Exercise & Joint Health

 Talk to anyone over the age of 40 and most likely they have some kind of ache or pain, often times involving their joints.  Sometimes the joint discomfort is the result of wear-and-tear but other times it can be caused by an infection, an autoimmune disorder or a condition like gout.

Any disease that involves the joints falls under the category of a rheumatic disease, of which there are 100 classified types.  Arthritis is one of the most common of the rheumatic diseases. Arthritic conditions are distinguished by red, swollen joints and inflamed connective tissues such as cartilage, synovial tissue, and tendons.  Autoimmune diseases happen when the body’s own immune system is turning on parts of the body.

The term rheumatic comes from the Greek root “rheuma,” which means flux, but it’s come to mean ‘related to the joint.  “Arthritis” means joint inflammation, and although it is really only a symptom or sign—not a diagnosis—the term arthritis has become the layperson’s label for any rheumatic disorder.

Signs of a rheumatic disorder include redness or heat, swelling, and symptoms such as pain and loss of function of one or more connecting or supporting structures of the body. In particular, joints, tendons, ligaments, bones, and muscles are affected.  The onset of arthritis symptoms can develop gradually or suddenly.

Collectively, rheumatic diseases affect more than 46 million Americans.  The most common form of arthritis in the Unites States is osteoarthritis followed by gout, fibromyalgia, and rheumatoid arthritis.

Risk Factors for Arthritis

Like most chronic diseases, there are certain factors are associated with a greater risk of arthritis. Some of these risk factors are modifiable while others are not.  The following risk factors are non-modifiable.

Age.  Unfortunately, the risk of developing most types of arthritis increases with age due to over-use of the joints.  .

Gender:. Most types of arthritis are more common in women; 60% of the people with arthritis are women.

Genetic. Specific genes are associated with a higher risk of certain types of arthritis.  Take a look at your family history and speak with your doctor about how much that might influence your developing the disease.

The good news is that your lifestyle choices can greatly influence whether or not you develop arthritis and the severity of your symptoms if you do have the disease.  The following are modifiable risks.

Preventing Arthritis

Body Weight.  Being overweight or obese contributes greatly to both the onset and the progression of arthritis.  This makes sense; the more you weight the more pressure is being exerted on your bones and joints to keep you moving.  Therefore, maintaining a healthy body weight is one of the best things you can do to keep arthritis in check.  Research suggests that maintaining a healthy weight reduces the risk of developing osteoarthritis and may decrease disease progression. A loss of just 11 pounds can decrease the occurrence of new knee osteoarthritis, and losing just 5% of body weight (12 pounds in a 250 pound person) can reduce pain and disability.

Protect your Joints.  Damage to a joint due to injury can contribute to the development of osteoarthritis in that joint.  You can’t go back and change the past but you can choose activities that are lower impact and have less likelihood of causing a joint injury.  Most importantly, if you have a family history of any arthritis, begin educating your children at an early age to know the risks and try and minimize them.

Occupation: Certain occupations involving repetitive knee bending and squatting are associated with osteoarthritis of the knee.

Exercise & Arthritis

Treatments for arthritis and rheumatic diseases vary depending on the specific disease or condition; however, medical professionals almost unanimously agree that regular exercise is critical.  “Motion is lotion” when it comes to the joints.

Numerous studies confirm that physical activity can reduce joint pain and stiffness and increase flexibility, muscle strength, endurance, and give you more energy. Exercise also can result in weight loss, which in turn reduces stress on painful joints.  Physical activity also can help manage other chronic conditions that are common among adults with arthritis, such as diabetes, heart disease, and obesity and can improve overall health and wellbeing. Regular physical activity can also lift your mood and make you feel more positive.  The key however is choosing the right type of exercise.

The best exercises for people with arthritis are those that place the least stress on the joints, such as walking, stretching, using weight machines, stationary cycling, exercising in water, yoga and swimming. All these types of activities are referred to as “low impact.”  People with arthritis should consider speaking with their doctor before beginning any new exercise program.

The good news is that there are many exercise programs that have been designed specifically for people with arthritis.  Below is a list of evidence-based programs that at are proven to improve the quality of life of people with arthritis.

Arthritis Foundation Exercise Program (AFEP)

AFEP  is a community-based recreational exercise program developed by the Arthritis Foundation. Trained AFEP instructors cover a variety of range-of-motion and endurance-building activities, relaxation techniques, and health education topics. All of the exercises can be modified to meet participant needs. The program’s demonstrated benefits include improved functional ability, decreased depression, and increased confidence in one’s ability to exercise. Classes typically meet two or three times per week for an hour.

Active Living Everyday (ALED)

ALED is a group-based program developed at the Cooper Institute that focuses on helping sedentary people become and stay physically active. Participants, about 20 people in a group, come together for one hour weekly sessions for 12-20 weeks of education and discussion to learn skills (i.e., identifying and overcoming barriers, setting goals, creating an action plan) needed to become more physically active. A variety of moderate and vigorous physical activities are discussed in the program, giving the background for individuals to make their personal decisions the type and amount of exercise they want to do. Participants do their actual physical activity outside of the group setting. Facilitators (instructors) that teach the course are trained and certified.

Arthritis Foundation Aquatic Program (AFAP)

AFAP is a water exercise program created by the Arthritis Foundation for people with arthritis and related conditions. The classes are conducted by a trained instructor and include joint range of motion, stretching, breathing, and light aerobic activities. The classes typically meet two or three times per week for one hour.

EnhanceFitness (EF)

EnhanceFitness (formerly Lifetime Fitness) is an evidence-based, community-delivered exercise program proven to increase strength, boost activity levels, and elevate mood. Certified EF instructors offer a program that focuses on stretching, flexibility, balance, low impact aerobics, and strength training exercises. Typically classes meet three times a week for one hour.

Fit & Strong!

Fit and Strong is a community-based physical activity and behavior change intervention offering stretching, balance, aerobic, and endurance exercises. Health education, problem solving and goal setting also are important components of Fit and Strong. The program was designed to target sedentary older adults who are experiencing lower-extremity joint pain and stiffness. Fit & Strong! classes are 90 minutes 3 times per week for 8 weeks and are delivered by a certified exercise instructor

Walk With Ease (WWE)

Walk with Ease is a community-based walking program developed by the Arthritis Foundation.  WWE group sessions meet three times per week for 6 weeks.  Trained group exercise leaders begin each session  with a pre-walk discussion covering a specified topic related to exercise and arthritis, followed by a 10- to 40-minute walk that includes a warm-up and cool-down periods.

Pain = NO Gain

It’s normal for people with arthritis to experience some soreness or aching in joints and surrounding muscles during and after exercise. This is especially true in the first 4 to 6 weeks of starting an exercise program. However, most people with arthritis find if they stick with exercise they will have significant long-term pain relief. Here are some tips to help you manage pain during and after exercise:

• Modify your exercise program by reducing the frequency (days per week) or duration (amount of time each session) until pain improves.
• Change the type of exercise to reduce impact on the joints – for example switch from walking to water aerobics.
• Do proper warm-up and cool-down before and after exercise.
• Exercise at a comfortable pace – you should be able to carry on a conversation while exercising.
• Make sure you have good fitting, comfortable shoes.

If you are experiencing any of the following, you should see your health care provider:

• Pain is sharp, stabbing, and constant.
• Pain that causes you to limp.
• Pain that lasts more than 2 hours after exercise or gets worse at night.
• Pain is not relieved by rest, medication, or hot/cold packs.
• Large increases in swelling or your joints feel “hot” or are red.

The bottom line is that your exercise program should be helping your arthritis, not exacerbating it.  Start slow, be smart and soon enough you will begin experiencing the benefits of exercise for your joints.

Getting Support

For people living with any type of rheumatic disease, sometimes finding answers to questions is not easy.  This is especially true if you don’t have access to a medical professional who specializes in rheumatology.  The American Chronic Pain Association (ACPA), founded in 1980, has offered peer support and education in pain management skills to people with pain, family and friends, and health care professionals. ACPA works to facilitate peer support and education for individuals with chronic pain and their families so that these individuals may live more fully in spite of their pain. Moreover, ACPA raises awareness among the health care community, policy makers, and the public at large about issues of living with chronic pain.  For more information, visit their website at www.theapca.org.