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The Role of Exercise in the Treatment of Arthritis

Arthritis is one of the most common diseases in the United States, affecting over 43 million Americans, or one out of every six people (Helmick, et al., 1995). Arthritis encompasses more than 100 diseases and conditions affecting joints, the surrounding tissues and other connective tissues. Symptoms include pain, aching, stiffness, and/or swelling in and around a joint. Moreover, arthritis is the number one cause of disability in the United States (Center for Disease Control, 2000). As a result, many individuals inflicted with arthritis confront many changes and limitations in the recreational aspects of their lives.

Osteoarthritis (OA) is the most common type of arthritis. In fact ~20 million persons have OA, which affects primarily the knee and hip joints. It is important to note that definitions of OA vary (e.g. physician diagnoses, radiographic, chronic joint swelling). In its basic form, OA, also referred to as degenerative joint disease, is a degenerative joint process caused by the wearing away of cartilage, leaving two surfaces of bone in contact with each other.

Osteoarthritis Risk Factors
Known

* Female gender

* Obesity/BMI

* Joint Injury

* Occupational physical activity

* Smoking

Undetermined

* Ethnicity

* Nutritional factors

* Genetics (up to 50%)

* Estrogen/bone density

* Mechanical alignment

Why is this information important for Diabetes Educators? If we take a look at the ‘Known’ risk factor column, we notice Obesity/BMI is listed. A large percentage of our clientele are obese and we are all aware of the link between obesity and the development and diagnoses of Type 2DM and Cardiovascular Disease. There has been recent discussion as to whether arthritis should be added to the list of risk factors for cardiovascular disease because of the sedentary lifestyle that often accompanies the arthritic population. Past research supported this ideology as 60% of subjects who were diagnosed with Osteoarthritis and tested for aerobic fitness fell below the predicted curve. It is interesting to note that those subjects terminated the treadmill test because of deconditioning/exhaustion rather than arthritis pain. (Minor et al., 1988).

Physical activity has been shown to relieve pain and stiffness, help preserve muscle strength and joint mobility, improve functional capabilities, prevent further deformities, improve overall physical conditioning, and reestablish neuromuscular coordination among the arthritic population. Programs that have promoted safe and effective exercise for those with arthritis include the PACEÒ and AF Aquatic programs. Most research on the effects of physical activity on arthritis has been performed with osteoarthritic patients.

From a prevention angle, it is interesting to note that an 11-pound weight loss may cut the risk of OA by 50%. Any weight loss has been reported to decrease the signs and symptoms of OA. As we well know, exercise is a pillar for good blood sugar management. It facilitates weight loss as well as improvement of cardiovascular fitness and function, which in turn improves insulin sensitivity. In our efforts to promote regular physical activity we are faced with the battle of resistance as we are often told, “I can’t exercise I have arthritis.” This can be one of those teaching moments that we as educators are so fortunate to have. Instead of reeling off findings from research, perhaps we can work on correcting this misconception by instructing the patient how to effectively introduce exercise into their lifestyle in a progressive manner. Discussing the need to ease into each session with long warm-ups and good stretching is essential. Education regarding the possibility of post exercise discomfort and what treatments they should seek not only provides good instruction, but enables the patient to treat their discomforts and therefore empowering them to take control. For example, when discussing treatments we need to correct the misconception that they should place heating pads on a sore area/joint rather than ice packs. Placing heat on a specific area and/or joint only draws more blood thus increasing inflammation. By placing ice, frozen vegetables like peas and corn are excellent as they conform to the area, you are working to minimize blood flow to the inflamed area and hopefully decreasing the amount of inflammation and discomfort.

The CDC has several research projects currently underway as well as published literature documenting the effects of regular physical activity and self-reported decreased sensations of pain and stiffness among arthritis sample groups. If we look in terms of what types of exercises people with arthritis should perform, we have some options to work from. Many have been told to exercise in a warm pool and research supports this suggestion as a 22% increase in cardiovascular aerobic fitness was found in those that walked laps in the shallow end of a pool. This improved cardiovascular fitness was again documented one year later in the same group (Minor et al., 1988). Aquatic exercisers often reported a major reduction in stiffness compared to walking on land, however those who walked on land still reported less pain and did not increase any pain medication.

Can we teach people with arthritis to safely and effectively exercise? Yes, we need to make sure we place emphasis on progression and tolerance. The exercise prescription needs to be developed based on the functional status of the individual. Any form of muscle contraction can help protect the joint surfaces from impact and torsional load. In other words, as we exercise and build muscle around the joint we take the load off the joint. The muscles we build act as a “buffer” for our joints.

Recommendations for aerobic exercise:

· 60-85% of maximum HR

· Progressive adjustment

· 2-3 times weekly (progressing to more days pending pain)

· ³ 45 minutes duration

· Clinic/supervised or home

· Walking, cycling, aerobic classes (low impact), aquatics

Recommendations for strengthening exercises:

· Dynamic or static

· 50-80% of maximum load

· Progressively adjusted

· 2-3 times weekly

· 1-2 sets of 8-12 reps

· Clinic/Supervised or home

· Body weight, pulley apparatus, elastic bands, dumbbells

Moderate, regular physical activity is safe and beneficial for many people with arthritis. Many individuals with arthritis can engage in aerobic/rhythmic exercise at recommended levels to improve physical fitness and therefore decrease body weight, improve insulin sensitivity, reducing the risk of a cardiovascular event and experience less pain and stiffness associated with arthritis.

Kristina Sandstedt, MS received her Masters of Science degree from the University of Montana-Missoula. She is certified as an Exercise Specialist through the American College of Sports Medicine. She is currently working as a Clinical Exercise Physiologist and Diabetes Educator for the Early Outpatient Phase II Cardiovascular Rehabilitation unit and the outpatient Diabetes Self-Management classes as well as individual consultations at Boone Hospital Center in Columbia, Missouri.

Kristina recently co-presented “Diabetes-What You Need to Know” at the National Speaking of Women’s Health Conference.