Ex­er­cise com­mit­ment

Arthri­tis suf­fer­ers need to stay ac­tive, ex­perts say, or pain might get worse

Orlando Sentinel - - EXTRA HEALTH & FITNESS - By Amby Bur­foot

Some days, it seems reg­u­lar ex­er­cise has be­come a panacea — good for the heart, good for blood pres­sure, good for glu­cose lev­els, good to limit sad days and de­pres­sion.

But what about peo­ple tor­mented with the pain and stiff­ness of os­teoarthri­tis, par­tic­u­larly in the knees and hips? What are they sup­posed to do?

There was an era when eth­i­cal med­i­cal prac­tice de­manded a no-move­ment so­lu­tion for peo­ple in pain. Not any­more. Today, the more than 50 mil­lion adult Amer­i­cans with arthri­tis are ad­vised to seek the same 150 min­utes a week of mod­er­ate ex­er­cise as ev­ery­one else.

Arthri­tis is ac­tu­ally a blan­ket term for more than 100 re­lated conditions that fre­quently at­tack the knees, hips, feet, spine and hands. Os­teoarthri­tis, the most com­mon form, is a wearand-tear con­di­tion that results from ag­ing, being over­weight, in­juries and ge­netic fac­tors. When a joint’s ar­tic­u­lar car­ti­lage — the tis­sue that cov­ers the ends of bones — wears down, bones start rub­bing against bones. This of­ten causes pain, swelling and stiff­ness.

If arthri­tis pain is caused by bone rub­bing against bone, why move?

“A joint like the knee joint doesn’t have a blood sup­ply, so it needs move­ment to swish around the flu­ids that de­liver nu­tri­ents to the car­ti­lage and other tis­sues,” says Marcy O’Koon, se­nior con­sumer health di­rec­tor at the Arthri­tis Foun­da­tion and ed­i­tor of Arthri­tis Today mag­a­zine.

“Ex­er­cise should be part of treat­ment for most arthri­tis, be­cause in­ac­tiv­ity in­creases joint dam­age,” sports medicine doc­tor Gabe Mirkin writes in his DrMirkin.com news­let­ter. Mirkin has been study­ing the re­la­tion­ship be­tween ex­er­cise and arthri­tis for a half-cen­tury. Once an avid run­ner, he switched to bi­cy­cling years ago, and at 84, he rides a tan­dem bike with his wife in ad­di­tion to do­ing solo rides. He ad­vises, “Choose a non-im­pact sport like walk­ing, cycling, swim­ming or cross-coun­try ski­ing, or use ex­er­cise ma­chines that sup­port your feet, so they don’t pound the ground.”

Mod­er­ate walk­ing is usu­ally the go-to ex­er­cise for those with os­teoarthri­tis. Walk­ing is in­ex­pen­sive, low-force-pro­duc­ing and sim­ple, re­quir­ing no spe­cial equip­ment or fa­cil­i­ties. It builds car­dio­vas­cu­lar fit­ness and strength, re­duces pain, and im­proves mood.

But even walk­ing proves too dif­fi­cult for some suf­fer­ers, es­pe­cially those who are over­weight and/or have not been phys­i­cally ac­tive. In that case, Allentown, Penn­syl­va­nia, or­tho­pe­dist Laura Dunne fre­quently ad­vises os­teoarthri­tis pa­tients to be­gin with aquatic ex­er­cise.

“When you get in wa­ter, you take grav­ity and pound­ing out of the equa­tion,” she says. “At the same time, wa­ter walk­ing or wa­ter jog­ging strength­ens many of the same mus­cles that are used on land.”

Dunne also likes sta­tion­ary bikes, not­ing that it’s im­por­tant to ad­just the seat height so the knee doesn’t flex too much while ped­al­ing.

There is a lot of re­search to sup­port the abil­ity of mod­er­ate ex­er­cise to safely com­bat arthri­tis. Among find­ings:

■ A year ago, the Bri­tish Jour­nal of Sports Medicine pub­lished a re­view of ran­dom­ized, con­trolled tri­als. It found no ev­i­dence that ex­er­cise harms the “ar­tic­u­lar car­ti­lage in par­tic­i­pants at in­creased risk of, or with, knee” os­teoarthri­tis.

■ A 2015 Cochrane Re­view re­ported less pain, bet­ter phys­i­cal func­tion­ing and a higher qual­ity of life among os­teoarthri­tis sub­jects who ex­er­cised vs. those who didn’t.

■ And a re­cently pub­lished sys­tem­atic re­view and meta-anal­y­sis con­cludes that yoga may re­duce knee pain and stiff­ness while en­hanc­ing phys­i­cal func­tion­ing. Be cau­tious, how­ever, be­cause some yoga pos­tures put too much pres­sure on one foot and leg or bend the knee too far. Don’t do any­thing that hurts. The Arthri­tis Foun­da­tion (www.arthri­tis.org) of­fers a va­ri­ety of ex­er­cise videos on its web­site.

For those new to ex­er­cise, the Arthri­tis Foun­da­tion sug­gests do­ing a mild warmup to get past the dis­com­fort and find­ing an ex­er­cise or walk­ing part­ner to im­prove your like­li­hood of get­ting out there.

“Get­ting started is tough for peo­ple with arthri­tis, no doubt about it,” O’Koon says. “But once you be­come con­sis­tent, ex­er­cise is sel­f­re­in­forc­ing, be­cause it gets eas­ier, you lose weight, you gain strength, you ex­pe­ri­ence less pain, and you feel bet­ter emo­tion­ally.”

For decades­long vig­or­ous ath­letes ex­pe­ri­enc­ing arthri­tis pain, ex­perts sug­gest switch­ing rou­tines over stop­ping com­pletely — bi­cy­cling in­stead of run­ning, for ex­am­ple. Don’t choose all or noth­ing; opt for mod­er­a­tion.

Whether you’re a re­cent or a life­long ath­lete, there will be pain. While NSAIDs — over-the-counter, in­flam­ma­tion-re­duc­ing painkiller­s such as as­pirin, ibupro­fen and naproxen sodium — can help, they do have oc­ca­sion­ally dan­ger­ous side ef­fects and should not be used for more than 10 days with­out con­sult­ing with a doc­tor.

Walk­ing poles, knee braces and cush­ioned footwear can also take some stress off the knees. A study pub­lished in 2009 con­cluded that walk­ing poles re­duce knee forces by 27%. Ex­er­cis­ing both the arms and legs at the same time also in­creases calo­rie burn. Braces are help­ful early in a work­out, says Casey Ker­ri­gan, a Har­vard­trained re­ha­bil­i­ta­tion ther­a­pist, be­cause they in­crease your knee “pro­pri­o­cep­tion,” or aware­ness. This helps you lis­ten to your body and make ap­pro­pri­ate de­ci­sions. Ker­ri­gan adds that you don’t want to wear braces all the time, or you will limit mus­cle growth that can as­sist knee sta­bil­ity.

Ker­ri­gan hit the global health head­lines in 1998 when the Lancet pub­lished her study show­ing that high-heeled women’s shoes dra­mat­i­cally in­crease forces across the knee joint. Eleven years later, she left a tenured po­si­tion at the Univer­sity of Vir­ginia to be­gin man­u­fac­tur­ing Oesh shoes for women in Char­lottesvill­e. (Women re­ceive about 60% of knee re­place­ments.)

Ker­ri­gan has watched as Nike and other ma­jor com­pa­nies de­vel­oped new shoes with rev­o­lu­tion­ary thick, cush­ioned mid­soles.

“These might be a good op­tion for those with knee pain; the flat­ter the heel, the bet­ter,” she says.


Walk­ing poles can help take some stress off the knees, re­searchers found.

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