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Arthritis: Exercise

by John H Bland MD(more info)

listed in arthritis, originally published in issue 17 - January 1997

Arthritis: What Exercises Work deals with one of the most important and significant aspects of the management of these two diseases. Exercise is very commonly prescribed for arthritis, but that's about as far as it all too frequently goes. In other words, doctors give patients too little detail or instruction, with few illustrations, and no precise direction. Yet many of the most troublesome and disabling aspects of both rheumatoid arthritis and osteo-arthritis are due to lack of exercise!

A joint that is immobilized initiates a series of changes that result in total destruction of the joint within about four months. This occurs even in the absence of disease – by dint of immobilization alone. Adhesions begin to appear in the joint, a strange tissue grows over the surface of the cartilage, and tears occur where tendons are inserted in bone. New planes of motion contrary to normal anatomical planes appear, followed by enzymatic degradation of the tissues. Ligaments become lax, losing their tensile strength. The cartilage that caps the ends of bones, and which is normally four times more slippery than Teflon, loses that slipperiness and becomes perforated by ulcers.

Many of the changes that occur in the joints of people with rheumatoid arthritis and osteo-arthritis are assumed to be caused by a disease process, when in fact they are often a consequence of relative immobility. These findings underscore the enormous importance of exercise in the fight against arthritis. I always counsel my patients to exercise to their point of tolerance.

My advice to you, the reader, is the same. You should realize that immobility will set off the destructive set of events I outlined above in just a few weeks. After four or five months, such degeneration may be quite well along, so that even if you initiate a program of vigorous exercise, you may have to wait up to a year for the joint's normal motion to return. Therefore, I say, prevention is the order of the day.

Exercise exerts a very favorable influence on the immunological system, affecting the production of white blood cells, lymphocytes and leukocytes, as well as the whole spectrum of antibodies against various viruses and bacteria. A protective agent called interferon is induced by brisk exercise. There is even evidence that people who are exercising significantly lower their risk of cancer. Exercising also reduces obesity.

Actively exercising to the best of your ability helps you discover your own fountain of youth. Do not heed the warning that because you have a disease you should rest more and more, and not stretch yourself at all. That would be the worst thing you could do.

Stretching, described in the book, is of major importance as a prelude to walking and as a regular habit to maintain healthy ligaments, muscles, bones, joints, and tendons. A complete stretching program would require approximately ten to fifteen minutes a day. It is wise to stretch before and after a walk, to help you maintain optimum balance, and avoid stumbling and falls.

Warm up before you exercise, and cool down afterward with some post-exercise stretching.

Walking, which almost everyone with rheumatoid arthritis or osteo-arthritis can do to some degree, is of extreme importance as an integral, essential part of a program of disease management. I've come to use the term "walk the walk" when urging my patients to carry themselves proudly, and to remember that self-confidence is the most important mental ingredient for success in arthritis management. The way you walk and move can strongly influence the way you think and feel. If your body is down, your thoughts and feeling will be down. If your body is up, your thoughts and feelings will be up, too.

Walking the walk means holding your head high and your chin up, while keeping your eyes forward, shoulders back, and arms swinging to the bounce in your step. It is difficult to walk the walk and say things like "I'm awful," "I hurt," or "I can't do this." Rather, a person who walks the walk says, "I am confident in my ability," "I know how to handle pressure," and "I'm going to practise walking the walk by being aware of how I carry myself."

When you focus on making positive physical changes, as this book shows you, you'll feel more positive and energetic.

To exercise, and especially to walk, is to induce the synthesis and release of a set of hormones called endorphins produced in the brain and the spinal cord. These normal, morphinelike substances actually diminish the perception of pain. Equally, or perhaps more important, is the fact that walking generates a sense of self-esteem, with increased optimism and decreased anxiety. Thus, walking confers both a physical and an intellectual appreciation of self-worth.

Increasing self-confidence not only makes you feel better physically and psychologically, but also improves sexual appetite and performance. You will look better and feel younger. You will grow tougher and more content. Best of all, you can say to yourself, "I set out to do it, and I did it."

Until recently, the question of how intensely one must exercise was unresolved. Taking a hint from a well-known fable, we can see that although the tortoise and the hare travel at different paces, the tortoise is the less anxious. You don't have to work up to a sweat to experience the stress-relieving and tissue-saving benefits of exercise. The evidence now is that walking, even at a slow pace, can induce the mechanisms in the body (arthritis or no arthritis!) that elevate mood, relieve anxiety, and improve one's overall self-esteem. Joint stiffness is reduced. Swelling tends to gradually disappear with regular walking. The prevention of bone loss is another benefit of walking.

As the authors of this book point out, walking is one of the few exercises to which age and physical condition usually pose no barriers.

I also consider it of great importance to exercise your brain. By that, I mean I encourage you to practice memory methods, remain with the times, read, study, and be all you can be. I know I still see myself as an underachiever. I haven't run as fast as I can, I haven't walked as fast as I can, I haven't written as well as I can. Not yet! I can still strive to do better. And so can you. Regardless of the presence of a chronic disease – or anything else – you are capable of improved physical and intellectual performance. This book will help you achieve them.

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About John H Bland MD

John H. Bland, M.D. Professor of Medicine, University of Vermont College of Medicine

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