Exercise as Treatment for Arthritis

Arthritis literally means "joint inflammation," but generally refers to the more than 100 rheumatic diseases and related conditions that can cause pain, stiffness and swelling in the joints and connective tissues. Affecting one in every seven Americans of all ages, arthritis also can deteriorate the joints' support systems, including:

• Muscles
• Tendons
• Ligaments
• Other parts of the body

While medication may be part of a recommended treatment plan for people with arthritis, a tailored exercise program can be beneficial to management of pain and fatigue and to preserve joint structure and function. Once you know what type of arthritis you have and understand what symptoms you can expect, you and your physician or physical therapist can develop a balanced program of physical activity to reduce the damaging affects of arthritis and promote overall good health.

Arthritis and exercise

Stiffness, pain and swelling associated with arthritis can severely reduce the range of motion in joints (the normal distance joints can move in certain directions). Avoiding physical activity because of pain or discomfort also can lead to significant muscle loss and excessive weight gain. Exercise, as part of a comprehensive arthritis treatment plan, can improve:

• Joint mobility
• Muscle strength
• Overall physical conditioning
• Help to maintain a healthy weight

A tailored program that includes a balance of three types of exercises can relieve the symptoms of arthritis and protect joints from further damage:

1. Range-of-motion
2. Strengthening
3. Endurance exercises

Exercise also may:

• Help maintain normal joint movement
• Increase muscle flexibility and strength
• Help maintain weight to reduce pressure on joints
• Help keep bone and cartilage tissue strong and healthy
• Improve endurance and cardiovascular fitness

Range-of-motion exercises

To help relieve pain, people with arthritis often keep affected joints bent - especially in the knees, hands and fingers - because it's more comfortable during the early stages of arthritis. While this may temporarily relieve discomfort, holding a joint in the same position for too long can cause permanent loss of mobility and hinder daily activities.

Range-of-motion exercises (also called stretching or flexibility exercises) help maintain normal joint function by increasing and preserving joint mobility and flexibility. In this group of exercises, affected joints are conditioned by gently straightening and bending the joints in a controlled manner as far as they comfortably will go. During the course of a range-of-motion exercise program, the joints are stretched progressively farther (maintaining comfort levels) until normal or near-normal range is achieved and maintained.

In addition to preserving joint function, range-of-motion exercises are an important form of warm-up and stretching, and should be done prior to performing strengthening or endurance exercises or engaging in any other physical activity. A physician or physical therapist can provide you with instructions on how to perform range-of-motion exercises for the fingers, shoulders and back, chin and neck, hips, knees and ankles.

Strengthening exercises

Strong muscles help keep weak joints stable and more comfortable and protected against further damage. A program of strength-conditioning exercises that target specific muscle groups can be beneficial as part of your arthritis treatment program. There are several types of strengthening exercises that, when performed properly, can maintain or increase supportive muscle tissue without aggravating affected joints.

Some people with arthritis avoid exercise because of joint pain. However, a group of exercises called isometrics are designed to strengthen targeted muscle groups without bending painful joints. Isometrics involve no joint movement, but rather strengthen muscle groups by using an alternating series of isolated muscle flexes and periods of relaxation.

Another group of exercises called isotonics are similar to range-of-motion exercises because they involve joint mobility. However, this group of exercises is more intensive, achieving strength development through increased repetitions or speed of repetitions, or by introducing light-weight resistance with small dumbbells or stretch bands.

A physical therapist or fitness instructor (preferably one with experience working with arthritis patients) can provide you with instruction on how to correctly and effectively perform isometric and isotonic exercises.

Hydrotherapy or aquatherapy (water therapy), is a program of exercises performed in a large pool. Aquatherapy may be easier on painful joints because the water takes some of the weight off of the affected areas while providing resistance training.

Endurance exercise

The foundation of endurance training is aerobic exercise, which includes any activity that uses large muscle groups, can be maintained continuously for a long period of time and is rhythmic in nature. Aerobic activity conditions the heart, lungs and cardiovascular system to:

• Use oxygen more efficiently
• Supply the entire body with larger amounts of oxygen-rich blood
• Build stronger muscle tissue

When paired with a healthy diet, aerobic activity also is fundamental for weight control (which reduces excess pressure on affected joints) and improving overall general health.

People with arthritis should perform about 15 minutes of aerobic activity (called the duration of the exercise) at least three times a week (called the frequency of the exercise) at first, then gradually build up to 30 minutes daily. The activity also should include at least 5 to 10 minutes of warm up plus 5 to 10 minutes of cool down. While peak benefits are achieved when an aerobic activity is performed continuously for at least 30 minutes, aerobic exercise can be spread out in smaller segments of time throughout the day to suit your comfort level, without overexerting yourself. Aerobic exercise should be performed at a comfortable, steady pace that allows you to talk normally and easily during the activity. Ask your therapist what intensity of exercise is appropriate for your fitness level.

Intensity is how hard you are exercising. During exercise, your heart's "training range" or training heart rate should be closely monitored. To improve your body's aerobic condition, you need to exercise at an intensity between 60 and 80 percent of your maximum heart rate.

Examples of aerobic activities include:

• Walking
• Swimming
• Low-impact aerobic dance
• Biking
• Mowing the lawn
• Raking leaves
• Playing golf

Walking is one of the easiest aerobic exercise programs to begin because it requires no special skills or equipment other than a good pair of supportive walking shoes, and it's less stressful on joints than running or jogging. Biking also may be more beneficial to people with arthritis than other aerobic activities because it places less stress on knee, foot and ankle joints.

Appropriate recreational exercise, including sports, can be helpful to most people with arthritis, but only if it is preceded by a program of range-of-motion, strength and aerobic exercise to reduce the chance of injury.

Beginning a new exercise program

Regardless of your condition, discuss exercise options with a physician before beginning any new exercise program. Also, begin new exercise programs under the supervision of a physical or occupational therapist, preferably one with experience working with arthritis patients.

People with arthritis who are beginning a new exercise program should spend some time conditioning using a program that consists only of range-of-motion and strengthening exercises, depending on their physical and athletic condition. Endurance exercises should be added gradually, and only after you feel comfortable with your current fitness level.

As with any change in lifestyle, your body will have to take time to adapt to your new program. During the first few weeks, you may notice changes in the way your muscles feel, changes in your sleep patterns or different energy levels. These changes are to be expected with increased activity levels. However, improper exercise levels or programs may be harmful, making symptoms of arthritis worse. Consult your physician or therapist and adjust your program if you experience any of the following:

• Unusual or persistent fatigue
• Sharp or increased pain
• Increased weakness
• Decreased range of motion
• Increased joint swelling
• Continuing pain (lasting greater than 24 hours)

Effective treatment of arthritis should include a comfortable balance of range-of motion, strengthening and endurance exercises. But regardless of the exercise program you select, it's important to begin slowly and choose a program you enjoy so that you maintain it. Make exercise part of your weekly routine so that it becomes a lifetime commitment.