Focus on Fitness: Getting Fit With Osteoarthritis

October 2017 Issue

Focus on Fitness: Getting Fit With Osteoarthritis
By Jennifer Van Pelt, MA
Today's Dietitian
Vol. 19, No. 10, P. 18

Moderate-intensity, low-impact exercise is recommended.

In 1996, Arthritis and Rheumatism International established October 12 as World Arthritis Day, a global initiative to increase awareness of rheumatic and musculoskeletal diseases. Osteoarthritis (OA) is the most common type of arthritis, affecting approximately 31 million Americans, according to the Arthritis Foundation. Also called degenerative joint disease or "wear and tear" arthritis, OA causes the bones and cartilage in a joint to slowly and progressively break down. Hips, knees, and hands are the most common joints affected by OA. Symptoms include pain, aching sensation, stiffness, decreased range of motion, and swelling in the affected joint. OA is a leading cause of disability and may result in difficulties walking, climbing stairs, grasping, and bending.

According to the Arthritis Foundation and the Centers for Disease Control and Prevention, risk factors include the following:

• Older age: Risk of developing OA increases with age.
• Overweight and obesity: Joints (especially the hips and knees) are stressed by extra weight.
• Female gender: Women are more likely than men to develop OA.
• Overuse and injury: Athletes, those who do high-impact exercise, and those with jobs involving repetitive bending or movement of a joint have a higher risk of OA and can develop it at a younger age due to increased stress on the joints.

Though some types of exercise can cause or aggravate OA, appropriate physical activity is part of the treatment plan for individuals with OA because it can help relieve pain and improve or maintain function in joints affected by the disease, as well as help with weight loss and healthy weight maintenance. However, the Arthritis Foundation notes that individuals with OA tend to be less active; almost 50% of adults with OA don't even perform active leisure activities, such as walking and gardening. The Arthritis Foundation and the Centers for Disease Control and Prevention recommend moderate-intensity, low-impact exercise such as walking, swimming, or cycling. The Arthritis Foundation has established exercise programs specifically for individuals with OA.

• Walk With Ease is a community-based walking program led by qualified Arthritis Foundation instructors; a self-directed walking program with online resources and a mobile app also is available. Instructor-led group sessions meet three times weekly for six weeks. Each session begins with a prewalk discussion on an exercise-related arthritis topic, followed by a 10- to 40-minute walk. Walk With Ease is a great program for those with OA who don't regularly exercise and who need motivation. More information can be found on the Arthritis Foundation website at www.arthritis.org/living-with-arthritis/tools-resources/walk-with-ease.

• The Arthritis Foundation Aquatic Program (AFAP) is a warm-water exercise program for those with arthritis. Developed jointly by the Arthritis Foundation and the YMCA and supported by the Aquatic Exercise Association, AFAP exercises are specifically designed to reduce fatigue, pain, and stiffness and improve mobility, muscle strength, and coordination. Classes are held at local community centers and YMCAs, usually for one hour, two to three times weekly. Pools offering AFAP must be heated to a range of 83° to 92° F, since the water's warmth helps with OA symptoms. More information is available at www.apta.org/uploadedFiles/APTAorg/Practice_and_Patient_Care/Patient_Care/
Arthritis/ArthritisFoundationAquaticProgram.pdf.

Both the Walk With Ease and AFAP programs are supported by studies showing improved outcomes in those with OA and other types of arthritis. Mind-body exercises also have been researched, and yoga, tai chi, and qigong all have been shown to effectively reduce pain, stiffness, and fear of falling and improve strength, functioning, and quality of life in those with OA.1 Some recent studies have found the following:

• Tai chi has been shown to produce benefits similar to those of standard physical therapy for knee OA, including improvements in pain, physical function, and stiffness.2,3 Some researchers have advocated for the inclusion of tai chi in OA rehabilitation programs.4 The Arthritis Foundation supports tai chi as an exercise for those with arthritis and provides links to videos/DVDs at www.arthritis.org/living-with-arthritis/exercise/videos/tai-chi.

• Qigong, a modality related to tai chi but simpler to learn and follow, also has been shown to help manage OA symptoms and improve quality of life and physical functioning.1,5

• Yoga has been found to reduce pain, stiffness, and improve functioning in individuals with OA, as well as improve sleep and psychological status. (Pain and other OA symptoms can lead to depression and anxiety.)5-8

Based on recommendations from the Arthritis Foundation and published evidence, an ideal exercise program for a client with OA should include some form of low-impact cardiovascular exercise such as walking, cycling, swimming, or water aerobics/water walking combined with mind-body exercises such as tai chi, qigong, and/or yoga. All three of these mind-body exercises can be performed seated in a chair for clients with movement limitations due to OA pain and joint stiffness. For clients used to more vigorous exercise who no longer can perform high-impact activities such as running, water jogging with a floatation vest and stationary cycling can both provide a high-intensity cardiovascular workout with minimal impact on arthritic joints.

— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Reading, Pennsylvania, area.

References
1. Chyu MC, von Bergen V, Brismée JM, Zhang Y, Yeh JK, Shen CL. Complementary and alternative exercises for management of osteoarthritis. Arthritis. 2011;2011:364319.

2. Wang C, Schmid CH, Iversen MD, et al. Comparative effectiveness of tai chi versus physical therapy for knee osteoarthritis: a randomized trial. Ann Intern Med. 2016;165(2):77-86.

3. Lauche R, Langhorst J, Dobos G, Cramer H. A systematic review and meta-analysis of tai chi for osteoarthritis of the knee. Complement Ther Med. 2013;21(4):396-406.

4. Yan JH, Gu WJ, Sun J, Zhang WX, Li BW, Pan L. Efficacy of tai chi on pain, stiffness and function in patients with osteoarthritis: a meta-analysis. PLoS One. 2013;8(4):e61672.

5. Brosseau L, Taki J, Desjardins B, et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs. Clin Rehabil. 2017;31(5):582-595.

6. Ward L, Stebbings S, Cherkin D, Baxter GD. Yoga for functional ability, pain and psychosocial outcomes in musculoskeletal conditions: a systematic review and meta-analysis. Musculoskeletal Care. 2013;11(4):203-217.

7. Sharma M. Yoga as an alternative and complementary approach for arthritis: a systematic review. J Evid Based Complementary Altern Med. 2014;19(1):51-58.

8. Cheung C, Wyman JF, Resnick B, Savik K. Yoga for managing knee osteoarthritis in older women: a pilot randomized controlled trial. BMC Complement Altern Med. 2014;14:160.