JointHealth
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In this issue
Listening to you Arthritis Consumer Experts (ACE)
JointHealth™ insight  Published May/June 2009

In this issue of JointHealth™ monthly, we look at the importance of exercise for people living with arthritis. We also discuss types of exercise that are particularly beneficial, and provide some examples of exercises that can be enjoyed outside during the summer months. We hope that you find it helpful.

Keeping Active with Arthritis
Much has been said and written about the importance of exercise for our health and wellbeing. However, for people with arthritis, it also can help manage symptoms. While people with arthritis may be reluctant to exercise fearing joint damage, exercise is especially crucial for people living with all forms of arthritis disease. In fact, exercise is a vitally important part of a well-rounded arthritis treatment plan.

For people living with arthritis, pain, body weight, age and lack of knowledge about appropriate types of exercises may be hurdles to getting started on an exercise program. Another barrier is the lack of recommendation and referral for exercise by physicians. A Canadian study of osteoarthritis patients showed that only one third had been advised to exercise by their doctor. However, exercise has numerous physical and mental health benefits and there are no specific exercises that should be avoided by people with arthritis.

One of the most important benefits of exercise is weight management, which helps to improve body image and can improve the symptoms of arthritis, especially of osteoarthritis. If a person is heavier than their ideal body weight, even a small amount of weight loss can help reduce both the risk of developing certain types of osteoarthritis and the chances of osteoarthritis worsening with age.

For everyone, exercise helps to improve heart and lung function, but for people living with arthritis, a variety of types of exercise can help to reduce joint pain and control joint swelling. These include:
  • Range of motion exercises help to keep the joints mobile and are also useful for helping to prevent injuries.
  • Weight bearing exercises can decrease bone loss, keep weak joints stable, and reduce the risk of osteoporosis.
  • Aerobic exercises, such as walking, help with weight loss. As well, exercise can help make it easier to fall asleep and to sleep more soundly.
In addition to improved physical health, exercise has many psychological benefits. Pain can seem more pronounced when we are unhappy or upset and exercise can help reduce depression. Additionally, it can improve self-esteem and self-confidence, improve the ability to relax, improve mood and wellbeing, and promote a good body image. Exercise also provides a good outlet for dealing with stress and anxiety.

Research suggests that most types of physical activity do not cause or worsen arthritis. In contrast, a lack of physical activity is associated with increased muscle weakness, joint stiffness, reduced range of motion, fatigue and overall reduced physical fitness.

Once a regular pattern of exercise has been established, it is important to maintain this pattern.

In order to get the benefits of exercise, it is vital to stay active.

Research shows that in people with osteoarthritis, once exercise stops, the reduced pain and disability they were experiencing ends.

To ensure that you keep up with a routine of exercising, consider joining a group program or bringing a friend or family member along to motivate you.


Eight ways to get started exercising:
  1. Try to choose a type of exercise, or an exercise program, that you enjoy. It will be much easier to stick to the program if you like what you are doing. Most types of activities are helpful for people living with arthritis, so feel free to do your favourite things such as walking, swimming, golfing, or gardening. Exercise doesn't have to be strenuous or boring to be good for you.
  2. Community centres can be a terrific resource. Flip through the lists of classes offered at your local community or aquatic centre to find activities that best suit your interests and physical abilities.
  3. You may find that having a partner to exercise with will be more motivating. Research tells us that people are more likely to stick with exercises if they bring along a friend or family member.
  4. Sometimes, having a detailed list of activities and realistic goals will help motivate you, so it may be useful to get a referral to a physical therapist to create an appropriate exercise regimen that suits you and your body. Also, keeping an exercise log can help you and your therapist monitor your progress.
  5. For some, assistive devices such as splints or orthotics may be helpful for protecting your joints while you exercise. An occupational therapist can be a good resource.
  6. Before beginning a new exercise program, it is a good idea to speak with your doctor or health care provider to determine the most appropriate exercise or activity for your needs and capabilities. Also, be aware that during flare-ups it is important not to over-stress and over-work joints, which may cause more pain. For this reason it is important to speak to your doctor about exercise and the types of exercises most suitable.
  7. Try setting a firm goal and then rewarding yourself when you achieve it. For example, set a goal of swimming 5 laps. When you reach that goal, reward yourself, and then set a new goal of swimming 10 laps. Rewards can be anything that is meaningful to you: setting aside time for yourself, treating yourself to a massage or a good book, or going out for a meal with friends.
  8. Acknowledge your effort. Be proud of yourself for taking an active role in your health care.


Tailoring your exercise to your disease type and situation:
Research has shown there are a range of exercises that are valuable for people living with various forms of arthritis. These include:
  • Range-of-motion exercises involve taking joints through their full range of movement in order to maintain maximum use. Some examples include stretching and include yoga and Tai Chi.
  • Aerobic (endurance) exercises raise the heart rate. Exercises in this category include low-impact aerobics or aquatics classes (pool exercise classes), swimming, and walking.
  • Muscle strengthening exercises help to keep muscles strong and prevent bone loss. This type of exercise includes activities such as weight training.
  • Recreation or lifestyle exercises are activities such as golf, tennis, cycling (including riding a stationary bike), or walking (outside or inside on a treadmill in a local recreation centre or gym). Weight bearing exercises, such as walking, can also prevent bone loss.
If you haven't been active for some time, begin a new workout regimen slowly. It is best not to launch into an exercise program without a careful plan of action and it is essential to avoid starting out with high impact or overly strenuous workouts. There is no hurry. In fact, overdoing it at the start could lead to injury—stopping your exercise program before it even begins. Gradually try to increase the intensity, complexity, and duration of your exercises as you get stronger and more confident. Also, try to avoid rapid, sharp movements and repetitive exercises. Work on matching your level of exercise to your physical abilities, and tailor your workout to protect your joints.

For those with osteoarthritis, it is important to do range-of-motion exercises to maintain joint flexibility. Avoid exercises that overwork the joints, such as climbing. Strengthening exercises will help to reinforce the muscles that support your joints.

For those with rheumatoid arthritis, gentle range-of-motion exercises will help to keep the joints mobile. Aquatic exercises will provide a good, low-impact workout that can be carried out even during flare-ups. Walking is a good exercise when symptoms are under control.

For people living with all types of arthritis disease, it is important to keep as active as possible to avoid losing mobility. Speak with a doctor about specific exercises for your needs.

Taking steps to get fit:
A little brisk walking (that is, walking at a speed when you feel just a little bit out of breath, but can still carry on a conversation) can go a long way to improving physical health and wellbeing. Walking is inexpensive and easy to do almost anywhere (no gym required). As well, it is probably one of the safest and easiest types of exercise, especially for people who are just starting out on an exercise program.

Brisk walking is an aerobic exercise that helps to increase your endurance and strengthens your heart and lungs. It helps to reduce pain by increasing your circulation and by releasing endorphins. Walking is also a weight-bearing exercise, helping to maintain bone density.

Here are some recommendations for a good walking workout:
  • Find a comfortable pair of walking shoes that provide good support and shock absorbance.
  • Try to walk a minimum of 3 to 5 days each week.
  • Start slow and increase the intensity of your walks as you become more fit. It is important to listen to your body and keep your intensity at a level where you increase your heart rate while getting only slightly out of breath.
  • Gradually build up the duration of your walk. About 30 minutes of walking in a day is ideal. You can start by doing three 10-minute walks and gradually build up to one 30-minute walk or more.
  • Try to find terrain that matches your fitness level. Relatively flat, smooth surfaces may be best for many, especially when starting out. Trails with uneven paths or steep hills may be too intense, and may make it difficult to keep your balance. Uneven terrain can also stress the knees, hips and feet, especially when you are just starting out your exercise regimen.
  • Consider making a plan that contains realistic objectives and short-term goals.
  • Each time you go out for a walk, remember to start slowly, and then do a gentle stretch before walking at a comfortable, but aerobic pace. As you near the end of your walk, slow your pace to cool down and lower your heart rate. When you are done, do another gentle stretch.
Playing outside:

Outdoor exercise often starts to look much more appealing as summer approaches. Now that the snow has melted and the sun is shining, consider taking some of your exercise outside.

Here are some suggestions for outdoor activities:
  • Go to the beach and spend time with your toes in the sand. Walking in sand can be great exercise.
  • Take a walk in the woods or in a local park alone or with a friend, or join a walking group.
  • Swim in the lake, ocean or an outdoor pool. Remember to wear waterproof sunscreen and re-apply often.
  • Take a bike ride with your friends, family or kids. Flat, smooth surfaces are best when starting out.
  • Play doubles tennis at an outdoor court. Playing tennis with a partner can cut down on the amount of running and side-to-side movements required in a tennis game.
  • Play a few rounds of golf or go lawn bowling. If you are golfing, consider leaving the cart behind and walking from hole to hole.
  • Plant a garden or participate in a community gardening program. There are many good adaptive devices available to make gardening more comfortable. An occupational therapist, or local arthritis group, can be a great resource for finding out more.


Listening to you

We hope you find this information of use. Please tell us what you think by writing to us or emailing us at info@jointhealth.org. Through your ongoing and active participation, ACE can make its work more relevant to all Canadians living with arthritis.

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Arthritis Consumer Experts (ACE)

Who We Are

Arthritis Consumer Experts (ACE) provides research-based education, advocacy training, advocacy leadership and information to Canadians with arthritis. We help empower people living with all forms of arthritis to take control of their disease and to take action in health care and research decision making. ACE activities are guided by its members and led by people with arthritis, leading medical professionals and the ACE Advisory Board. To learn more about ACE, visit: www.jointhealth.org

Acknowledgements

Over the past 12 months, ACE received unrestricted grants-in-aid from: Abbott Laboratories Ltd., Amgen Canada / Wyeth Pharmaceuticals, Arthritis Research Centre of Canada, Bristol-Myers Squibb Canada, Canadian Institutes of Health Research, GlaxoSmithKline, Hoffman-La Roche Canada Ltd., Merck Frosst Canada, Pfizer Canada, Schering-Plough Canada, and UCB Pharma Canada Inc. ACE also receives unsolicited donations from its community members (people with arthritis) across Canada.

ACE thanks these private and public organizations and individuals.

Disclaimer

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