Written by A. Lynn Millar, PT, Ph.D., FACSM
If you have arthritis, you may think that exercise will increase your joint pain or speed the joint breakdown; however, regular exercise is actually beneficial for the person with arthritis. Often the joint pain and stiffness that are the primary symptoms of arthritis cause us to reduce our activity.
Unfortunately, this actually will lead to an increase in symptoms and loss of normal function, and may even speed the breakdown within the joint. Regular exercise will actually decrease symptoms and enable you to continue with normal activities. In fact, one study found that a group arthritic patients who exercised regularly had less joint replacement surgeries when compared to a group of similar-aged persons who did not exercise.
Most experts agree that participating in a regular exercise program that follows ACSM guidelines is important and safe for those with arthritis. This means your program should include aerobic conditioning (30 to 60 minutes on five days per week), resistance training (one set, major muscle groups, two times per week) and flexibility activities. Some benefits relevant to arthritis include:
- Decreased joint pain and stiffness.
- Improved or maintained joint motion.
- Decreased risk of cardiovascular disease (higher in those with rheumatoid arthritis).
- Improved ability to do activities such as getting in and out of a car or going up and down stairs.
- Decreased disease activity.
You may need to make a few modifications to your program based upon the type and severity of arthritis that you have. If you have a systemic type of arthritis, such as rheumatoid arthritis, the immune system is affected. Thus you may need more rest, especially when you are having a flare-up. Other modifications are usually activity specific.
While some individuals can successfully jog for their aerobic training, and it does not speed up the breakdown within the joint, others find that the impact of jogging starts to become too stressful for their joints. Brisk walking, cycling or elliptical training are exercise activities that will reduce the joint impact. If you have not been very active, it is very important that you start out slowly and you will find that doing two to three short sessions a day will help you get used to the activity, without increasing your joint pain. Good shoes with proper arch support and cushioning are necessary. Another concern during aerobic activities is joint alignment and stability. Alignment may be improved with shoe inserts and joint stability is often addressed by use of a splint or brace.
Resistance training is especially useful – it will help with functional activities, absorb stress around a joint, and help support unstable joints. Training moves for the legs that do not support the extremity, such as putting a weight around your ankle and straightening the knee when sitting, can put a lot of stress on a joint. A modified squat is a good alternative; either doing only a partial move or altering the position to keep your body weight behind the knee. A good alternative to training with machines are body weight activities, such as the modified squat.
While flexibility is very important, you should make sure that the stretch is gentle. If you have joint instability you should not stretch beyond normal range for that joint. Probably more helpful than stretching are range of motion (ROM) activities. Moving your joints through the normal motion on a daily basis will help to prevent loss of motion and will also decrease the sensation of stiffness. You should do five to 10 moves for each joint that is affected, and can even do such activities a few times a day.
If you enjoy group activities there are classes developed for people with arthritis. The “PACE” program (People with Arthritis Can Exercise) is a class that combines aerobic, flexibility and some muscular toning. Aquatic classes are great for reducing stress to the joints, although the aerobic benefits are not as great as some other activities. Tai chi, which is often promoted for balance and fall prevention, provides good conditioning and flexibility and there is a form which was specifically developed for individuals with arthritis. If you opt for a traditional class you may need to modify moves based on your specific limitations. Avoid extreme motions or positions – anything that may increase your pain.
Regardless of the activity you choose, make sure you warm-up and cool-down properly. This means you start with smaller, slower movements and gradually increase the intensity of movement. Doing some range of motion prior to and following aerobic or resistance training is a good way to get the joints ready for the activity and to slow down afterwards. As noted in other issues and in many articles, the most important thing is for you to get started. If you are not sure about your medical limitations, check with your physician prior to starting. Find a partner or support group to help you and get moving.
View the full spring 2008 issue of the ACSM Fit Society® Page online.