According to the CDC approximately 1 in 5 adults and 50% of older adults (> 65 yrs of age) have been diagnosed with some form of arthritis (1). The physical pain associated with arthritis is well documented, however, there is a large social impact on arthritis suffers. From an outsiders perspective, arthritis goes undetected. Outsiders do not see the pain or suffering that arthritic patients must suffer through. They are often labeled as weak, malingerers, or even lazy. Point is, many people with arthritis are unable to work, socialize, keep up with house chores, or play with their children. The pain and social impact often leads to depression and anxiety.
The effect arthritis has on a person is almost unquantifiable. Thankfully, there are ways for arthritic patients to cope and prevent the disease. This blog will hopefully shed some light on the disease as well as provide basic exercise and dietary guidelines that can provide a holistic approach to resolving or reducing the effects of this chronic disease.
There are more than 100 rheumatic diseases and conditions that affect joints, the tissues which surround the joint and other connective tissue (1). It is the most common chronic condition in older adults. The two most common forms of arthritis include osteoarthritis and rheumatoid arthritis.
Osteoarthritis is characterized by the gradual deterioration of cartilage and bone within a joint (2). It is most commonly seen in joints that are load-bearing or highly mobile such as the fingers, hips, knees, lower back, and feet. The synovium of a joint produces a lubricating substance called synovial fluid. Healthy cartilage functions much like a sponge, it is receives nourishment by absorbing synovial fluid during joint movement. As a result of decreased synovial production or inflammation the articular cartilage lining bone becomes dehydrated. This, creates an inflammatory cycle (figure below).
Following repeated bouts of inflammation there is eventual loss of cartilage. Eventually, the release of surface-active phospholipids (a lubricating surfactant) is also limited (3) . With limited lubricant and dehydrated cartilage bones do not respond well, which results in exotosis (bone spurs) that further damage the structures of the joint.
The most common symptoms in affected joints include pain, inflammation, reduced range of motion, and grinding sensations upon movement.
There is no cure for osteoarthritis and since pain is alleviated with rest, many of those afflicted tend to avoid regular exercise for fear of pain. Despite this, a recent study on aerobic and resistance exercise shows that older adults who exercise are effectively able to relieve arthritic pain and improve joint function (4, 5).
Rheumatoid arthritis affects approximately 1% of Americans. It is an autoimmune disease where by the body’s own immune system attacks joint structures, including cartilage, synovial membrane, and ligaments. Rheumatoid arthritis is a systemic condition characterized by periods of activity and remission where affected joints are painful and swollen in addition to whole body symptoms of fever and malaise. Currently there is no cure of rheumatoid arthritis, but there are medications designed to relieve symptoms.
Holistic Approach to Arthritis Treatment and Prevention:
Although I have great respect for western medicine and the research that pharmaceutical companies do to help cure chronic diseases, I have always been a believer in the holistic approach. The body is a self-healer – it is its own internal mechanic. Thus, I think we should try everything to heal naturally, rather than taking medications that bring about serious side effects.
As I had mentioned previously, cartilage gets nourishment through dynamic pressure gradients caused by movement and joint loading. Most people with arthritis can safely participate in physical activity programs to help the disease. Many studies have shown physical activity to have a positive effect on the reduction of arthritic pain. A 2010 agenda released by CDC lists physical activity as a priority intervention to improve arthritis symptoms and prevent arthritis-related limitations in activity (6). Unfortunately, there is a fine line; arthritis causes pain and subsequently, sufferers will not move due to pain. The perpetuates the disease and worsens symptoms. So movement is prudent, however we must be careful and be cognizant of exacerbating the issue. Below are exercise guidelines.
Things to avoid:
- Rheumatoid arthritis results in early morning stiffness so avoid early morning exercise.
- Avoid end ranges of motion.
- Extreme cases may require may only allow client to work in a small mid-range of motion only.
- Be certain to distinguish between exertional in the muscles and pain in the joints.
- If any movement causes moderate pain in a joint, stop immediately and modify or regress.
- Always move joints through a slow and controlled range of motion.
- Avoid fast or jerky movements.
- Progress and increase exercise intensity very slowly.
Exercise tips and suggestions:
- Exercise sessions should be relatively short and of low to moderate intensity.
- Use circuit training (to give body parts a rest between exercises)
- Aerobic exercise should be comprised of multiple sessions of using various cardio equipment (treadmill, to bike, to rower, etc)
- Self myofascial release (foam rolling) might be painful, but try it.
- Static stretching as tolerated but avoid end range of motion for the joint
- Low intensity
- 1–3 sets of 10–12 repetitions 2–3 days per week
- Work on core musculature
- Use a circuit or peripheral heart action training system
- Avoid high reps or high loads
- Use thera-bands or cuffs when possible to avoid gripping
- In severe cases training sessions maybe have to be limited to short bouts (8-10 minutes at a time).
- Emphasize the development of functional flexibility and eccentric control through simple reactive training exercises.
- forward lunge with emphasis on lowering.
- Eccentric training will improve soft tissue to absorb ground reaction forces and reduce the transduction of force to damaged joint structures.
- Water aerobics or swimming may be the best environment for clients with severe arthritis.
As I explained above, arthritis is part a chronic inflammation cycle, where inflammatory mediators remained elevated and a continued process of degradation ensues. I wrote about this in a previous blog entry titled “Is Your Diet Making You Sick?”.
Arthritis is actually classified as an inflammatory disease. Individuals with chronically elevated inflammatory markers are at high risk of chronic disease and now research shows that poor diet can also contribute to increased inflammatory markers. Excessive consumption of refined carbohydrates and low dietary fiber intake is strongly associated with the production of proinflammatory molecules (7). One large study compared a western diet, which contained more red meat, refined carbohydrates and saturated fat to a paleolithic diet (8). The Western diet group had greater levels of inflammatory markers, including CRP and E-selectin (8). Those following the paleo-like diet had a significant decrease of inflammatory markers (8).
Clinical studies in found frequent nut and seed consumption is associated with lower levels of inflammatory markers such as C-reactive protein (CRP), IL-6 and fibrinogen(9). Consuming a high-almond diet (68 g/d per 8386 kJ) for four weeks significantly decreased serum E-selectin compared with the control diet in healthy men and women (9).
The rise of these inflammatory diseases over the past few decades may be linked to the Western diet of saturated fats, low antioxidants, and refined carbohydrates. A diet rich in omega-3 fatty acids such as fish and nuts as well as whole grains and high fiber have been shown to reduce chronic inflammation markers in the blood.
Arthritis is a serious chronic inflammatory disease which has both physiological and psychological effects on overall health. Pharmaceutical companies continue to search for a magical cure for arthritic conditions, but to date nothing has been found. Thankfully, we can do something to help relieve the pain and symptoms of arthritis. Creating a safe and systematic physical activity program can help prevent cartilage deterioration and improve overall function. In addition, a dietary change can also help. By limiting intake of refined carbohydrates, excessive sugar, and foods high in saturated fat we can lower chronically elevated inflammatory markers that are responsible for chronic diseases such as arthritis. I hope these tips help you or someone you know improve quality of life.
- http://www.cdc.gov/arthritis/data_statistics/arthritis_related_stats.htm. retrieved August, 23, 2012
- Ferrini AF, Ferrini RL. Health in the Later Years. 4th ed. New York, NY: McGraw-Hill; 2008.
- Hills, B. A., Ethell, M. T., and Hodgson, D. R. Release of Lubricating Synovial Surfactant By Intra-Articular Steroid. Br J of Rheum. 1998;37:649–652.
- Petrella RJ. Is exercise an effective treatment of osteoarthritis of the knee? West J Emerg Med.2001; 174(3): 191-196.
- Ettinger WH, Burns R, Messier SP, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA. 1997: 277(1): 25-31
- Centers for Disease Control and Arthritis Foundation. A National Public Health Agenda for Osteoarthritis. 2010
- Neustadt J. Western Diet and Inflammation. IMCJ. Vol. 10: 2 Apr/May 2011.
- Lopez-Garcia E, Schulze MB, Fung TT, et al. Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am JClin Nutr.2004;80(4):1029-1035.
- Rajaram, S, Connell, KM, and Sabate´ J. Effect of almond-enriched high-monounsaturated fat diet on selected markers of inflammation: a randomised, controlled, crossover study. BR J of Nut. 2010: 103, 907–912.