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What is Occupational Therapy and How Can it Help You?
Exercise is probably the last thing on the mind of an arthritis sufferer. Aching joints can make moving painful, and some individuals even believe physical activity will speed up the progression of their arthritis. But they’re wrong. In addition to helping overall health, exercise can actually help lessen arthritis symptoms. All it takes is developing a fitness program that does not stress arthritic joints.
Experts OK Exercise
According to John Hopkins Arthritis Center in Baltimore, MD, being overweight can increase pain for an arthritis patient. Carrying just 10 extra pounds of weight can up the force on the knee by 30 to 60 pounds with each step. Also, overweight women are four times more likely to develop knee osteoarthritis, while overweight men are five times as likely.1
In the Framingham study on obesity and knee osteoarthritis, researchers found that when overweight women lost weight, they dramatically lowered their risk of knee osteoarthritis. An 11-pound weight loss decreased the chances of the condition by half.1
Lynn Millar, PT, PhD, professor of Physical Therapy at Andrews University in Berrien Springs, MI, says exercise helps arthritis in several other ways.
“A single bout of exercise has been shown to decrease pain and based upon basic physiology. We know that movement of the joint and surrounding muscles will help lubricate the joint and improve circulation to the area,” she said. “Regular exercise improves circulation, which promotes healing and helps to decrease inflammation. Increase in muscle mass translates to increased strength, which helps reduce the forces through a joint and helps to control the joint stability, often a problem with arthritis.”
Let The ACSM Be Your Guide
Dr. Millar says arthritic individuals can adhere to the basic exercise guidelines from the American College of Sports Medicine (ACSM). The college recommends 20 to 60 minutes of aerobic activity three to five days per week at an intensity of 60 to 80 percent of heart rate reserve, which is based on maximal heart rate minus resting heart rate. Modifications can be made based on the severity of the individual’s arthritis and their current fitness level. 2
“With severe lower extremity arthritis, cycling or aquatic exercise might be preferable,” Dr. Millar suggested. “If the individual has been sedentary, then the therapist might use short bouts of interval activity to build up endurance. Lower intensities have also been shown to be beneficial, especially if the person has severe arthritis or if they have more than one co-morbidity. I would recommend starting with lower intensities and durations, which improves adherence and allows the person to adapt to the activities.”
But don’t forget to include resistance training and stretching for your arthritic clients. Again, the ACSM guidelines suggest eight to 10 basic exercises, with one set of eight to 12 repetitions each, two to three times a week. Range of motion activities can help alleviate stiffness and should be done a minimum of two to three days. Dr. Millar suggests tai chi or yoga for improving flexibility and range of motion.
Aquatics and Therapy Balls
Practicing Physical Therapists had additional suggestions for activities for arthritis patients. Ron Chadwick, PT, has his clients do seated bouncing on a therapy ball.
“It gives cardiovascular effects to increase the metabolic rate, provides core strengthening, goes easy on the joints and lends repetitive motion that aids in pain control. And it can be combined with watching TV so there is better compliance,” he said.
Mary Ellene Castillo, PT, recommends aquatic exercises to lessen the amount of pressure on joints while still providing a solid cardio workout.
“You don’t have to have swimming skills to do it, but by just walking back and forth while in the water at waist to chest level for more resistance and some cycling with noodle floats or jogging in the water can shed pounds and improve the condition.”
Daniel Montue, PT, also prefers pool-based exercise. “This decreases weight bearing, and higher temperatures help with the pain,” he said. “Aquatic exercise is good for cardio and there are also various exercises that can be done in the supine position with flotation devices. But certain conditions such as severe cardiac and respiratory dysfunction and kidney disease are contraindicated, so be sure to do your research.”
Go Above and Beyond
Before starting an exercise program with an arthritis patient, therapists should check joint stability and alignment which can impact exercise, Dr. Millar said. They should make sure the patient has good shoes and resistance equipment that they can hold on to without pain, and use proper body mechanics while lifting. Also, therapists should guide these individuals in how to properly warm-up and cool-down as part of the exercise program. Screening the cardiopulmonary system beforehand is also recommended, because individuals with systemic arthritides, such as rheumatoid arthritis or ankylosing spondylitis, have a higher risk of cardiac disease.
While there are many elements to consider when developing a fitness regimen for arthritis clients, therapists shouldn’t be afraid to push them beyond the basics.
“While I think it is important to start out at a low intensity, there is plenty of research supporting the importance of higher intensity exercise (which is not the same as high impact),” Dr. Millar said. “Patients with arthritis should progress the intensity, just as any other individual. Therapists do need to understand the types of arthritis and need to balance rest with exercise for the patient.”
The only motions therapists should avoid with their arthritis patients involve anything that takes them beyond the normal range of motion or that places an unusual stress on a joint, Dr. Millar continued. Some yoga moves, for example, stress the cervical vertebra and may not be safe if the individual has arthritis. For many activities, the patient can simply modify the movements.
Words by Lauren Fritsky
- The John Hopkins Arthritis Center. (2009). Osteoarthritis Weight Management. Retrieved from the World Wide Web: http://www.hopkins-arthritis.org/patient-corner/disease-management/osteoandweight.html
- American College of Sports Medicine. (2009). Physical Activity & Public Health Guidelines. Retrieved from the World Wide Web: http://www.acsm.org/AM/Template.cfm