1999 Volunteer Leadership Training Guide
Managing Arthritis
Handout 1
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Introduction
• Understanding Arthritis
• Causes of Arthritis
• Forms of Arthritis
• Joint Protection •
Exercise is Essential • Designing
Your Program
• Activity Goals
• Additional Resources
Introduction
Arthritis is the number one cause of disability in America. One in seven
persons, or approximately 40 million Americans, has some form of arthritis. By
2020, an estimated 60 million people will have arthritis. The costs for medical
care and lost productivity amount to an estimated $65 billion annually.
Arthritis strikes people of all ages. Women are at special risk, accounting
for almost two-thirds of all arthritis cases.
Understanding Arthritis
The word "arthritis" is a blend of Greek words. It literally means joint
inflammation.
Arthritis is not one single disease. There are over 100 forms of arthritis.
Some forms occur gradually; others appear suddenly and then disappear, recurring
later; and other forms are chronic and progressive.
The best known symptoms of arthritis include joint pain, a sense of
discomfort after rest or inactivity and stiffness. However, arthritis disorders
frequently affect more than joints. Some forms can affect body organs and can
threaten life.
Causes of Arthritis
Most of the underlying causes of arthritis are unclear. Physical trauma can
set the stage for osteoarthritis, the most common form of arthritis. Other
causes include lack of physical activity, excessive weight or a joint defect,
genetic factors, the environment, infectious agents and an imbalance of certain
enzymes. Stress or emotional trauma can worsen symptoms.
The various forms of arthritis may be associated with the following:
- Breakdown of cartilage (osteoarthritis)
- Inflammation of the lining of the joint, the blood vessels, muscles,
tendons and ligaments (inflammatory arthritis)
- Development of crystals in the fluid of the joint (acute gout)
- Shortening or shrinkage of muscles or tendons, leading to joint
deformities
- A tightening of the skin (scleroderma)
- Damaged internal organs (rheumatoid arthritis)
- Loss of joint movement
- Decreased muscle strength
- Decreased mobility
Forms of Arthritis
The majority of arthritic patients have one of two forms – osteoarthritis or
rheumatoid arthritis.
Osteoarthritis affects about 20 million Americans and is most common in
women. Symptoms include:
- Pain in a joint during or after use
- Discomfort in a joint before or during a change in the weather
- Swelling and stiffness in a joint, particularly after using it
- Bony lumps on the middle or end joints of the fingers or the base of the
thumb
- Loss of flexibility of a joint
Rheumatoid arthritis can strike at any age, but often develops between 20 and
50 years of age. It affects an estimated 2 million Americans, twice as many
women as men.
Symptoms include:
- Pain and swelling in the smaller joints of the hands and feet
- Overall aching or stiffness of the joints and muscles, especially after
sleep or rest
- Loss of motion of the affected joints
- Loss of strength in muscles attached to the affected joints
- Deformity of the joints as time passes
- Fatigue (severe during a flare-up)
Joint Protection
One of the most effective ways to preserve and protect your joints is through
proper exercise. Exercise can:
- Strengthen muscles surrounding arthritic joints
- Increase joint flexibility and range of motion
- Reduce fatigue
- Increase energy levels
- Help you lose weight
- Improve sleep
Before you engage in any physical activity, you need to know the basic
principles of joint protection.
- Seek medical advice – If you aren’t physically active or if
you’re not sure what kind of activity is beneficial or appropriate, consult
your doctor. The doctor may refer you to an occupational or physical
therapist.
- Start slowly - Move each joint through its full pain-free range
of motion at least once daily.
Gently stretch muscles of affected joints at least once daily, perhaps when
you awaken in the morning and definitely at the beginning and end of any
exercise. Stretching loosens muscles and reduces risk of injury. Slow and
gentle stretching can increase a stiff joint’s range of motion.
- Warm up and cool down – Warm up your joints and
muscles by gently walking in place for a few minutes; using a
heating pad or hot pack; taking a warm bath or shower. Do not
apply heat to an already warm, swollen joint. After exercise,
apply cold to the affected joints for 10-15 minutes.
- Increase the pace gradually – Start where you are –
at a comfortable level. Then increase your exercise level as you
progress.
- Learn the difference between discomfort and pain from
overuse
– Adjust your level of activity to avoid excessive pain.
Don’t over exercise tender, injured or badly inflamed joints.
- Know your limits – If you have osteoarthritis of the
hip or knee and the bones and cartilage of the affected joints
aren’t too worn down, then a relatively high-impact activity
such as walking is ok. If the bones and cartilage are
significantly worn down, walking can cause more damage. Then,
swimming would be a better option.
If you have rheumatoid arthritis, low-impact activities are better,
depending on the amount of wear and tear on joints affected by the
arthritis. If the joint is not painful and the activity isn’t painful, it’s
probably ok to continue. If the activity causes pain, stop and select an
alternative exercise.
- Rest – There’s a delicate balance between being
active and resting. There will be times when you’ll need to rest
to conserve energy. At other times, you’ll need to exercise to
maintain the strength of your muscles, nourish your joints, stay
reasonably flexible and build your energy.
There are two kinds of rest – joint rest and whole-body rest. Using an
affected joint helps keep it healthy and promotes the supply of nutrients
and oxygen to the joint. If a particular muscle or joint seems tired, that’s
a signal to rest.
If you have arthritis, especially rheumatoid arthritis, a well-rested body
is an important goal to achieve daily. Inflamed joints makes you vulnerable
to fatigue. If you experience a flare or joint inflammation, you need to
schedule more rest time.
If you’re exhausted, you may not feel like doing anything. However, if you
don’t get enough physical activity, your muscles will get weaker and
physical activity will be more difficult to do. The key is to pace yourself.
Exercise Is Essential
Physical activity is essential to health. Aerobic exercise increases
cardiovascular fitness. Cardiovascular health is complex – it’s more than how
hard your heart pumps and how well you breathe. It involves how well your
muscles and tissues take oxygen from the blood. It includes the density of the
small
blood vessels that feed your tissues (capillaries). Body composition affects
cardiovascular health. So does your body’s ability to handle fat or fat-like
substances found in your blood (lipids). Prolonged bed rest or inactivity
aggravates these functions and leads to poor cardiovascular health. Inactivity
causes reduced circulation in the legs. It also decreases the body’s ability to
extract oxygen from the blood. Lack of exercise makes the bones less dense and
causes muscles to become weakened and lose flexibility.
Exercise is part of the solution for the most frequent complaints of people
with arthritis. Arthritics say pain is their number one problem. Appropriate
types and amounts of exercise help reduce arthritic pain. Fatigue is the second
most common complaint of arthritics. Adequate rest and aerobic conditioning is
the prescription for fatigue.
A sensible exercise program can reduce the risk of cardiovascular disease and
increase endurance. It can slow bone loss that leads to thinning of the bones
(osteoporosis). Appropriate exercise increases flexibility and strengthens the
muscles that help stabilize the joints. It reduces morning stiffness and
maintains mobility. It improves balance and increases endurance. It can help
control weight. Exercise also boosts your psychological well-being.
Designing Your Program
Learn to pay attention to your body to determine what level of activity is
appropriate for you. Know how you feel as you begin an activity. Note how you
feel when you finish the activity. An activity level that’s appropriate for you
should make you feel the same or better afterward. If you feel worse, you’re
doing something wrong.
Before you change your exercise program, have a thorough physical examination
and discuss your plans with your doctor. Determine if you need to consult with a
physical or an occupational therapist.
Your program should include activities you enjoy. Walking is a good way to
start and excellent for overall conditioning. Include activities daily to
improve flexibility. Stretching and range-of-motion exercises counteract
stiffness in major joints and spine. Moderate, regular exercise is the emphasis
of new guidelines from the Centers for Disease Control and Prevention, the
American Heart Association, the American College of Sports Medicine and others.
The frequency and duration of the activity is more important than the intensity.
Activity Goals
Guidelines recommend at least 30 minutes of low to moderately intense
physical activity most days. Be creative. Schedule exercise into your day. You
can benefit from short periods of activity – 5-10 minute intervals that add up
to at least 30 minutes. The key is the total amount of energy expended, not the
intensity. If you can’t carry on a conversation or you experience severe pain
while exercising, you’re pushing too hard.
Additional Resources
Arthritis Foundation, 6213 Lee Ave., Little Rock, AR 72205,
501-664-7242
Arthritis Foundation, 1330 West Peachtree Street, Atlanta, GA
30309, 404-872-7100
Arthritis Answers, 800-283-7800, to order brochures, subscribe to
magazine Arthritis Today
Arthritis: A Take Care of Yourself Health Guide for Understanding
Your Arthritis by James F. Fries, M.D.
Mayo Clinic Health Oasis Web Site
Arthritis Foundation Web Site
Department of Health and Human Services Web Site
National Institute of Arthritis and Musculoskeletal and Skin Disorders Web
Site
Healthinfo
Clinical
American
Medical Association Web Site
American College of Rheumatology Web Site
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