first. Many may even have issues with everyday tasks like sitting for a long period of time, standing, walking or climbing stairs. Our initial instinct when we have an injury or any soreness is to avoid use of the joint to let it heal, but is that the right approach with a chronic condition like arthritis? Or should we heed the old adage –‘use it or lose it’? The answer is likely a balanced approach – exercise without increasing risk of injury or overdoing things.

Exercise does seem to help improve symptoms of osteoarthritis. In one study, a group of 56 patients with knee osteoarthritis were given anti-inflammatory pain medications, acupuncture, physiotherapy. Half of them were told to do exercises for knee strength and half were not. The exercises were daily stretching and strengthening movements for the muscles around the knee (hamstrings, quadriceps and calf muscles). The participants who incorporated the knee exercises into their routine for 3 months noticed a significant improvement in pain levels compared to the group only receiving the other therapies. [7]

A large review study examining the evidence on exercise in osteoarthritis summarized that regular exercise can improve muscle strength, range of motion in joints, balance and heart health. Increased mobility and decreased risk of falls as well as improvements for blood pressure, blood sugar and cholesterol may also be important benefits for this patient population. Most studies have focused on individuals with knee osteoarthritis. Muscle strengthening is an important part of most exercise regimes and many different types of exercises have been studied. Benefit does not seem to depend on any one specific type of exercise, rather consistency with whatever is chosen. Some research has been done on Thi Chi which seems to be beneficial for pain, function, balance and flexibility in those with osteoarthritis. Aquatic exercises have not been well studied for osteoarthritis, although research suggests minimal improvements in ability to walk and range of motion in joints. Studies consistently show improvement through strengthening exercises, whether a physiotherapist delivers the program or the patient is simply continuing a routine that can be completed at home. The impact this can have on pain and physical function is even comparable to NSAID pain medications, with many less side effects and risks. [8]

Is Exercise Good for Rheumatoid Arthritis?

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Exercise has also been shown to help manage the disease progression of rheumatoid arthritis. The autoimmune attack on joints in this disease leads to damage that can significantly affect mobility and quality of life. In patients with rheumatoid arthritis, exercise has been show to help decrease inflammatory markers that are used to track progression of disease. Long-term control of inflammation may help decrease damage to joints. Another common observation in patients with rheumatoid arthritis is the development of heart disease, which may be due to chronic inflammation in the body. Using exercise to control inflammation may improve cardiovascular outcomes for these patients. Depression and anxiety are also common psychological concerns in this disease, which may be improved due to endorphin release during exercise. [9]

One size may not fit all when it comes to recommendations for exercise in arthritis, but it is clear that the right forms of exercise tailored for your needs and physical restrictions can help maintain mobility and boost morale while preventing injury. Strengthening exercises may be useful to help you get ease back into an evening walk or household activities. Incorporating some form of exercise into daily life should be a part of every arthritis management plan. [10] There are plenty of benefits to exercising with arthritis including decreased pain and risk of falls, improvements to sleep and balance and management of body weight. Exercise will also decrease your risk of chronic conditions like type 2 diabetes, high blood pressure and heart disease. Ongoing use of joints can also keep them healthy by increasing the uptake of nutrients in supportive joint cartilage. [10] It is amazing how our body is designed to thrive on movement!

Start Slow

Arthritis

When it comes to getting started, more is not always better. Maintaining mobility can be as simple as practicing ankle rolls and shoulder stretches, or beginning to take a short walk every day. Choose activities that are low impact like using an elliptical or biking to reduce trauma if knee, hip or back pain is present. Set realistic goals and go slowly, some stiffness can be expected for the first few days but should improve as time goes on! A physiotherapist can also help design an exercise program for your needs and monitor performance to prevent injury. Be cautious when exercising with an inflamed, hot and swollen joint, sticking to gentle range of motion movements to prevent aggravation. [10] Visit the arthritis society at www.arthritis.ca for more great tips on exercising with arthritis.

As a Naturopathic Doctor, there many other tools I use to help decrease inflammation and pain in arthritis so that patients can feel more comfortable exercising. Dietary factors can play a large role in inflammation, and I often recommend decreasing intake of refined sugars and processed foods, increasing intake of antioxidants through fruits and veggies, as well as identifying any individual food sensitivities that could be aggravating the condition. Proper support with glucosamine, calcium, magnesium, vitamin K, boron and other nutrients may also help over time, and acupuncture can be used to improve acute pain especially during a flare-up. The verdict seems to be that exercise is a friend of arthritis when care is taken. Talk to your healthcare provider today if you are unsure how to start or want to clarify what exercise is safe for you!