Folks With Arthritis Need to Get Moving, Studies Say
Joan Poe felt the first symptoms of arthritis in 1962, at a time when physicians typically advised people with the disease to avoid exercise in an attempt to “save their joints.”
Whenever the pain in her knees got bad, Poe would put her feet up and rest.
“By 1985, I couldn’t walk more than a city block, I couldn’t sleep from the pain and I couldn’t reach my arms over my head to curl my hair, so I cut it off,” recalls Poe, 61, who has two kinds of arthritis--osteoarthritis and rheumatoid arthritis--and a related condition called fibromyalgia. “I was sure I’d be in a wheelchair within a few years.”
But Poe’s rheumatologist urged her to participate in a study on the effect of exercise on people with arthritis at the University of Missouri, near her home in Columbia, Mo.
“People had been assuming the disability came from the disease itself,” recalls the study’s principal investigator, physical therapist Marian Minor, an associate professor at the university who holds a doctorate in human performance and aging. “We were challenging that assumption and trying to determine how much of the loss in function actually came from inactivity and deconditioning.”
After three months of exercising regularly in chest-deep water, Poe could walk almost a mile without pain and could put her arms over her head to curl her hair, which she grew back.
“The exercise made a tremendous difference in how I looked, how I felt and whether it seemed like the disease was controlling me or I was controlling the disease,” she says.
Today Poe works out at a gym at least three times a week, walking 30 minutes on the treadmill, pedaling 25 minutes on a stationary bike and stretching for 45 minutes.
“I still have problems with my spine when I do too much bending,” she says. “But I can do almost everything I want to do. I tell other people with arthritis that if they don’t exercise, they’re a prisoner of the disease. But exercise will set them free.”
Arthritis, which literally means joint inflammation, refers to more than 100 diseases that affect the joints and the tissues around the joints, including Sjogren’s Syndrome and Scleroderma. Nearly 40 million Americans, or one in seven, have arthritis, says the Arthritis Foundation, a national nonprofit agency that supports research and provides community-based programs for people with arthritis.
The prevalence of arthritis increases rapidly after age 45, and nearly half of all people with the disease are 65 or older. As baby boomers age, the number of Americans with arthritis is expected to grow to 59.4 million (nearly one in five) by 2020. The main cause of disability in this country, arthritis frequently limits everyday activities such as dressing, climbing stairs and walking.
And half of those who suffer from the disease don’t think anything can be done to help them. Yet during the past decade a growing body of research points to exercise as one of the best ways to keep joints in working order, boost overall health and, in some cases, prevent further damage.
For example, results of the Fitness, Arthritis and Seniors Trial, published in the Journal of the American Medical Assn. in January, concluded that “exercise is a safe and effective nonpharmacological therapy that improves both pain and function in older people with osteoarthritis of the knee.”
The 18-month study of 365 seniors with that affliction found that participants who exercised showed significant improvements in tests of physical performance (such as climbing stairs, getting in and out of a car, and lifting and carrying 10 pounds), compared with seniors in a health education group who did not exercise. Those in the exercise groups also scored better on assessments of physical disability and self-reported knee pain.
Even high-intensity strength training “is feasible and safe in patients with well-controlled RA [rheumatoid arthritis] and leads to significant improvements in strength, pain and fatigue without exacerbating disease activity or joint damage,” notes a recent article in Arthritis Care and Research, a journal of the American College of Rheumatology.
The federal Centers for Disease Control and Prevention highlighted the topic of exercise and arthritis in a recent issue of its Morbidity and Mortality Weekly Report.
“There is a mistaken belief that persons with arthritis should not exercise,” the report notes. “Most persons with arthritis and other rheumatic conditions should engage in physical activity.”
Exercise helps people with arthritis “maintain normal muscle strength and joint function . . . [and] reduce the risk of premature death, heart disease, diabetes, high blood pressure, colon cancer, overweight, depression and anxiety.”
The U.S. Surgeon General’s Report on Physical Activity and Health urges people with arthritis to exercise because “regular physical activity can help control joint swelling and pain.”
And the American Academy of Orthopaedic Surgeons, in its “Keep Moving for Life” campaign, says exercise keeps the joints flexible, the muscles around the joints strong, and bone and cartilage tissue strong and healthy, and it reduces pain.
The benefits are so significant that the Arthritis Foundation’s theme for 1998, its 50th anniversary year, is, “Make this the year you become active.”
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“In general, exercise is good for virtually all kinds of arthritis,” says rheumatologist Rowland Chang, a professor at Northwestern University Medical School and co-director of the Arthritis Center at the Rehabilitation Institute of Chicago, which is affiliated with Northwestern’s medical school. “We now know that most people with arthritis can achieve substantial reduction in pain and increase in functioning by participating in a regular exercise program.”
But for people with arthritis who often hurt so much that getting out of bed in the morning is a challenge, the prospect of starting an exercise program seems daunting.
“The trick,” Chang admits, “is trying to convince people that exercise will help.”
Since movement hurts, many people with arthritis stop moving. This sets off a vicious cycle: Inactivity leads to increased pain, immobility and joint damage from weakened muscles, which makes it even harder to move.
Sedentary living is linked to a variety of other health problems, including depression, osteoporosis and increased risk of heart disease. And reduced mobility often prompts weight gain, which can worsen the symptoms of osteoarthritis, a degenerative joint condition that is the most common form of the disease.
“Muscles atrophy very quickly when you have arthritis,” says rheumatologist John Winfield, director of the Thurston Arthritis Research Center at the University of North Carolina at Chapel Hill. “And joints that aren’t used can become ‘frozen,’ sometimes within days or weeks.”
This weakening of muscles and bones is “the single biggest determinant of who winds up in nursing homes,” Winfield says. “It’s not Alzheimer’s or heart attack or stroke that lands most people in institutions. It’s bones and joints and letting your muscles get non-functional.”
Yet many people, including some physicians, still haven’t heard the message that exercise can help keep people with arthritis from spiraling into decrepitude.
“It takes exercise to build strong muscles for joints to work properly,” Winfield says. “But many people are still afraid that if they walk too far the exercise will make their arthritis worse, when just the opposite is true.”
In the past, physicians had advised gentle stretching exercises for arthritis patients. Taking each joint through its full range of motion helps reduce stiffness, and experts still advise people with arthritis to do these exercises daily. But today, they also recommend two other kinds:
Endurance exercises: Sometimes called aerobic exercises, because they demand large quantities of oxygen for a prolonged period of time, endurance activities strengthen the heart and lungs. They also help boost mood, manage weight, improve sleep and reduce stress. People with arthritis should choose endurance activities, such as walking or water exercise, that do not jar their affected joints.
Strengthening exercises: Isometric exercise, which requires tightening muscles by pushing or pulling against a fixed object, helps people with arthritis strengthen muscles without moving painful joints. In addition, new research suggests that resistance exercises using weights may also be helpful.
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The idea of people with arthritis pumping iron is new, says rheumatologist David Pisetsky, co-director of the Duke University Arthritis Center. “Several studies within the last couple of years indicate that resistance exercises may be helpful with rheumatoid arthritis in particular,” he says. “Exercise can help people get their strength and their flexibility back. Many people with arthritis think they’re disabled because of their disease, when actually much of their problem comes from disuse.”
To achieve the best results, a person with arthritis should get a physician’s referral to a physical therapist, who can design an individualized exercise program that takes into account the kind of arthritis, the affected joints and the person’s overall conditioning. Most insurance companies will pay for at least three visits to a physical therapist for assessment and exercise instruction, says the University of Missouri’s Minor.
Her research has appeared in numerous peer-reviewed journals, including Arthritis Care and Research and Arthritis and Rheumatism, both published by the American College of Rheumatology. She has written for professional texts, including the American College of Sports Medicine’s “Exercise Management for Persons with Chronic Diseases and Disabilities” (Human Kinetics, 1997).
“People with arthritis need therapeutic exercise to maintain their flexibility and strengthen joints and muscles,” Minor says. “But they also need exercise to maintain their general health.” People with arthritis tend to be less fit than other adults, she notes.
Studies from the CDC show that people with arthritis and other rheumatic conditions have much lower rates of physical activity than the rest of the population.
“The most common reason people over 65 give for not being active isn’t heart disease or diabetes or poor vision; it’s arthritis,” Minor says. Yet the surgeon general’s report advises regular moderate exercise for all Americans, including those with arthritis.
The report states that the recommended amount of activity for health (about 30 minutes of moderate exercise a day) is not associated with joint damage. Not only can regular exercise boost the health of people with arthritis, but it can also reduce joint swelling caused by the disease.
“We’re not sure exactly why,” says Minor. “But we do know that dynamic movement tends to increase circulation in the joint.” When joints are actively swollen and inflamed, however, such as during a “flare” of rheumatoid arthritis, Minor advises skipping endurance and strengthening exercises. “If joints appear red, hot and swollen,” she says, “stay with flexibility [range-of-motion] exercises and maintain your daily activity level until the flare is under control.”
It’s also important to consult a physician for a specific diagnosis of the type of arthritis, since some forms can be treated with medication that may halt the progression of the disease, notes Dr. Doyt Conn, senior vice president of medical affairs for the Arthritis Foundation. The foundation estimates that about 6 million Americans believe they have arthritis but have never consulted a physician about the disease.
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Exercise is critical for both physical and psychological fitness, Conn says. “After two to three months of exercising, most people report less pain, anxiety and depression,” he says. “Exercise helps people take charge of their condition.”
Arthritis Foundation-sponsored exercise classes have grown in popularity over the last several years. Nationally, participation more than doubled in the past three years, in both land-based exercise classes and water classes, which are done in heated pools. In 1996, 156,000 people participated in the exercise classes, compared with 62,000 in 1993, notes Michelle Boutaugh, the foundation’s vice president for patient and community services.
The 1996 figure, however, represents just a fraction of the millions of Americans with the disease. In an effort to encourage more people with arthritis to exercise, the foundation plans to launch a walking program that can be done in groups or as an individual activity.
“The average newcomer to an arthritis exercise class is in pain, both physically and emotionally,” says Jinny Brow, a Virginia medical exercise specialist at Alexandria Hospital who teaches water exercise classes and does personal training for people with arthritis. “Usually people finally decide to try a class because they realize they have only two choices: to learn to exercise in a safe way or to lose function.”
Brow began exercising 12 years ago to manage her weight and her arthritis, which she says are now under control. “Most people with arthritis feel immediate relief when they get in the warm water,” she notes. “And over time, the results can be very dramatic.”
One of Brow’s 70-year-old students had needed a cane to walk, but was able to walk unassisted and resume gardening after several months of exercise.
Another senior, who had been confined to one floor of her town house, was able to use the stairs and all three floors again after exercising regularly. And an 83-year-old woman who had to stop driving because she couldn’t turn her neck was able to get her license back after 12 months of regular water exercise.
* Fitness runs Monday in Health.
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Resources
* Arthritis Foundation
(800) 954-CURE
Web site: https://www.arthritis.org
* Scleroderma Foundation
(310) 677-0477
* United Scleroderma Foundation
(310) 393-5647
(800) 722-4673
* National Sjogren’s Syndrome Assn.
Web site: https://www.sjogrens.org
* Sjogren’s Syndrome Foundation
(818) 346-2804
* Ehlers-Danlos National Foundation
(213) 651-3038
* Spondylitis Assn. of America
(818) 981-1616
(800) 777-8189
Web site: https://www.spondylitis.org
* Lupus Foundation of America
(714) 833-2121
