People with joint pain are encouraged to step up the exercise, but how much and what type of activities are best? Paulette Crowley asks the experts.
Being told to exercise more after being diagnosed with osteoarthritis (OA) can be a daunting prospect, especially if you’re in a lot of pain.
But movement is important to manage pain and inflammation, slow the disease’s progression and to defer or avoid joint replacements, says physiotherapy lecturer Daniel O’Brien from Auckland University of Technology.
Resigning yourself to having arthritis as part of getting old is selling yourself short, he says, as there is a lot that you can do.
First, plan an exercise routine that includes weight-bearing and strengthening exercises, such as walking or cycling and squats. Don’t be afraid of getting the joint moving, as exercise feeds key nutrients to the area, he says.
However, starting slow and pacing yourself is important. A former sports physiotherapist, O’Brien’s golden rule is to double the amount of time before you’d normally progress the level of exercise. For example, in a standard gym workout the norm might be two weeks, but with arthritis take four weeks before increasing the difficulty.
“Snacking” on exercise is also a good approach. “You don’t have to do a 40-minute walk – you can do three 15-minute walks. You’ll get the same benefits.”
For OA in the knee, which responds particularly well to exercise, a combination of cycling and squats works well. The same applies for OA in the hips, although stretching should be added.
Stair climbing is also useful. “You only need two steps and as long as you put your weight on your heels, it shouldn’t hurt.”
Hydrotherapy, such as aqua jogging or aqua aerobics, is good for people with advanced arthritis but people in the early-mid stages of the disease should push themselves harder, he says.
And there is hope for some people who’ve been told they have to give up vigorous exercise. O’Brien’s uncle was set for surgical intervention for his arthritis but decided to try exercise first. He’s now planning to walk the Inca trail to Machu Picchu in Peru.
Pain management
Pharmacist Alan Wong from Unichem Silverdale Pharmacy advises: For joint care, glucosamine and chondroitin can prevent and delay the degradation of cartilage in joints. Both have good science to support their use and the earlier you start using the products, the better effect you’ll have.
Inflammation is a major culprit in the pain of arthritis, so treating it can reduce pain. Fish oil, which has excellent anti-inflammatory qualities in the correct doses, is a good long-term treatment.
Ibuprofen and diclofenac can help in the short-term but can be harsh on the digestive system. However, topical gels containing these agents can work just as well with less harm to the gut.
Turmeric is the new kid on the block as a natural anti-inflammatory. Some people with OA take it as a pain killer, just as they would with something like Nurofen.
But one of the most effective treatments by far for pain is paracetamol, as it’s so safe. Taken regularly and responsibly, it builds up to prevent pain.
No more running
A “cardio buzz” has always been the motivation for runner Dean Te Paa. The freedom of hitting the road first thing in the morning is a feeling the personal trainer from Auckland was not only passionate about, but happily addicted to.
But his days of pounding the pavements to train for half and full marathons came to a grinding halt last year. After a sore knee took him to a specialist, he was diagnosed with a torn meniscus muscle, and had an operation to repair it.
During the procedure, the surgeon discovered his knee was affected by arthritis. He was eventually told that he would never run again.
“I was gutted,” says Te Paa, 51. “I was told about an option of having a knee replacement but the answer to my question about being able to run again was no. The doctor told me you only get one chance with a knee replacement – if you wear it out [by running] you don’t get another one.”
Although a bad day sees him holding onto the hand rail when climbing stairs, his pain is not excruciating. “Some people are much worse off than me. The doctor told me that you know when you’re really bad, because you can barely walk to the letterbox.”
Dean’s positive attitude toward having OA was helped by the knowledge that though running was off the agenda, swimming, biking and other low-impact exercises were still possible to maintain his fitness. He also cycles and does strengthening exercises, such as leg presses and squats, to maintain his muscle mass.
So far, his knee is in pretty good nick, something he credits to remaining fit and strong. “I want to keep it that way.”
A new app for arthritis sufferers Carrying extra weight increases stress on the joints and can worsen OA, Arthritis New Zealand CEO Sandra Kirby says. In line with government support for early intervention programmes, Arthritis NZ in partnership with Melon Health are launching an online self-management programme. The programme, which will start as a pilot and be rolled out further as funding allows, targets people with early to mild to moderate OA.
Its key messages are around healthy eating, increasing physical activity and managing pain. Along with experts’ advice, the programme will encourage online community interaction and support, with people being assigned a personal arthritis educator if needed.
This article was first published in Living Well magazine, March 2017
Paulette Crowley 