The benefits of regular physical activity are well established. National Arthritis Week, led by Arthritis Ireland takes place this year from April 4th-10th. The focus of this year’s campaign is to promote the benefit of being physically active for people with arthritis. We have outlined some of the key benefits below:
1. Physical activity is an anti-inflammatory
Both inflammatory arthritis & osteoarthritis are associated with increased levels of inflammation. Physical activity positively affects the function of our immune system. Specifically, regular exercise has an anti-inflammatory effect which can help reduce pain in the long term. When we exercise, the brain releases a number of chemicals such as opioids that can act in a similar way to pain medication but without the side effects. For people with persistent pain, this effect is often not immediate and requires consistency over weeks and months. An increase in pain in the short term is not uncommon when starting a new exercise program. It is important to know that pain does not always mean damage.
2. Arthritis, general health & physical activity
There are different forms of arthritis such as osteoarthritis & inflammatory arthritis. Osteoarthritis is often referred to as “wear and tear”. This is not strictly true. While a previous injury to a joint or excessive training loads may increase one’s risk, we now know that inflammation & metabolic health play an important role. With this is mind, lifestyle factors such as poor sleep quality, high stress levels, diet or general health factors such as diabetes or high cholesterol are important to consider. Regular physical activity can have a very positive effect on these risk factors. Contrary to common belief, there is no evidence that regular physical activity is harmful to cartilage or joint health in people with arthritis.
3. Physical activity for people with arthritis is safe
People with arthritis often become less active as a result of pain or fear of making pain worse. This can lead to a vicious cycle of reduced muscle strength, a reduction in fitness levels, increased pain and ultimately a loss of confidence. A well designed exercise program can address all of these factors if they arise. It is now well established that exercise is safe for people with osteoarthritis and inflammatory arthritis. It should however be individualised and progressed gradually over time, taking into account the person’s preferences, current fitness levels, pain sensitivity, time commitments and access to resources.
4. A scan is not a deterrent to becoming more physically active
People with arthritis often have an X-ray or an MRI of the affected area. We now know that the amount or severity of changes on a scan do not often match up with the intensity of pain or functional ability. Pain will be affected by other factors including your overall fitness, general health, sleep quality & your mental health. So more pain does not mean more damage and should not be a deterrent to getting more active. The reverse is also true - people with more severe changes on their scans do not necessarily have more pain. Pain is complex!
5. Flare ups are common but don’t panic!
Flare ups are common for people with any persistent pain problem and arthritis is no different. A flare up is not a set-back but a learning opportunity. While doing “too much too soon” is common, a flare up may also be the result in changes in your general health, wellbeing or lifestyle. Changes in sleep routines, mental health status or stress levels can be a part of the puzzle. It is important to develop a toolkit together with your healthcare team to help deal with flare ups e.g. ways to modify your exercise or activities, relaxation techniques, tips for improving your sleep and strategies for dealing with negative emotions etc. Take control back of your situation.
6. No one type of physical activity is better than another
There is no scientific evidence to suggest that one type of exercise is more beneficial to another for people with arthritis. A common belief among the general public that “low impact” or “non weight bearing” exercise is more beneficial than other types of exercise is not supported by the evidence. Such beliefs can reduce people’s confidence with certain activities, result in fear and ultimately avoidance of activities that an individual likes, enjoys or might help them. For example, among runners, there is evidence that self selected running does not worsen knee osteoarthritis and can be associated with an improvement in pain (Lo et al. 2018). A recent study among men with ankylosing spondylitis showed that a high intensity weight training program was well tolerated, improved pain and function and had no significant negative effects (Sveaas et al. 2019). The choice of exercise will depend on an individual’s specific situation, their pain sensitivity, their preferences, abilities & goals. This can change over time. No one size fits all!
For further information or advice, please contact the physiotherapy team here at the Bon Secours Hospital Tralee. When it comes to physical activity, more can be better but a little goes a long way. Every step counts.
Derek Griffin PhD, BSc
Clinical Specialist Physiotherapist
