Osteoarthritis is the inflammation of a joint or joints that causes pain, swelling, and stiffness and is a leading cause of disability among older adults. Arthritis can be difficult for a person to deal with, but it doesn’t have to undermine his or her overall fitness.
There are several types of arthritis, a potentially debilitating degenerative condition of the joints, but osteoarthritis (OA) is the most common, afflicting an estimated 27 million adults each year — and that is considered a conservative estimate.1 OA typically occurs in the hands, knees, spine and hips affecting a multitude of joints.2 The goal for someone who has arthritis is to stay, or become, as physically active as possible. If activity stops because of limitations in one or even several joints, the whole body can suffer due to muscle weakness, loss of flexibility and a reduced level of aerobic fitness.
Osteoarthritis starts to develop when the slippery cartilage covering the bone endings degenerates. Joints are held in place by tough, fibrous ligaments and a joint capsule. Smooth cartilage covers the ends of the bone endings in order for them to move easily. A thin membrane known as the synovium covers the inner lining of the joint capsule and secretes joint-lubricating fluid known as synovial fluid. Osteoarthritis, also known as degenerative arthritis, is associated with age. By age 55, about 80% of the population shows some X-ray evidence of the condition. Another common form of the disease, known as rheumatoid arthritis, is an autoimmune disorder that causes inflammation of the synovial membrane and can also lead to bone loss. Like OA, the risk of developing rheumatoid arthritis increases with age.
Education is widely held to be the most effective form of treatment for OA. Education should start with a physician and be followed by the health professional, such a physical therapist, and personal trainer. For the trainer, arthritis should be identified during an initial client consultation. However, because the condition can develop over time, it is best to “stay in the loop” with a client and his or her physician, particularly when a doctor’s orders include contraindications to specific exercises.
There are medications discussed between physicians and patients physicians. Some of the more common are NSAIDS(non-steroidals) including ibuprofen, naproxen, cyclooxygenase inhibitors(celebrex) and vioxx. Steroid injections are another treatment option, but can only be administered on a limited (often just three times per year). One downside of the prolonged use of steroid injections can be a predisposition to osteoporosis – clearly a counterproductive development.
Exercising with OA
The onset of OA is associated with factors such as body misalignment and heredity, but other potential contributors include obesity (due to the extra stress it places on the weight-bearing joints such as the hips and knees) and (especially in younger people) joint injuries and trauma. The pain of arthritis often goes beyond the affected joints and tissues. Arthritis pain sufferers may experience feelings of depression, anger, anxiety and loss of self-esteem. In additon, arthritis can impact a person’s willingness to perform exercise, which can become a vicious cycle: An anticipation of pain can be enough for someone with arthritis to cut down on many activities and avoid certain activities altogether, which in turn can contribute to less physical activity in general. This reduced activity can lead to reduced mobility, which can aggravate the condition. With that in mind, it is important to realize that arthritis pain sufferers can perform any type of non-load bearing exercises that the specific joint condition will allow (within reason). This can mean the performance of swimming, cycling, and walking, among other activities.
Other activities may include resistance exercise programs to the brisk performance of the activities of everyday living. Exercise programs that include range of motion, flexibility, strength and endurance exercises can have noticeable benefits such as:
- less muscle shortening and joint contraction; improved circulation in affected joints;
- increased mobility and range of motion;
- decreased likelihood of disability and deformity, and;
- improved sense of well-being and self-esteem.
In order to get the most benefit from exercise, arthritis pain sufferers should accommodate the affected joints in order to make staying physically active enjoyable.
Some suggestions for planning exercises for people with OA include:
- Performing 30 minutes total of activity each day. These can be performed in 10-minute intervals.
- Performing moderate resistance exercise, which can reduce joint pain. If there are multiple joints affected, it might be appropriate for the person to consult with a qualified rheumatologist. In cases of severe, multi-joint pain, physical therapy may be necessary.
- Seeking out support from peers. Many communities have support groups for arthritis pain sufferers, such as People with Arthritis Can Exercise (PACE).
2. Lawrence RC, Delson DT, Helmck CG et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Arthritis Rheumatology. 58(1) pgs: 26-35. 2008.