Exercise benefits arthritis sufferers

Editor's note: This article is part of a series to run over the next few months on heart disease and women. Visit www.americanheart.org or call 336-7005 to request your free women's heart kit.

In the early 1970s, it was thought that people with arthritis should rest and reduce their physical activity to feel better. However, in the 1980s and '90s there was growing evidence that any exercise is good for arthritis. In fact, researchers are now stating that exercise is vital for those with rheumatic (arthritic) diseases.

There's a new concept called rheumatic cachexia, caused by chronic inflammation on the body. Cachexia leads to loss of lean body mass in patients with rheumatic conditions such as rheumatoid arthritis.

Chronic inflammation profoundly affects the body's metabolism, composition and function. This is driven by the ongoing activity of the immune system that also damages the inflamed joint. Cachexia occurs silently without pain or symptoms and can be overlooked even by physicians.

Cachexia can occur even in the presence of adequate dietary intake and proper medication. Rheumatoid arthritis patients who are treated well with medications can have about 15 percent less body cell mass than individuals of the same age, sex and race. Researchers point out that a loss of more than 40 percent muscle mass from baseline can be fatal.

There's a great deal of evidence that exercise can counteract this problem. Regular exercise can reduce joint pain and stiffness, build strong muscles around joints and increase flexibility and endurance.

Other benefits of exercise include protection against heart disease and osteoporosis, improved diabetes blood sugar, reduced blood pressure, protection against colon cancer, more energy, weight control and increased metabolism. It also will help you sleep better, reduces depression and improves your self-esteem.

Strength training and aerobic exercises can usually be done by most people with arthritis. Consult your doctor before you begin any heavy exercise program. Start with stretching flexibility exercises, which can improve your range of motion and help you with daily activities.

Gradually move to weight training and endurance exercises. Swimming, bicycling and walking are ideal exercises for patients with rheumatoid arthritis and even those who are unfit.

Weight training includes using wrist and ankle weights at home or weight machines at a gym. Then move on to more resistance training with heavier weights (only when you are stronger). Repetitions of six times for five large muscle groups three times a week can benefit arthritis patients tremendously.

For those with osteoarthritis, strength training along the functional planes of motions is beneficial. Avoid rotational stresses. Many use hot or cold packs to the affected joint before and after exercising.

Some patients argue that they can't exercise because they are in pain. Inactivity worsens the pain over time. As you exercise, your pain gradually decreases.

Those with severe pain may want to start with isometric exercises like moving their limbs in a horizontal direction, or begin with a water exercise program. As you float in the water, a great deal of stress is taken off your major joints like the knees, hips and spine.

Walking, playing golf and taking Yoga or Tai chi classes are all beneficial forms of exercise for arthritis. A recent 12-week study conducted by Dr. Wang at Tufts New England Medical Center in Boston looking at the benefits of Tai chi on rheumatoid arthritis found that more than half of the patients experienced improvement in their disease. They had improved grip strength and reduced number of swollen and tender joints.

In regards to Yoga, one has to begin gently, especially for first timers. A random controlled study published in 1994 in the Journal of Rheumatology found that Yoga practice significantly improved tenderness and finger range of motion for patients with osteoarthritis of the hands.

Another study in the British Journal of Rheumatology suggested that Yoga helps rheumatoid arthritis patients by improving grip strength and reducing joint swelling.

Whatever exercise you enjoy or would like to start, a physical or occupational therapist can help you tailor it for your needs. A physical therapist can help you develop good technique and precautions for certain exercises. An occupation therapist can provide assistive devices to make the exercise comfortable.

Finally, make sure you are having fun with whatever exercise you choose and try to stick to a regular schedule.

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Dr. Ali Bazzi is a board certified rheumatologist in private practice full time with the Arthritis Center of Yuma, 3250 S. 4th Ave., Suite F. Dr. Bazzi is a member of the medical staff of the Yuma Regional Medical Center. He can be reached at 314-1200.