________________________________
By: Sara M. Aksoy
Exercise is a critical element to any arthritis treatment program. Beyond benefiting cardiovascular health, exercise can strengthen several structures of the joint, relieving arthritis pain and improving your quality of life. In particular, maintenance of bone strength, muscle strength, and range of motion are essential in success with your arthritis.
Some individuals with rheumatoid arthritis find that certain foods tend to exacerbate their symptoms. As with medication, different types of food can affect various individuals’ bodies differently, so the substance that causes one to have more aching joints will not necessarily adversely affect another. Foods that tend to affect RA more often include alcohol, red meat, and members of the nightshade family, which consists of tomatoes, potatoes, eggplant, and peppers (not black or white pepper). To test if your arthritis symptoms are worsened by a specific food, conduct an elimination diet. Stop eating the foods you plan to test for a fixed period of time then introduce them one at a time. Keep a journal and take note of any changes you experience in your joints: inflammation, pain, or otherwise. If you find that a specific food hurts or helps your joint pain, appropriate dietary changes may positively affect your life.
While many of us consider the bone to be a static structure that
undergoes little change during our lifetimes, in truth it is very
dynamic and is constantly being remodeled. Specialized cells in
the bone break down or build up new bone according to our
body’s current supplies and needs, so bone health should
also be a major focus.
Maintaining good bone health is especially critical as we age, when risk for osteoporosis, a disease where the bone becomes porous and weak, is at its highest. Osteoporosis, referred to as the “silent disease,” often first manifests itself as a bone fracture, which is more reason to take precautionary measures to strengthen the bone. Bone mass reaches its peak around age 25, after which it declines at different rates depending on the individual. Women are at the highest risk for osteoporosis, making up eighty percent of the afflicted population. Post-menopausal women are at especially high risk, for the decrease in estrogen levels is linked to a significant loss in bone mass. For this reason, estrogen replacement therapy is often considered, especially for those at high risk.
Forms of inflammatory arthritis, such as rheumatoid arthritis or lupus, result in the production of substances that contribute the loss of bone mass, increasing the risk of osteoporosis. Further, the glucocorticoid treatments for these diseases (also used in other forms of arthritis) stimulate degradation of bone and inhibit the formation of new bone mass.
While bone loss seems to be inseparable from the aging process, there are several easy measures that can be taken to prevent its progression, the most basic of which is taking calcium supplements. Calcium plays a key role in a number of physiological processes, from muscle contraction to nerve responses to signaling between your cells. The body needs at least 1000mg of calcium daily for these mechanisms, with post-menopausal women needing at least 1500mg. If your body does not receive the necessary amount of daily calcium, it will turn to the bones to make up the difference, resulting in a loss of the strengthening calcium in the bone. For this reason, calcium supplements of 1000-1500mg depending on your gender and age can deliver the necessary calcium to your body and avoid the need to use calcium stored in the bones.
Vitamin D is also a critical player in strengthening the bones by increasing the absorption of calcium from your intestines. While vitamin D supplements are available, your body actually makes and stores an inactive form of vitamin D in the skin. This vitamin D precursor is converted into its active form by the sunlight, allowing it to go to work and increase your bone strength. By spending 15 minutes in the sun every day you can activate your daily requirement of vitamin D.
What may people do not know is that physical activity can increase bone strength as well. Weight-bearing exercise, where your bones are required to support your body’s weight, actually helps to maintain bone mass. While many forms of weight-bearing exercise, such as running or aerobics, may be painful on arthritic joints, walking or tai chi provide the same beneficial results but are much gentler on the joint. Begin with 20 minutes of weight-bearing exercise three times a week and try to work your way up to 30 minutes five times weekly. The Jackson Arthritis Center offers tai chi classes; call (510) 238-4851 for details.
Muscle strength is critical in reducing arthritis pain. By
strengthening the muscles surrounding a joint, you can reduce the
impact felt by the joint and align it for smoother motion.
However, exercises targeted at strengthening the muscles around
the joint often result in arthritis pain, and ? to exercise. If
this is the case, there are modifications you can make to reduce
pain in your exercise program as well as several alternative
programs available that strengthen muscle that reduce pressure on
the joint.
When we exercise, we often do not consider the external forces such as gravity that provide resistance against movement. Take, for example, the knee straightening exercise for the thigh muscle, where, from the sitting position, the bent leg is extended until it is straight. Energy goes both into moving the leg from bent to straight and into lifting the leg against gravity. This combined force can be too much for the joints of some people, resulting in pain. An alternative exercise would be to perform the same exercise, lifting the leg from bent to straight position, while lying down on your side. Here you remove the force of gravity and are still strengthening the muscle while decreasing pressure on the joint.
Some exercise programs use other methods to remove pressure from the joint while still strengthening the muscle. For example, water exercises combine the buoyancy of water, which removes joint pressure, as well as its resistance, which increases the intensity of the movement, to protect the joints while strengthening the muscle. Yoga, which uses many poses to contract specific muscle groups improves muscle strength without the painful repetitive movement of the joint that often accompanies other forms of exercise.
Another critical area of physical health is the range of motion
(ROM) of the joint, which is the degree to which your joint can
move in different directions. Pain and stiffness in the joint can
decrease your range of motion, resulting in more difficulty of
movement and often limitations on the activities that you can
participate in. Maintaining or increasing range of motion is
therefore critical not only in preventing stiffness and
deformity, but also in dictating your quality of life. Exercises
that improve ROM take your joints through their complete ranges
of motion. The Arthritis Foundation’s PACE class, or People
with Arthritis Can Exercise, focuses on improving strength and
range of motion in the joints. Call the Jackson Arthritis Center
for more details.
Besides being beneficial for increased physical strength,
exercising also has a profound effect on mental and emotional
health, making it even more important in the treatment of
arthritis. Mental and physical health are closely related so
arthritis affects more than physical well-being; it often causes
stress and depression which extend into all areas of life. The
infamous chronic pain cycle illustrates this strong relationship
between aspects of mental and physical health. By strengthening
the body and range of motion of your joints you can help to ease
the pain and resultant muscle tension of arthritis, reversing
this downward cycle characteristic of chronic pain.