Exercise and Rest

Exercise and Rest

By its very definition, arthritis is a disease that limits activity and laces movement with pain. It's no wonder, then, that those who suffer from its effects tend to neglect one of the most important health habits known to man or woman: exercise. The truth is, most Americans—even those without injury or disease—fail to provide their bodies with the physical exertion required to keep their bones strong, their muscles limber, their hearts and lungs healthy, and their joints supple. In fact, the results of a 1994 study performed by the National Center for Health Statistics showed that fewer than 50 percent of Americans perform any kind of exercise on a regular basis. Furthermore, the same study revealed that nearly one third of Americans remain obese—more than 20 percent above a healthy weight.

Overweight and underexercised, the human body leaves itself open and vulnerable to a myriad of chronic conditions, including arthritis, back pain, heart disease, and diabetes, to name just a few. Without question, a large part of the current crisis in the American health care system derives from the mainstream medical community paying too little attention to the importance of fitness. Indeed, only in the past decade or so has the average general practitioner or, certainly, the average cardiologist or other specialist, emphasized the preventative and restorative power of exercise to his or her patients. For those of us who grew up before the message about exercise began to be enunciated as clearly and strongly as it has in the past few years, looking at the relationship between activity, health, and disease is a new experience. Hence, building exercise into our lives may seem like a tedious and difficult challenge.

At the same time, you may have noticed that the title of this chapter is "Exercise and Rest." While it's true that exercise is extraordinarily important—so much so that information about exercise and arthritis makes up the overwhelming bulk of this chapter—resting your muscles, bones, and spirits is equally important to your health. The trick is, you cannot have one without the other. "Resting" an unstimulated mind or an underworked body leads not to renewal but to lethargy and weakness. You'll discover that rest, experienced at the right time and in the right ways, may feel far more invigorating and energizing than you imagine. In the meantime, however, we must examine the flip side of rest: activity.

Exercise and Your Health

Before we admonish ourselves for being lazy and unmotivated—as most of us do when we look at our general approach to activity and exercise—it is important that we recognize the powerful forces aligned against us on the road to health and fitness. First, the "miracles of modern medicine" have seduced many of us into believing that medication, surgery, and technology could protect us against the ravages of time and the environment. Furthermore, and perhaps most important, we live in a world driven by very mixed media messages about weight, body image, and lifestyle. We see rail-thin models advertising fat-laden potato chips and athletes peddling beer. Advertising prods us to buy time- and energy-saving devices like power-driven lawnmowers, snow shovels, and dishwashers. The television beckons to us constantly, urging us to relinquish the physical in favor of the passive. Too many of us give in to these temptations and spend from six to eight hours a day—every day—in front of the tube, while our automated appliances do our work for us. Thus our muscles grow weaker, our hearts give out sooner, our physical lives become more proscribed and limited.

Breaking out of this cycle of inactivity and chronic disease takes time, energy, and commitment. It also requires us to peel back the layers of misinformation, apathy, and frustration about health and fitness that may have built up over the years. Eating a proper diet will make you feel better and can be every bit as tasty and enticing as the foods you see advertised. Reading a book or learning a new language is more relaxing than passively watching television hour after hour.

And as for exercise, it is a positive life-enhancing habit that promotes physical and emotional well-being. It need not be a tedious grind or a painful ordeal. Properly performed on a regular basis, exercise allows you to connect with your physical body in an intimate way. You'll be able to feel your muscles grow stronger, your heart beat harder, and your nervous system throw off the built-up tension and stress of the day. Exercise will restore balance—balance within your body and balance between you and the physical world. With every hour we spend in the artificial environment promoted by television, fax machines, stuffy offices, and noisy factories, the further we get from nature and the true role we are meant to play within it.

What makes exercise so important? Let's take a look at the many different ways it affects our bodies and souls:

Exercise increases the efficiency of your heart and blood vessels. A primary function of your cardiovascular system involves transporting oxygen—an element essential to life—to every cell in your body. With regular aerobic exercise (exercise that requires oxygen for energy), your heart and vessels are able to pump more blood and thus deliver more oxygen and other nutrients to all the muscles and joints of your body. At the same time, the vessels known as veins, equally stimulated by exercise, carry away waste products, including excess calcium, uric acid, and other substances that might otherwise collect within your joints. Finally, exercise helps keep your blood pressure and blood cholesterol at normal levels, thus reducing your risk of heart disease and high blood pressure. Although not directly connected to arthritis, per se, these two chronic conditions remain the nation's number one health problem.

Exercise stretches joints and strengthens muscles. Of primary importance to those of us interested in preventing or alleviating arthritis is the development of supple, flexible joints and strong, lithe muscles. And, so far at least, the only way to do so is by using them every day and, on a regular basis, pushing them to their limits and a little beyond. Later in this chapter, we'll give you some tips on exercising safely and comfortably, even if arthritis has inflamed your joints and made them tender and difficult to move.

Exercise maintains your body's proper metabolism. More and more Americans suffer from obesity, which at least in part explains why arthritis is so prevalent. Every pound of extra weight places that much more stress on the joints, making them work that much harder, and promoting the kind of wear-and-tear degeneration associated with osteoarthritis, the most common form of the disease in the United States today.

With regular exercise, however, maintaining a healthy weight almost comes naturally, especially if paired with a sensible low-fat, high-fiber diet like the one described in Chapter 4. Through aerobic exercise, your body learns to burn stored fat more efficiently in order to meet its increased energy needs. Muscle tissue is more metabolically active than fat: Your body must burn more calories to feed and nourish muscle tissue than it would to maintain fat. Therefore, the more muscle you have, the more calories you'll burn every day.

Exercise allows the body and mind to relax. Stress plays a significant role in triggering arthritis flare-ups and perpetuating the cycle of pain once a flare-up begins. With tension comes tightness in the muscles and joints of the body and, if they fail to relax, they lose their suppleness. Over time, they may become permanently restricted and actually lose their ability to release and move naturally. Only by working your muscles and keeping your joints moving will the stress of the day (or the year!) ever be released.

Another mind/body benefit of exercise concerns certain body chemicals known as endorphins. Known to dull pain and invoke feelings of mild euphoria, endorphins are released whenever the body feels pain, including during vigorous exercise when the muscles begin to tire and "burn." Produced in the spinal cord and the brain, endorphins serve as a perfect example of the body's power to return itself to a state of balance. Indeed, endorphins may be one reason that exercise appears to reduce anxiety and stress in those who perform it on a regular basis.

For all of these reasons, you should begin to make exercise a part of your daily life. In this chapter, we briefly cover the three categories of exercise necessary to achieve overall fitness as well as help your joints to remain healthy and strong: stretching (range-of-motion), strengthening, and aerobics.

Devising an Exercise Plan

Now that you've read about the many benefits of exercise, you are (we hope) ready to make physical activity a regular part of your life. Before you jump in with both feet, however, it is essential that you speak first with your doctor or health practitioner, especially if you've been inactive in the past. Arthritis is a serious disease, one that has serious consequences for your muscles and joints. Depending on the state of your general health as well as the condition of joints, your physician may recommend that you first visit a physical therapist for an evaluation and advice. A physical therapist is a health professional with experience in working with people injured, ill, or otherwise physically restricted. He can take a look at the exercises we recommend in this book, offer you additional ones more suited to your needs, and help you perform all of them safely and in proper form. As careful as we might be to choose and describe appropriate exercises, nothing beats having someone watch the unique way your muscles work while you exercise, steer you to the exercises that will provide you with the most benefit, then make sure you're performing them efficiently.

STRETCHING

Many people neglect flexibility, even those who consider themselves to be in top physical condition. Part of the reason may lie in the noncompetitive nature of stretching: Unlike aerobics and weight training, there are no times or weight limits to beat. Instead, stretching the muscles and the joints they support, slowly and steadily to their limit and slightly beyond, requires an intensely personal effort, one that will bring you closer to truly understanding the unique structure of your own body. Stretching increases the range of motion of a joint, enriches the blood supply to the muscles, and brings important nutrients to the cells within and outside the joints.

If you have arthritis, range-of-motion or stretching exercises aim to move each of your joints as far as possible in all directions. They help keep your joints fully mobile and prevent stiffness, while decreasing the risk of the disease causing permanent deformities. Such exercises are especially important for those people with rheumatoid arthritis who tend not to want to move their inflamed joints. Lack of movement leaves the joints vulnerable to atrophy and even more pain.

Before we describe a few range-of-motion exercises, we want to stress the importance of performing a brief warm-up consisting of a few minutes of gentle jogging in place, riding on a stationary bicycle, or walking. Warming up in this way increases blood flow to the muscles and gets your heart started beating a little harder.

Once you've done your warm-up, you're ready to start taking your muscles and joints through a series of gentle stretches. When you stretch, you should never jerk or bounce. Instead, the movements should be slow and fluid. Try to hold each position for at least ten seconds, allowing the muscles and connective tissues to feel the full extent of the stretch. Do as many repetitions as you can manage—from 1 to 5 at the start to about 20—on each side.

Shoulder Stretch #1

1. Lie on your back, arms at your sides, and palms facing up.

2. Slide your right arm along the floor in an arc until you've raised it above your head.

3. Slowly bring it back down to your side.

4. Repeat with the left arm.

Shoulder Stretch #2

1. Lie on your back, arms at your sides, and palms facing your body.

2. Keeping your elbow straight but not locked, lift your right arm toward the ceiling until it is perpendicular to the floor. Hold for 10 seconds.

3. Slowly drop the arm down, again keeping your elbow straight, until it is lying on the floor again.

4. Repeat with your left arm.

Elbow Stretch

1. Lie flat on your back, placing your arms at your sides.

2. Keeping your upper right arm against the floor, bring your right hand as close to your shoulder as possible.

3. Hold this position for 10 seconds, then slowly lower it until the right elbow is completely straight.

4. Repeat on the left side.

Back Stretch #1

1. Lie on your back with your knees bent and your feet flat on the floor.

2. Tighten stomach and press your back against the floor. Try to feel every vertebrae making contact with the floor. Hold for 10 seconds, then relax.

3. Repeat.

Back Stretch #2

1. Lie on your back, with your knees bent and your lower back pressing into the floor.

2. Slowly lift both knees at the same time and bring them toward your chest.

3. Gently wrap your arms around your knees, pulling them in even closer.

4. Hold for 10 seconds, then release.

Hip Stretch #1

1. Lie on your back with your knees bent.

2. Lift your right leg, bending at the hip, raising your right knee toward your chest. Hold this stretch for 10 seconds, then slowly lower the right leg.

3. Repeat with the left leg.

Hip Stretch #2

1. Lie on your back with your knees bent and your feet flat on the floor.

2. Tighten your buttock muscles and lift your bottom and lower back up about 2 to 3 inches off the floor. Be careful not to push too hard with your shoulder or arm muscles.

3. Hold for 10 seconds, then slowly release.

Knee Stretch #1

1. Lie on your back with your legs straight. Try to straighten your right knee as flat as it can go by lifting your ankle and tightening the muscles around your knee.

2. Hold for 10 seconds, then slowly lower.

3. Repeat with your left knee.

Knee Stretch # 2

1. Lie flat on your stomach with your legs flat on the floor and your hands flat on the floor under your shoulders and elbows perpendicular to your chest.

2. Bend your right knee, aiming your right ankle toward your right buttock. When you've reached the extent of your stretch, hold for 10 seconds, then slowly lower the leg.

3. Repeat with left leg.

Ankle Stretch

1. Lie on your back with your legs straight.

2. Bend your right ankle, flexing your foot until your toes are pointing upward and your heel is pressing toward the wall in front of you. Hold for 10 seconds.

3. Release the flex, then point your toes as tightly forward as possible. Hold for 10 seconds.

4. Repeat with left leg.

Arch Stretch

1. Sit or stand with your right foot resting on a towel.

2. Attempt to pick up the towel by curling your toes and gathering the material under the arch of your foot. Clutch it as tightly as possible, then rest.

3. Repeat with your left foot.

Hand Stretch #1

1. Make a fist with your right hand, making sure to tuck your fingers into your palm.

2. Hold for 10 seconds.

3. Repeat with left hand.

Hand Stretch #2

1. Place your right hand and forearm flat on a table with your palm down.

2. Spread all five fingers as far apart as they'll go. Hold for 10 seconds.

3. Pull them together.

4. Repeat with left hand.

Wrist Stretch

1. Place your forearm flat on a table and dangle your wrist and hand over the edge.

2. Flex your wrist up as far as possible. Hold for 10 seconds.

3. Gently release.

4. Bend your wrist the other way, pointing your fingers toward the floor. Hold for 10 seconds, then release.

5. Repeat with your left wrist.

Depending on your current strength and desire for increased mobility, you may want to add the following stretches to your routine as well. Again, it's important for you to check with your doctor to make sure that working your body so thoroughly will not risk damage to your joints and muscles.

Shoulders/Upper Back Stretch

1. Raise your right arm and reach down your back as far as you can.

2. At the same time, reach your left arm behind your back and try to reach the fingers of your right hand. Hold the stretch for 10 seconds.

3. Repeat with your arms reversed.

Calf Stretch

1. Stand facing a wall, about an arm's length away. Lean forward on the balls of your feet, heels lifted, and bounce—very gently and only after you've warmed up!—20 times.

2. Place your palms on the wall, leaning forward slightly, but this time, keeping your heels firmly planted on the floor. Hold this stretch for 10 seconds.

Hamstrings

1. Stand up straight. Place your right foot about 12 inches in front of your left foot.

2. Try to raise your right toes in the air.

3. Keeping both knees slightly bent, lean your torso forward as if to take a bow.

4. Feel the stretch in the back and front of your thigh for about 10 seconds.

5. Reverse the position, leading with your left foot.

STRENGTHENING EXERCISES

If you have arthritis, strengthening the muscles that support the joints involved in the disease process is essential. In addition, overall muscle strength and endurance are critical to your general health and fitness. Indeed, every muscle in your body plays a vital role in keeping you standing tall, moving smoothly, and maintaining your balance.

We achieve muscle strength and endurance by applying resistance to normal body motion. The resistance, or load, causes muscles to contract at an increased tension. We add resistance in two ways: through the weight of our own bodies in a series of exercises called calisthenics (sit-ups, push-ups, and so forth) and by using hand-held or adjustable weights. Because the techniques of calisthenics and weight training are very precise and, if not performed correctly, can lead to injury, we suggest that you visit a local gym or YMCA to receive firsthand instruction before you begin a program on your own.

A weight-training routine should involve about 30 minutes of slow but constant stress on different muscles of the body using your own body weight (calisthenics), free weights, or strength-training equipment (such as Nautilus). An exercise specialist familiar with your limitations and goals should help you formulate a complete strength-training routine. Generally speaking, however, you should perform about a dozen exercises, six for the upper body and six for the lower.

Please note: Anaerobic exercises, including calisthenics and weight training, are usually not recommended for people with high blood pressure or other types of cardiovascular disease. Such exercises may cause temporary but marked rises in blood pressure. If you suffer from high blood pressure or heart disease, or if you are over the age of 40 and are new to weight training, talk to your physician and/or alternative practitioner before beginning a routine.

ENDURANCE EXERCISE

Endurance exercises, also known as aerobic exercises, are those activities that promote cardiovascular fitness by enhancing your body's ability to deliver large amounts of oxygen to working muscles. Aerobic exercises generally involve working large muscle groups (such as leg muscles) for a sustained length of time, usually more than 20 minutes, at a steady, moderate pace. In addition to furthering cardiovascular health, aerobic exercise increases your body's ability to burn fat more efficiently and deliver more nutrient-rich oxygen and blood to joint tissue and muscles.

It should be noted that not all people with arthritis are able to perform endurance exercises. Those who have had rheumatoid arthritis for many years and thus already suffer many functional limitations, for instance, may not be able to participate in this type of activity. Generally speaking, however, most people with early- to middle-stage arthritis of any type will benefit from adding endurance exercise to their lives.

At the same time, you should choose an endurance exercise carefully in order to avoid further injuring already affected joints. For that reason, the vigorous jumping and pounding involved in city jogging or high-impact aerobics should be avoided by those with arthritis, especially arthritis that affects the feet, ankles, and/or knees.

There are literally dozens of safe and enjoyable activities that can provide aerobic benefits if performed over a sustained period of time—at least 15 to 30 minutes—including walking, cycling, and swimming. Some activities, however, tend to involve a bit more risk to the joints than others, and thus should be undertaken with extreme care. If you enjoy a sport or exercise that you find to be painful or if you are fearful that pain might occur if you attempt it, talk to a trained physical therapist or fitness trainer. She may be able to help you modify the activity or work with you until you feel more comfortable.

Remember, a prime benefit of exercise is the sense of release and relaxation it offers. You should enjoy this time of your day, not be held prisoner by either the activity itself or any anxiety you feel about performing it. To help you on your way to a creating a safe and enjoyable exercise routine, we provide a list of the most common aerobic activities along with a description of how they might affect a person with arthritis:

LOW-RISK ACTIVITIES

Walking. Perhaps the best overall exercise for every adult, with or without arthritis, walking puts less strain on the joints of the hips, knees, back, and feet than jogging, running, or cycling.

Swimming. Because water supports the joints, swimming tends to relieve pressure while putting your muscles through a full range of motion.

Bicycling. Stationary or outdoor cycling is an excellent aerobic exercise that can usually be performed without adding too much stress to your joints. The one exception involves those who have severe knee problems who may find this exercise too difficult and stressful on these joints. If you decide to try cycling, make sure to adjust the handlebars and seat so that you don't have to hunch over when you pedal or overextend your limbs (locking your elbows, knees, and/or wrists, for example).

HIGHER-RISK ACTIVITIES

Jogging/Running. These activities place a great deal of stress on the joints of the ankles, knees, and hips. Unless running is your passion and you've talked the matter over with your doctor and a fitness trainer, you might do best to choose another aerobic activity.

Tennis and Other Racquet Sports. Tennis, racquetball, and squash require a great deal of twisting, turning, and pivoting of the hips and legs, as well as plenty of sudden starts and stops. The grip required to hold the racquet and the stress that hitting the ball places on your elbows and shoulders are other potential challenges of taking up a racquet sport. On the other hand, these sports are fun, can provide aerobic benefits if performed at a sufficient level of play, and certainly work important muscles like the shoulders, chest, hip flexors, and quadriceps. If one of these activities interests you, ask advice from your doctor and/or a fitness trainer.

Football, Basketball, Baseball. Apart from the bending, lifting, and stop-and-start aspects of play that may affect any arthritis in your spinal column or hips, these sports often involve sliding, falling, jumping, and contact with other players. If your joints are already weak and/or inflamed, it might be best to avoid these activities unless you have your doctor's permission.

General Exercise Guidelines

In the best of all possible worlds, every one of us would get out of bed bright and early, take a few deep breaths, run in place for a few minutes, gently stretch our muscles, then take a brisk walk, a short jog, or a play a set of tennis. But for most of us, that scenario is not a reality. Instead, we must work exercise into our lives, slowly but surely making it part of our weekly, if not our daily routine.

To start, we suggest concentrating first on performing the stretching exercises outlined in this chapter—every day if possible. This way, you'll be sure to keep your joints as supple and flexible as possible, even if you can't yet add strength training or endurance exercises to your routine. Once you're able, try to exercise aerobically for at least 30 minutes at least three times a week, then add a half-hour of strength training on the days you aren't jogging or swimming.

Above all, don't get discouraged if you are not able to meet this schedule at first: Every time you move your body—even if it's for just 10 minutes a day—you're doing something positive for you health. On the other hand, to really experience a difference in the way you feel about your body and your health, you'll need to make exercise a regular part of your life.

Here are a few tips to get you started on the road to fitness:

Check with your doctor or practitioner. Your first step in starting any exercise program is to consult with your physician and/or alternative practitioner, especially if you're overweight, suffer from late-stage arthritis, or have any risk factors for cardiovascular disease.

Start slow. A study published in the Journal of the American Medical Association in November 1989 showed that moderate exercise—defined as 30 minutes a day of light activity such as walking and gardening—is almost as beneficial to one's health as higher levels of exercise, such as high-impact aerobics and jogging. Moreover, moderate exercise is far safer than high-intensity activities for those people whose joints have already been damaged by the arthritic process.

Choose activities you enjoy. Perhaps the most important element in the design of your exercise program is choosing activities you will enjoy over the long haul. Think of it this way: If you exercise three times a week for 30 minutes a session, you'll have jogged, danced, or walked for about 78 hours—the equivalent of two solid workweeks—by the end of the year.

Wear proper footwear. Although there is no need for you to spend lots of money on fancy walking shoes or aerobic sneakers, you should choose a shoe that has a rigid arch and some cushioning on the heel and ball of the foot. Such support will help keep your body properly aligned and thus less likely to place undue stress on your ankle, knee, or hip joints as you exercise.

Set realistic goals. If you've been sedentary for a number of months or years, deciding to train for next month's marathon by running ten miles every morning would be counterproductive and even dangerous, especially if you have arthritis. After failing to meet the unrealistic goal, maybe damaging your knees or hips trying to do so, you'd most likely become too frustrated and discouraged to exercise at all. In