Managing arthritis with exercise

doi:10.1067/mgn.2001.116380

Geriatric Nursing

Volume 22, Issue 3, May–June 2001, Pages 143-150

https://doi.org/10.1067/mgn.2001.116380 Get rights and content

Abstract

Almost half of all older adults have arthritis, either degenerative or inflammatory. Regular exercise is an important therapeutic intervention for all types of arthritis. Specifically, regular exercise can prevent deconditioning of the muscles, keep the joints stable, improve joint function and flexibility, decrease pain, enhance aerobic fitness, improve balance, and decrease falls. A comprehensive exercise program should include stretching exercises followed by a range-of-motion program for joints, muscle strengthening, and aerobic exercise, if possible. Unfortunately, despite these known benefits, most older adults with arthritis do not engage in regular exercise. The Seven Step Approach was developed to provide a practical framework to help overcome barriers and improve exercise activity in older adults with arthritis. (Geriatr Nurs 2001;22:143-50)

Section snippets

Degenerative arthritis

Degenerative arthritis, also called osteoarthritis (OA), is the most common form. The problem is in the joint cartilage tissue, which provides a cushioning structure to reduce the mechanical forces on joints and cover bone ends. In OA, the cartilage thins and tears, decreasing both its cushioning and covering functions. The areas most commonly affected are the small finger joints or large, weight-bearing joints, such as the knees and hips.

The earliest change in OA is an increased water content

Rheumatoid arthritis

Rheumatoid arthritis (RA), an autoimmune disorder, is not as common as degenerative arthritis but occurs in 0.5% of Americans, two-thirds of whom are women.⁶ The peak incidence of RA occurs between 35 and 45, but disease onset in older adults is not unusual. Moreover, older adults are living with this disease late in its debilitating course. Wrists and knuckles are the joints most involved, resulting in impaired functional performance, particularly fine motor skills.

The inflammation of the

Exercise and OA

Although many older adults with arthritis tend to avoid activity, exercise is actually one of the most effective nonpharmacologic treatments for OA, particularly of the knee.7, 8, 9, 10 Specifically, long-term walking,9, 10 isokinetic quadriceps exercise,11, 12, 13 high and low intensity cycle ergometry,¹⁴ aquatic exercise classes,¹⁵ and a 12-week program of specially designed physiotherapy¹⁶ may improve physical function and gait and reduce knee pain in older adults with arthritis. Recent

Exercise for rheumatoid and inflammatory arthritis

Although less extensively studied, exercise has been noted to decrease acute inflammation of joints, improve function, and decrease pain. Static and dynamic shoulder rotator exercises in women with RA decreased the number of swollen joints in the upper extremities and decreased shoulder pain.²⁰ In a comprehensive review of studies, Van den Ende, Vlieland, and Hazes²¹ reported that dynamic exercise was effective in increasing aerobic capacity and muscle strength in individuals with RA, and there

Barriers to exercise

Despite the known benefits of exercise and the fact that little risk of damage to joints exists from regular, moderate intensity exercise in individuals with arthritis, it is particularly challenging to motivate these individuals to initiate or adhere to a regular exercise program.9, 23 A multidimensional framework, as afforded by social cognitive theory (SCT), is essential to maximize adherence. SCT is based on a model of reciprocal determinism in which behavior, cognitive and other personal

Step I. Education

Education about the benefits of exercise is an essential first step to helping older adults, particularly elders with arthritis, start a regimen because many of these individuals believe that simply resting joints and avoiding activity is the best way to manage their problem. Education about specifically what type and amount of exercise are needed and what benefits can be expected from regular engagement helps strengthen self-efficacy and outcome expectations related to exercise. Friedrich et

Conclusion

Despite the known benefits of exercise, motivating older adults with arthritis to initiate and engage in a regular exercise program is challenging. The Seven Step Approach provides a practical framework to help overcome the barriers to exercise and improve exercise activity in these individuals.

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What type of physical activity or exercise is undertaken by people with rheumatoid arthritis? What type of physical activity or exercise do they prefer? What is their attitude towards physical activity or exercise? What are the perceived barriers to undertaking physical activity or exercise?
Survey of a random sample of people with rheumatoid arthritis.
Four hundred people with rheumatoid arthritis in the Netherlands.
Of the 252 people who returned the questionnaire (63% response) 201 (80%) people participated in some type of physical activity or exercise. Significantly more inactive people were male, less educated, and older than the active people. Of the active people, 45 (22%) participated exclusively in supervised activities, 72 (36%) in unsupervised activities, and 84 people (42%) combined supervised and unsupervised activities. Cycling and walking were the two unsupervised activities people performed most often. Supervised group exercise and unsupervised individual physical activity were reported as the favourite activities. Further, more people preferred being physically active under expert supervision than without supervision and preferred water-based over land-based activities. The most frequently-mentioned barriers were lack of energy, presence of pain, lack of motivation, lack of information, and fear of joint damage.
The majority of people with rheumatoid arthritis participated in some physical activity or exercise, mostly under supervision. Preferences for types of activity varied, underpinning the need for a variety of options for people with rheumatoid arthritis.
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Citation Excerpt :
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Testing in an indoor track facility; exercise programs conducted in community settings.
A volunteer sample of 30 men and women with arthritis (osteoarthritis, n=22; rheumatoid arthritis, n=8), randomly assigned into either an aquatic exercise (n=10), on-land exercise (n=10), or control group (n=10).
Eight-week on-land and aquatic exercise program.
Functional fitness, ADLs, and hand-held dynamometry measures assessed on a 1-day pretest and posttest session, before and after an 8-week exercise program.
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Both NAF exercise programs appear to be effective in improving functional physical fitness and perceived ability to perform ADL measures in older adults with arthritis.
Exercise after stroke: Patient adherence and beliefs after discharge from rehabilitation
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ArticlesManaging arthritis with exercise

Abstract

Section snippets

Degenerative arthritis

Rheumatoid arthritis

Exercise and OA

Exercise for rheumatoid and inflammatory arthritis

Barriers to exercise

Step I. Education

Conclusion

Arch Phys Med Rehab

Rheum Dis Clin North Am

Musculoskeletal Connective Tissue Disorders

Am J Prevent Med

Arthritis prevalence rising as Baby Boomers grow older

Osteoarthritis of the knee: effects on gait, strength and flexibility

Arch Phys Med Rehab

Static and dynamic balance responses in persons with bilateral knee osteoarthritis

J Orthop Sports Phys Ther

Risk factors for serious injury during falls by older persons in the community

J Am Geriatr Soc

Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States

Arthritis Rheum

Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized controlled trial

Ann Intern Med

Self-reported causes of physical disability in older people. The Cardiovascular Health Study

J Am Geriatr Soc

A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis

JAMA

Effects of long-term aerobic or weight training regimens on gait in an older, osteoarthritis population

J Appl Biomechanics

Improvements in quadriceps sensorimotor function and disability of patients with knee osteoarthritis following a clinically practicable exercise regimen

Br J Rheum

Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomized controlled trial

Ann Rheum Dis

The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis

J Gerontol

Recruiting adults with osteoarthritis into an aquatic exercise class: strategies for a statewide intervention

Arthritis Care Research

The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial

J Rheum

Long-term exercise and its effect on balance in older osteoarthritic adults: results from the fitness, arthritis seniors trial (FAST)

J Am Geriatr Soc

Psychosocial bases of perceived exertion

Med Sci Sports Exer

Effects of static and dynamic shoulder rotator exercises in women with rheumatoid arthritis: a randomized comparison of impairment, disability, handicap, and health

Scand J Rheum

Articles
Managing arthritis with exercise