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[Editor: I was reading an article on exercise and arthritis in our local paper recently and was happy to see our old friend Kevin Fontaine prominently quoted. I became acquainted with Kevin in 1998, when he emailed to say he’d found Ripped 2 “interesting and potentially valuable to my training.” I was especially pleased to hear this when I learned he was an Assistant Professor of Medicine at Johns Hopkins University School of Medicine. He’d been a serious weight trainer for seven years, after having been bitten by the bug some years earlier, as an 11-year-old seeing Arnold in Pumping Iron. In later years, he was “influenced by Mike Mentzer,” and somewhere along the line discovered our books and website. I believe his main interest at that time was obesity; he was associated with the Weight Management Center at Johns Hopkins. To make a long story short, he wrote superb reviews of Lean For Life and Challenge Yourself. The first review appeared in the Johns Hopkins Weight Management Letter (you’ll find it at the bottom of our home page) and the second was featured in FittQuarterly, a Canadian publication (I was honored to be on the cover). He’s now in the Division of Rheumatology at Johns Hopkins, with a list of peer-reviewed articles as long as your arm. Happily, it only took a bare minimum of urging to get him to write this article for our site. Both of us have experienced the benefits of exercise on gimpy joints first hand. As you’ll see, he really knows his stuff.]
We’ve all heard the saying, “You can run but you can’t
hide.” Never has that saying been truer that it is with regard to
arthritis. If we live long enough, we will all experience the “wear and
tear” joint damage that constitutes arthritis. Arthritis is the leading
cause of disability in the United States, and its prevalence will only rise as
improvements in medical care mean that, on average, our lifespan will increase.
Indeed, it is estimated that virtually everyone has X-ray evidence of arthritis
by the age of 75. Arthritis, we are talking here about osteoarthritis, as
opposed to rheumatoid arthritis, which appears to be an autoimmune
disease, is most common in the knees, hips, and hands.
The major symptoms of arthritis are pain in and around the affected joint, stiffness, swelling around the joint, and crepitus (crackling sounds) when the joint is moved. This is because the cartilage that cushions the joints erodes. Unfortunately, arthritis is a progressive disease; it gets worse overtime. Arthritis has no cure; thus, current treatments revolve around trying to control the symptoms, especially the pain and swelling. Typically someone with arthritis takes either an over-the-counter or a prescribed analgesic to reduce pain and swelling. For many people, the joint damage is so extensive and the pain so excruciating that they decide to undergo joint replacement surgery. However, this is generally reserved for older adults since the synthetic joints that are implanted tend to wear out within about 15 years.
For the longest time, exercise was not recommended for people with arthritis for fear that repetitive moments would further damage the joint and hasten the worsening of the arthritis. However, several studies now make it clear that regular exercise can help to reduce pain and improve physical capacity. Because of this, the American College of Rheumatology (ACR), the health professionals who focus on diagnosing and treating arthritis, now recommend that patients with arthritis engage in a program of moderate-intensity physical activity. Adopting the prescription of the American College of Sports Medicine, the ACR advocates a program of exercise that includes an aerobic component and resistance-training component performed 3-5 times per week.
Interestingly, studies indicate that aerobics or resistance training, either alone or in combination, appear to be equally effective in reducing pain and improving physical capacity in adults with knee arthritis. Although exercise is an effective arthritis treatment for many people, we don't really know why. In other words, we do not know the precise mechanism or mechanisms by which exercise produces reductions in pain and improvements functioning and range of motion. (This shouldn’t be surprising though because we still don’t really have a solid grasp on how weight training produces muscular growth!)
With regard to knee arthritis, the most popular explanation for how exercise helps is that it produces an increase in quadriceps strength and this increased strength stabilizes the knee joint thereby compensating for the loss of cartilage. There is a strong association between increased quadriceps strength and decreased pain. However, one recent study found that the stronger one's quadriceps were at the start of the study, the more likely they were to experience a worsening of their arthritis. This implies that strengthening the quadriceps may be detrimental to patients with knee arthritis. An important caveat is that the worsening of the arthritis that was observed among those with stronger quadriceps was ONLY present among those patients with misaligned or lax knees. That is, strength was a bad thing only for those whose knee joints were not properly aligned. It seems, therefore, that if one’s knees are poorly aligned increasing quadriceps strength might produce damaging reaction forces to the joint that, in turn, make the disease worse. Since we know that arthritis can alter knee alignment and produce a change in ones walking (gait), it would be worthwhile to see a physician who could evaluate your knee alignment to determine whether you might benefit from strengthening your quadriceps.
A second explanation for the beneficial effects of exercise is that moving the joints during exercise promotes an increase in blood flow around the joint. In other words, you literally “warm-up” the joint and in so doing you increase the flow and circulation of chemicals in the blood and synovial fluid around the joint that might serve to reduce pain and increase range of motion. Just as an exercised biceps muscle becomes engorged with blood, a knee joint experiences an increase in blood flow and this might hasten the delivery of nutrients and chemical compounds that both lubricate the joint and increase cushioning. Indeed, it is quite common for someone with “gimpy knees” to report a lessening of pain and an increase in range of motion during and for some limited period after exercising. While we cannot yet explain what is happening inside the joint, it is clear that moving the joint during exercise can be of benefit to many, perhaps most, people with knee arthritis.
Another possible explanation for the benefits of exercise is that the quadriceps muscles of people with knee arthritis don’t activate properly and that this results in a higher impact force across the knee when a step is taken. This would help explain the benefits of increasing quadriceps strength in that a stronger muscle is a muscle that has a more efficient alpha-motor discharge and tone. In other words, a strong muscle is a more efficient muscle with regard to neural and proprioceptor pathways.
In closing, although we don’t exactly know how or why exercise benefits people with arthritis, it is clear that it can provide a powerful and effective treatment. [Emphasis added.] Of course, even if exercise produced no arthritis benefit, it still produces a range of benefits to one’s general health. This alone would make it an essential component to an overall wellness program.
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