Harvard Health Letters
8:26 PM EST, January 23, 2013
For a disease that affects 50 million adults in the United States, or about 1 in 5 people, arthritis is remarkably misunderstood.
Many people believe it's a crippling and inevitable part of growing old. But things are changing. Treatments are better, and plenty of people age well without much arthritis. People also tend to think of arthritis as a single disease. In fact, there are more than 100 different types of arthritis. And although they all affect joints, their causes and treatments can vary considerably.
If you have arthritis, you can take steps to protect your joints, reduce discomfort and improve mobility. Because describing your symptoms is so important for a correct diagnosis, it's important to take note of the symptoms you experience. Then talk with your doctor to determine which kind of arthritis you have.
The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. Other types include gout, pseudogout and infectious arthritis. There are several established medical therapies for each, as well as complementary treatments, such as acupuncture, chiropractic and massage.
Self-care, especially exercise, is also important. People with arthritis commonly discover that regular exercise not only helps maintain joint function but also relieves stiffness and decreases pain and fatigue. The key is having the energy to get moving.
Feeling tired may be partly the result of inflammation and medications, but it's also caused by muscle weakness and poor stamina. If a muscle isn't used, it can lose 3 percent of its function every day and 30 percent of its bulk in just a week.
A 2009 review article in Current Opinion in Rheumatology asserts that both aerobic and muscle-strengthening exercises are safe and effective for people with chronic arthritis. Below are brief summaries of different forms of structured exercise programs (most of which are offered by local Arthritis Foundation chapters) and their potential benefits. For more, or to locate a class near you, visit arthritis.org/resources/community-programs or call 800-283-7800.
Land-based programs: These include community-based group classes led by health or fitness professionals with specialized training in instructing people with arthritis. Examples include Fit and Strong, a program targeted to older adults with osteoarthritis, and the Arthritis Foundation's Exercise Program and its Walk with Ease program. All include some combination of a warm-up routine and three standard exercise goals, plus specialized activities to enhance body awareness, balance and coordination.
Studies have found that people with arthritis in their hips, legs and feet who took Fit and Strong classes were able to exercise longer, felt more confident about their ability to exercise and reported less joint stiffness compared with those in a control group. Many of the benefits lasted between six and 12 months. Those attending these kinds of classes for eight weeks had less pain, stiffness and fatigue, and these improvements persisted at least six months as well.
In one study, people who completed the Walk with Ease program, which also teaches participants about managing their disease, had more confidence, less depression and less pain compared with participants who attended classes focused on pain management.
Water-based programs: Also known as aquatic or pool therapy, these group classes are done in water that's nearly 90 degrees and feature a variety of exercises, including range-of-motion and aerobics. According to one study, people who took the Arthritis Foundation Aquatic Program improved knee and hip flexibility, as well as strength and aerobic fitness.
Other investigations suggest water exercise lessens pain and boosts physical functioning, and the benefits after the 12-week session were sustained for three months after the last class.
Strength and resistance training: This form of exercise, which uses weight machines, free weights and resistance bands or tubing, strengthens not only muscles but also your bones and your cardiovascular system. Resistance training improves muscle strength, physical functioning and pain in 50 to 75 percent of people with knee osteoarthritis, according to a 2008 review article.
One Japanese study compared people with knee osteoarthritis who either took nonsteroidal anti-inflammatory drugs or did twice daily knee extension exercises to strengthen their quadriceps (the muscles on the front of the thigh). At the end of the 8-week study, both groups had less pain and stiffness, as well as improved functioning and quality of life.
Yoga: Scant research has explored the benefits of yoga for people with arthritis. One study showed that people with knee osteoarthritis who took eight weeks of Iyengar yoga, a form of yoga that focuses on correct body alignment and uses blocks, belts and other props to assist in performing postures, had less pain and could function better at the end of the study.
Another study of people with rheumatoid arthritis found benefits from participating in twice-weekly Iyengar sessions for six weeks — namely, less pain and depression and greater mobility. But both studies were quite small, and neither included a comparison group.
Tai chi: With origins in Chinese martial arts, this low-impact, slow-motion exercise also emphasizes breathing and mental focus. A number of small studies suggest tai chi helps people with different forms of arthritis, mainly by increasing flexibility and improving muscle strength in the lower body, as well as aiding gait and balance.
The Arthritis Foundation, along with Dr. Paul Lam, a family physician and tai chi instructor, developed a standardized form of tai chi designed specifically for people with arthritis. Based on Sun-style tai chi, one of the discipline's five major recognized styles, it includes agile steps and a high stance (meaning the legs bend only slightly).
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