Arthritis

Two common forms of arthritis exist, namely osteoarthritis and rheumatoid arthritis. Osteoarthritis is a degenerative joint disease in which the cartilage of a specific joint degenerates, resulting in localized pain and inflammation within that joint. The most common joints affected by osteoarthritis are the hands, spine, hips and knees. Rheumatoid arthritis is an inflammatory, multi-joint disease in which numerous joints and organ systems may be affected as a result of an autoimmune response. The most commonly affected joints include the wrists, hands, knees, feet and neck.

When exercising a person with osteoarthritis, one needs to consider the degree of articular cartilage degeneration in the specific joint, the level of pain and discomfort in that joint, the range of motion of the joint, the strength of the surrounding muscles of the affected joint, and finally, whether or not the individual is having a flare up. Osteoarthritis will periodically flare up and then may almost go into remission. During a flare up, pain will be much more severe. Common features associated with exercise include joint pain and stiffness, osteophytes (small bony formations) and cartilage destruction. It is important to strengthen the muscles surrounding the affected joints so that they can support those joints. However, these exercises must be performed carefully, placing minimal stress and impact on those joints. It is also essential to stretch the muscles surrounding the affected joints in order to maintain their range of motion and reduce joint stiffness.

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When selecting exercises for individuals with rheumatoid arthritis, you need to know if the individual is having a flare up – increased pain will be the primary symptom. Common features associated with rheumatoid arthritis include morning stiffness that lasts longer than 30 minutes, acute and chronic inflammation, chronic pain and reduced joint integrity. Low-intensity and low-impact exercises, with lots of stretching, are recommended for these individuals.

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For any form of arthritis, it is important that individuals do regular low-impact, aerobic exercise, such as swimming or cycling, and lots of stretching. Any exercises that place heavy stress on the affected joints should be avoided. During flare ups, vigorous exercise must be avoided. Water therapy and water aerobics are highly recommended for individuals who suffer from arthritis.

Arthritis is a common condition, which often leaves people afraid to do any form of physical activity. However, exercise is important in managing the condition and maintaining mobility. So, if you suffer from arthritis, see a biokineticist to have a comprehensive assessment and be given an appropriate exercise programme. This will allow you to function more normally and improve your quality of life.

Osteoporosis

Tomorrow, October 20, is World Osteoporosis Day, so I decided that this would be an appropriate time to provide you with some insight into osteoporosis and the importance of exercise in managing and preventing this condition.

Osteoporosis refers to a decrease in bone mass and bone quality, mainly due to increasing age. After the age of 35 years, there is a reduction in the activity of the cells that contribute to bone formation. This results in reduced bone mass. This is a concern because it puts these weaker bones at an increased risk for fracture. A bone density scan is the most accurate way to diagnose osteoporosis.

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The American College of Sports Medicine (ACSM) found that every 1 in 2 women and 1 in 8 men over the age of 50 are likely to experience an osteoporotic fracture at some stage in their lives. Women are at a much higher risk for osteoporosis due to the reduction in estrogen levels following menopause, while men generally experience bone loss much later on in life (after age 70) and to a much lesser extent, as a result of reduced testosterone production.

ACSM identifies the following risk factors for osteoporosis:

·         Females are at a higher risk than males

·         Increasing age

·         Race – Caucasian/Asian

·         Family history of osteoporosis

·         Low body weight for height (individuals with small frames)

·         Early menopause

·         Prolonged premenopausal amenorrhea (missed periods over a long duration)

·         Low testosterone levels in men

·         Lack of physical activity

·         Smoking

·         Excessive alcohol consumption

·         Low dietary calcium intake

·         Chronic use of medications causing bone loss (e.g. steroids)

It is essential that adequate calcium is ingested as part of one’s diet, particularly during a child’s growth years, as this is when the bones are forming and developing. The Good Life Dietitians can provide more insight into dietary requirements for osteoporosis.

In terms of exercise, it is essential that individuals keep physically active throughout their lives in order to prevent osteoporosis. This means performing aerobic, weight-bearing activity at least 3 times per week for 30 to 45 minutes. If you already have osteoporosis, then the types of exercises you can perform depend on the degree of severity of osteoporosis, as one does not want to increase the risk for injury or fracture. Weight-bearing exercises are particularly important in building bone strength. These exercises include walking, squats and lunges. ACSM recommends aerobic, weight-bearing activities 4 days per week and resistance exercises 2 to 3 days per week. By strengthening the muscles around the bones, bone mass is conserved and the muscles can support the weaker bones. It is essential that balance exercises are performed on a regular basis in order to reduce the risk of falling and thus injury or fracture. Functional exercises that will assist an individual to perform the activities of daily living are also recommended.

The Science of Stiffness

Anyone who has done any form of strenuous activity will have felt that painful ache in the muscles for a few days after exercise. A lot of you may have decided that this pain couldn’t possibly be good for you and, therefore, have avoided any exercise since. Some of you might have decided you quite like that achy feeling, reminding you of what a good workout you had the day before. Basically, this mild discomfort is not bad for you and the good news is it won’t last forever.

Various myths regarding muscle soreness as a result of exercise exist. The most common is the idea that a build up of lactic acid in the muscle causes muscle soreness the next day. It is true that there is a build up of lactic acid in the muscle tissue with strenuous exercise; however, this lactic acid is removed within an hour of finishing exercise. Thus, it is not the cause for pain and stiffness that materializes the following day.

Muscle stiffness or pain after exercise is termed delayed onset muscle soreness (DOMS). There are two key models to explain this exercise effect. The first is known as the Local Ischemic Model. This model suggests that following either strenuous exercise, or even moderate, non-traumatic exercise, there is swelling in the soft tissue. This causes an increase in tissue pressure and a local reduction in blood and oxygen supply to the muscle (ischemia). This in turn causes muscle spasm and the pain known as DOMS.

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The second model is known as the Mechanical Trauma Model. Here, it is suggested that there is structural damage (microtears) to the muscle tissue as a result of increased mechanical forces during muscle contraction. This again leads to swelling and inflammation in the muscle tissue, resulting in pain.

Neither of these models suggests that there is permanent damage to the muscle tissue. In fact, it is recommended that one repeats the same exercise on a regular basis so that the muscle tissue can adapt to the increased force placed on it. This is called the “repeated-bout effect”. The more the exercise is performed, the quicker the muscle tissue adapts, reducing muscle soreness.

So, next time you wake up the morning after exercise, cursing your trainer, the gym, exercise and life in general because you can’t walk up stairs or stand up from the toilet, think of the positive changes taking place to the muscle. Take yourself off to the gym and do a light exercise session with a good cardiovascular warm-up and lots of stretching – even if it hurts a little. This will increase blood flow to the sore muscle tissue, improve flexibility and thus reduce pain and stiffness.