Avoiding Inactivity in Arthritis
By Jennifer Green, B.S.
|Jennifer Green, NCHPAD Visiting Information Specialist|
Arthritis is a joint disorder that has many different types and commonly features both inflammation and joint pain. The types of arthritis range from those related to wear and tear of cartilage to those associated with inflammation resulting from an overactive immune system. Symptoms of arthritis include both pain and limited function of joints. Inflammation of the joints from arthritis is characterized by joint stiffness, swelling, redness, and warmth. Nearly 40 million people in the United States are affected by arthritis including men and women as well as adults and children. Effects of the disease process as well as the fear of recurring pain and disability are powerful forces that encourage prolonged inactivity. As fitness professionals, it is our job to both encourage and teach individuals dealing with arthritis that physical activity can be beneficial in both relieving some of the symptoms as well as increasing overall health and wellness.
When creating an exercise program for someone with arthritis, it is important to remember that each individual will be different depending on which joints are involved and the amount of inflammation, as well as how stable the joints are and whether a joint replacement procedure has been done. Health professionals want to focus on three major types of exercise that are suitable for arthritis patients; range-of-motion, strengthening and aerobic or endurance exercise.
Range-of-motion exercises help to maintain normal joint movement and relieve stiffness while also helping to maintain or increase flexibility. Gentle stretching and range-of-motion exercises should be performed everyday and can help individual's warm-up for more strenuous exercise by getting the body moving. Yoga and Tai chi are great examples that can help to reduce pain and both strengthen and relax muscles that become stiff from arthritis. Traditional stretching also helps to improve symptoms that are common with arthritis. It is recommended to perform up to 15 minutes of these exercises per day.
Strength or weight training is important to incorporate into a program in order to support and protect the joints that are affected. There are two types of strengthening exercises that are recommended for people with arthritis, isometric and isotonic. Isometrics are a type of strength training in which the joint angle and muscle do not change during contraction. They are done in a static position rather than being dynamic through a range of motion. This type of strength training can be beneficial because it works by tightening the muscles without moving the joint which can reduce stress on the joint. Isotonic exercises help strengthen the muscle while moving the joint with or without resistance added. This type of strength training can be beneficial in individuals with arthritis because the exercise can be made easier during periods of inflammation by adding little or no resistance and more difficult when little inflammation is present.
When focusing on muscle groups, its important to focus on those surrounding the affected joint(s) in order to support and protect yet incorporate all muscle groups as recommended for healthy adults. For individuals with arthritis, American College of Sports Medicine (ACSM) Guidelines recommend incorporating strength training into a fitness routine 2-3 days/week, making sure to warm-up with stretching beforehand. Intensity should start with relatively low amounts of weight, about "10% of the individual's maximum, and progress at a maximal rate of 10% increase per week to the point of pain tolerance and/or low to moderate intensity for 10 to 15 repetitions per exercise for one or more sets."
Aerobic or endurance exercise is an important component to improve cardiovascular fitness and overall function while also helping to control weight. Weight control is critical for individuals with arthritis because extra weight puts extra pressure on the joints. Cardiovascular or aerobic activities can include dancing, swimming, walking and bicycling, among many others. ACSM suggests to incorporate aerobic activity at least "3-5 days/week and keeping in mind that intensity level may be limited by pain." Individuals with arthritis should start with "short bouts of 5 to 10 minutes to accumulate 20-30 minutes/day as tolerated, with a goal of progressing to a total 150 minutes per week of moderate-intensity activity."
ACSM also recommends several special considerations to keep in mind while creating an exercise program for people with arthritis:
- Avoid strenuous exercises during acute periods of inflammation. However, it is still important to gently move joints through their full range of motion during these periods.
- Progression in duration of activity should be emphasized over increased intensity.
- Adequate warm-up and cool-down periods of 5 to 10 minutes are critical for minimizing pain.
- Educate individuals with arthritis that some discomfort during or immediately after exercise can be expected, and this discomfort during does not necessarily mean joints are being further damaged.
- Encourage individuals with arthritis to exercise during the time of day when pain is typically least severe.
- Appropriate shoes that provide shock absorption and stability are especially important for people with arthritis.
- Healthy weight loss should be encouraged in order to decrease stress on the joints.
Arthritis and rheumatic disease are the leading causes of pain and disability, which commonly leads to physical inactivity. Many studies have shown that adding a fitness program that includes stretching, strength training and aerobic activity can help alleviate some of the symptoms that are commonly associated with these diseases. As fitness professionals, it is our job to properly educate these individuals on the benefits of physical activity and create appropriate exercise prescriptions that can decrease symptoms, improve range of motion, strengthen surrounding muscles and improve overall health.
Exercise and arthritis: Types of exercise. (2010). Retrieved 01/06, 2010, from http://www.arthritis.org/types-exercise.php
Minor, Marian A. P.T., PhD. (1991). Physical activity and management of arthritis. Exercise and Aging:Arthritis, 13(3), 117.
Thompson, W.R., Gordon, N. F., & Pescatello, Linda S. (Eds.). (2010). ACSM's Guidelines for Exercise Testing and Prescription (8th ed.). Baltimore: Lippincott Williams & Wilkins.
Please send any questions or comments to Jennifer Green at firstname.lastname@example.org.