Jewish World Review March 31, 2003 / 27 Adar II, 5763

A little exercise can bring great benefits for arthritis patients

By Marlene Cimons | For years, people with arthritis shunned physical activity, thinking it was bad for them. And experts agreed -- then. Today, however, they believe just the opposite: that arthritis patients need to move, and often.

To be sure, rest is important. But too much inactivity can lead to weakened muscles, stiffer joints, less energy and weight gain, all of which can worsen the symptoms of arthritis. Instead, experts often recommend aerobics, range-of-motion and flexibility exercises, as well as strength training, swimming, biking and even running.

Exercise helps people with arthritis in numerous ways. It reduces joint pain and stiffness, and increases flexibility, muscle strength, cardiovascular fitness and endurance. It also helps with weight control, which is very important for people with arthritis; the less weight on the joints, the less the symptoms may manifest themselves. And, most of all, it feels good -- it creates an overall sense of well-being.

To be sure, the level of exercise depends on the severity of the disease. If you have arthritis and wants to continue your sport, it is important that you talk to a physician -- preferably a specialist, such as a rheumatologist -- about how much you can do safely, and for how long. The advice you get will likely be based the type of arthritis you have, what joints are affected and how far the disease has progressed. But most agree that for the most arthritis patients, exercise helps rather than hurts.

Arthritis -- a term that refers to conditions that cause pain, stiffness and swelling in joints and other connective issues -- afflicts an estimated 43 million in the United States, where it is the leading cause of disability, according to the federal Centers for Disease Control and Prevention. Experts believe that most people, if they live long enough, will develop some degree of osteoarthritis, the most common form of arthritis.

There are at least 100 different kinds of arthritis, chief among them osteoarthritis and rheumatoid arthritis, although both diseases require different approaches to treatment.

Osteoarthritis strikes about 21 million U.S. adults. It most often occurs among the elderly; in fact, by age 65, more than half the population has X-ray evidence of osteoarthritis.

It is a joint disorder that mostly affects the cartilage, the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over one another, and it also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away; this allows bones under the cartilage to rub together, causing pain, swelling and loss of motion of the joint.

Over time, the joint may lose its normal shape; in addition, bone spurs may grow on the edges of the joint. Bits of bone or cartilage can float inside the joint space, causing more pain and damage.

Unlike other types of arthritis, osteoarthritis only affects joints. It is not a systemic disease, as is rheumatoid arthritis, which can affect other parts of the body. Scientists aren't sure what causes it, but they suspect a combination of factors in the body, and in the environment, as well as aging. Some sports and workplace activities can play a role --the repetitive twisting in basketball and football, for example, or years at a job using a jack-hammer.

Kevin Smith, for example, a brick mason in Pacific Grove, Calif., likely accelerated his osteoarthritis by years in his job, one that requires much lifting and squatting. He also indulged a serious interest in wrestling for years. (He placed second in the first California State Championships in 1973 at 106 pounds, and for 13 years helped coach a wrestling team.) But several years ago, after years of unspeakable pain, he underwent hip replacement surgery, which worked wonderfully. Today he hikes, rides a stationary bike, walks on a treadmill or on the road, and takes stretching and conditioning classes. He is pain-free and believes that exercise is helping to keep his arthritis under control.

For years, many also believed that running was a factor in the development of osteoarthritis. Happily for runners, most studies have shown that this is not true -- with one caveat.

``First studies showed a decreased incidence of osteoarthritis of the knees in runners, but subsequent studies on former members of national teams showed an increased incidence in elite runners,'' says Dr. Marc Lieberman, a rheumatologist in private practice in Monterey, Calif. ``The latest studies show an increased incidence in competitive runners. The take-home message is probably that running is good for your knees if not taken to excess.''

By ``good,'' he means protective. ``Running probably increases circulation of synovial fluid through the joint, carrying nutrients to the cartilage and removing waste products,'' says Lieberman, also associate professor of medicine at the University of California at San Francisco. ``Weight-bearing exercise leads to increased bone density providing better support to the cartilage, and less development of microfractures.''

Also, two of the biggest risk factors for osteoarthritis are obesity and injury, and people who exercise tend to be thinner.

One caveat: The injury rate among athletes tends to be high, and if an athletic injury leads to long-term joint instability, the risk for osteoarthritis climbs sharply.

Rheumatoid arthritis, on the other hand, is an inflammatory disease affecting about 2 million U.S. adults, but it is different from osteo- and other kinds of arthritis. It is an autoimmune disease, meaning that the body's immune system, for unknown reasons, attacks a person's own cells inside the joint capsule. It cannot be prevented.

The disease causes pain, swelling, stiffness and loss of function in the joints. It often occurs in a symmetrical pattern, meaning if one knee or hand is involved, the other is, too. It often affects the wrist joints and the finger joints closest to the hand. It also can affect other parts of the body, besides the joints; patients may be fatigued or suffer fever and a general malaise.

Range-of-motion and muscle strengthening exercises are helpful, experts say, but more care must be taken with rheumatoid arthritis because it is a systemic disease and can affect more than just the joints of the body.

Both types of arthritis are treated with a variety of different drugs. There are no drugs that slow the progression of osteoarthritis, so patients usually just take pain medication, such as non-steroidal anti-inflammatory drugs, as needed for pain relief. In the case of rheumatoid arthritis, drugs are generally prescribed to reduce inflammation. Many have side effects, so these are best tailored by the doctor to the individual.

Also physical therapy, moist heat (not for inflammation), cold (good for inflammation), hydro (water) therapy, massage, biofeedback, transcutaneous electrical nerve stimulation, dietary supplements and acupuncture may help.

Some research has shown that taking glucosamine and chondroitin sulfate may help patients with osteoarthritis. The two substances -- which are naturally found in and around the cells of cartilage -- may help in the repair and maintenance of cartilage, researchers theorize.

In extreme cases, a physician may recommend surgery, such as joint replacement, as in Kevin Smith's case. Smith, a former runner, has not returned to regular running, but not because he can't. His wife, an ultra runner, won't let him.

``He can run,'' Sally Smith says. ``But his job, unfortunately, is hard on him physically, and doing both will just wear out the prosthesis that much sooner.''

If you want to maintain any kind of exercise program with arthritis, the old advice -- ``listen to your body'' -- couldn't be more important. Also:

-- Keep your weight down. This will lessen the impact on the joints.

-- Consider getting orthotics, which will help correct the body's biomechanical imbalances.

-- Use good running or exercise shoes, and don't let them wear down. Replace them often.

-- If you experience pain for more than two hours after exercise, cut back. Some experts are even more conservative, suggesting that one hour be the limit.

-- Engage in low-impact workouts if symptoms worsen after more strenuous workouts, or exercise on alternate days. Go swimming, biking or walking. If you don't want to give up more strenuous exercise, then alternate running days with low-impact days. You'll add extra years of running that way. But whether strenuous or not -- exercise can and should make a positive difference in the disease.

Judi Sheppard Missett is CEO of Jazzercise Inc., an international aerobic-dance instruction company. Comment by clicking here.


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