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Aquatic Pre-Hab for Joint Replacement

By 2030, the demand for primary total hip arthroplasties is estimated to grow by 174% to 572,000. The demand for primary total knee arthroplasties is projected to grow by 673% to 3.48 million procedures.

Pre-surgical or prehabilitation (prehab) programs have been gaining increased popularity and show promising results in getting clients moving quicker after surgery. Prehab can be defined as an individualized physical conditioning program to improve strength, endurance, and range of motion prior to surgery.

I have found in my experience that by incorporating an aquatic program six or more weeks prior to surgery can have significant benefit post-operatively.

A multicenter study performed at New England Baptist Hospital, Beth Israel Deaconess Medical Center and Harvard Medical School found that knee- and hip-replacement surgery patients who had participated in prehab for just six weeks prior to surgeries reduced the need for inpatient rehabilitation by 73 percent. This study involved water-and land-based strength training, plus aerobic and flexibility exercises.

Why Use the Water to Help with Pre-hab?

Reduced Pain & Swelling

Clients awaiting joint replacement surgery are usually in a significant amount of pain. They may experience pain not only at the specific joint but also in corresponding joints that have compensated for improper biomechanics. Using the water’s unloading properties to reduce pain, as well as the hydrostatic pressure to help with swelling reduction, are tremendous benefits.

Restore Range of Motion (ROM)/Muscle Balance

I always tell my clients, “Motion is Lotion.” This means that the more you move correctly, the better you will feel. Gaining as much ROM prior to joint replacement is very important. I also share, “The doctor will be replacing your joint, not your ligaments, tendons or muscles. The more muscle balance we can get the better you will do post operatively.” I give the example of a worn out tire on a car. Over time the cars suspension adapts to that worn tire and pulls out of alignment. The replaced joint represents the new tire; now we have to realign the suspension so everything rides correctly.

In the water using flotation equipment on the lower extremities allows the client to gain much more ROM.

Buoyancy unloads the joint and assists the motion, but more importantly the client has control over the movement.  If try to manually stretch a client, he/she is automatically guarded, no matter how much I remind them to “relax”. Moving freely in the water, the client is more likely to push their ROM than if I stretch him/her manually.

Improve Strength

Pain causes muscle inhibition and hence muscle weakening. Neuromuscular control needs to be restored prior to surgery in order to facilitate muscle recovery post-operatively. The stronger the muscles are, the faster the recovery. Strengthening exercises to help balance all muscle groups are much easier and comfortably performed in the water. Water provides an accommodating three-dimensional resistance which allows multiple muscle groups to be strengthened simultaneously.

Improve Proprioceptive Awareness & Normal Movement Patterns

Any functional movement depends on the coordination and fine tuning of the neuromuscular system. Joint degeneration affects the soft tissues that contain proprioceptors, which will cause significant reduction in the awareness of joint movement.

Proprioceptive exercises can be be started prior to surgery to stimulate the neuromuscular mechanisms and make them more responsive after surgery. The water provides a surrounding proprioceptive enriched environment to help restore neuromuscular function, including balance and proprioception.

Improve Gait

Degeneration of lower extremity joint will commonly result in a compensated gait pattern. This pattern is often continued, even after surgery, because of abnormal motor patterns. Use the water to correct gait patterns prior to surgery, which will assist with alignment, weight shift and proprioceptive input, and therefore facilitate a normal post-op gait pattern.

Client Education

Surgeons often do not tell the client what they will experience post operatively. Thus, another benefit of prehab is the opportunity to educate the client on the post-op process. Clients often compare themselves to other people who have had a similar surgery, which can lead to frustration. By educating the client and with the understanding that everyone progresses at a different rate.

In my experience, by utilizing the water for prehabilitation prior to a total joint replacement is one of the best ways to get clients moving and feeling better faster!


If you’re interested in sponsoring a Medically Based Aquatics (MBA) course at your facility, please contact Rick McAvoy at rick@rickmcavoyaquatics.com

Dr. Rick McAvoy has specialized in Aquatic Physical Therapy and Sports Performance for over 30 years and promotes aquatic fitness, rehab and training. He is the Owner of Rick McAvoy Aquatics, an Aquatic Fitness and Sports Performance Training and Consulting Company. Rick is also a published author and researcher in the field of Aquatic Therapy and Fitness as well as Sports Performance.

Essential oil made from medicinal cannabis

An Introduction to Cannabis’s Role as an Emerging Therapeutic Agent

With cannabis becoming increasingly mainstream in modern culture, its population is becoming aware of its use for a number of purported medical reasons ranging from skin ailments to digestive issues and pain. California has recently allowed its recreational use. Today, the industry is still nascent with a market of ill-vetted products with equally nascent scientific claims. However, cannabis may be unique in its application to holistic care as mediated by the endocannabinoid system and thus it is prudent to know what is useful and what isn’t.

The history of cannabis use is ancient and has resulted in many breeds of cannabis which differ in the phytocannabinoid content, ratio and terpene profile. Cannabinoids are molecules that act on cannabinoid receptors that comprise the endocannabinoid system. The endocannabinoid system modulates the psychological stress, emotionality and inflammation responses. CB1 and CB2 are examples of receptors within this system whose span is diverse, for example, they are found in the brain, gut and persist in osteoarthritic cartilage despite degradation grade. Interaction with these receptors can occur through phytocannabinoids; each of which has differing effects. To complicate matters, phytocannabinoids influence the effects of one another. Furthermore, the method of delivery also influences the effects; for example, ingestion allows the liver time to process phytocannabinoids into its derivatives which have their own effects.

Tetrahydrocannabinol (THC) and cannabidiol (CBD) are two well-known examples of phytocannabinoids. THC has claims to work as an analgesic, antiemetic and antispastic; although, adverse effects include paranoia, lethargy, and tachycardia. THC can also induce euphoria which may play a role in how the analgesic properties work. CBD has claims to work as an anti-inflammatory, antiepileptic and works to block the binding of THC to CB1 and CB2 receptors. The interplay that cannabinoids have on one another has led to the notion of the “entourage effect.” (The idea that cannabis plant as a whole has curative effects.) Pharmacologically speaking, only a combination of THC and CBD, in a 1:1 formulation, manufactured by G.W. Pharmaceuticals has been vetted for its medical claims.

From oils and tinctures to hash and kush, the recreational market has driven into existence a myriad of products with a myriad of claims akin to the early days of the dietary supplement market. Assuming the source comes from one that complies with the current regulation, medical cannabis falls into three categories: plant, processed and formulations. Plant products refer to cannabis products in which the cannabinoids have not been altered and removed from the cannabis plant. These products use no heat or chemicals in their preparation and include: buds, keef, hash.

Processed products apply heat or chemicals to the cannabis plant in order to remove desired terpenes and cannabinoids. Processed products include oils, tinctures, e-juice, etc. and can be assumed to contain a higher percentage of cannabinoids in natural and unnatural ratios. Formulations are processed products whose consistency in manufacturing and medical claims have been vetted by the FDA. Formulations include products like Sativex and Epidiolex. Of course, marketing practices blurs the usage of terms; therefore, it is incumbent of the self to understand the product.


Jakub Pritz, Ph.D. has been working in the cannabis industry since 2015 as a separation operator and consultant for the production of recreational cannabis oils and other cannabis-related products.  He can attest to current cannabis production methods and what the person should be aware of.  His interest is to create botanical extracts of cannabis to be delivered in differing modalities depending on the effects sought and data affirmation.  For example dosage control in inhalation for acute pain relief, transdermal applications for arthritic pain and oral methods for digestive symptoms.  Patrons should be aware of the euphoric effects of THC and the interactions cannabinoids have with one another in varying ratios.   

Prior to this, Jakub held a post-doctoral position at UCSD’s Moore’s Cancer Center where he was in charge of data management and accruing international radiation oncology centers to join the International Evaluation of Radiotherapy Technology Effectiveness in Cervical Cancer (INTERTECC).  This trial required the coordination of several centers to follow strict data collection standards, quality checking of the institution capabilities and implementation of plan protocol.  He received his Ph.D. in Applied Physics (concentration in Medical Physics) from the University of South Florida in 2011.

As an athlete, Jakub competed in the Patriot League as a swimmer, setting records along the way.  During his graduate school years at the University of South Florida, he participated in, coached and competed with their water polo club.

Senior man in a gym talking to personal trainer

Where to Begin When You Are Working Out With a Health Condition

The gym can be a confusing place especially for individuals with health concerns. Many times, these clients are trying to navigate their workouts by themselves because they are unsure of the appropriate questions that they need to ask.

First of all, there are two different types of trainers. There are trainers who have a four year degree and certifications. These trainers are sometimes called Fitness Specialists and have had many hours of study related to a wide variety of diseases and injuries. They are used to modifying exercises and programs based on any specific condition you may have. Fitness Specialists are usually found in a medically based fitness facility affiliated with a hospital. Please note that some Fitness Specialists will specialize in a certain area. Some work with individuals with diseases and disabilities and some don’t. You can search the free MedFit Network directory to find a fitness pro in your area. In their MFN profile, you’ll find information about their condition-specific education and services.

When you finally narrow down who you might like to hire you will want to ask some questions. Please don’t be afraid to ask these questions as they will help you to decide which trainer is right for you. It is also recommended that you observe Fitness Specialists training clients.

First you want to make sure that the trainer has had experience with your condition. If not, they should be willing to research it and or speak with your doctor with your permission. There are exercise guidelines that all Fitness Specialists should follow when working with clients who have health conditions.

You will also want to ask about the trainers background. It is alright to ask about education, certifications, and years of experience. You also want to hire someone who is patient with you. This is extremely important as you figure out which exercises work best for your body. I would also like to add that you need to be patient with yourself as well. Try to relax and enjoy your training session.

Asking the questions from above help to keep you feeling confident. Exercise can seem frustrating in the beginning but you have to keep a positive mindset. In the beginning, set small goals and do the best you can during each training session.


Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness.

Depositphotos_84018014_l-2015

Simple Tips to Stave of Arthritis Symptoms

Offer up these simple tips to aid arthritic clients reduce flare-ups, decrease symptoms, and experience more pain-free days!

There are many simple practices that may greatly decrease the risk and severity of flare-ups. To help reduce painful and swollen joints, improve mood, and increase quality of life, implementing a few of these simple techniques may make a world of difference.

1. Drink Water!  The body is comprised of about 60% water. Dehydration causes a decrease in function of all major organs, muscles, and even bones.

2. Get to Sleep!  Adults of all ages need 7-9 hours of sleep each night. Sleep is when your body repairs muscles, organs, and cells. In this resting state, chemicals will circulate in the blood that help to strengthen the immune system.

3. Set a Schedule!  Plan your days! Get into a routine of good habits. Setting alarms to get up, make phone calls, exercise, cleaning, and meals will provide a daily purpose.  Writing “to-do” lists on a paper calendar and crossing off items as they are accomplished provides a heightened sense of satisfaction and self-worth.

4. Eat Real Food!  The fewer ingredients, the better.  Read labels to avoid too much sugar, salt, and oil. I call these the “S.O.S.” These are foods that are known to cause inflammation and increase the risk for flare-ups.  For example, if you have the choice between an apple or apple pie, choose the apple with less ingredients. It also most likely contains less sugar or processed ingredients.

5. Exercise Daily!  Think of exercise as something you “work in” each day and not as a “work out.” Improving muscle strength, mobility, flexibility, and cardiovascular health reduces symptoms of autoimmune disease.

6. Hiring a Arthritis Fitness Specialist once or twice a week to provide accountability and write safe and effective exercise programs is a great start!

7. Practice Mindfulness!  The simple act of taking a few deep and meaningful breaths throughout the day is a great way to reduce stress and decrease negative physiological responses. Incorporating some gentle stretches in the morning, after periods of inactivity, and before bed is also a great way to bring awareness to the body, ease tension, reduce anxiety, and lessen the symptoms associated with arthritis.

Join Christine for her webinar, Thriving with Arthritis: What Your Doctor May Not Tell You


Christine M. Conti, M.Ed, BA is and international fitness educator and presenter. She currently sits on the MedFit Education Advisory Board and has been nominated to be the 2020 MedFit Network Professional of the Year. She is the author of the MedFit Classroom Arthritis Fitness Specialist Course and is the CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation. Christine is also the co-host of Two Fit Crazies & A Microphone Podcast and the co-owner of TFC Podcast Production Co.

senior-yoga-water

Don’t Let Arthritis Stop You: Move On

Arthritis comes in many forms and has many manifestations, affecting almost every joint in the body. We generally speak in terms of the two most-known if not popular forms of arthritis: rheumatoid (RA) and osteo-arthritis (OA.) The essential difference is in the root cause. RA is an auto-immune disease whereby the body, for unknown reasons, attacks itself, particularly in the joints. OA, on the other hand, is often considered the downstream effect of wear and tear, over-use, prior injury, or, as we’re seeing more of as society gets more sedentary, from lack of use. In OA, typically, some insult to the joint disrupts the natural repair processes and further deterioration occurs subsequently.

Due to their differing causes, there are obviously differing treatments; but the basics of medical management are essentially the same. I am not qualified to address the specifics of the treatments available but, in lay terms, treatment usually entails some version of anti-inflammation and pain-reduction drugs, precautionary movement or positional guidance (don’t do’s, for example), physical therapy to manage pain and inflammation, and therapeutic exercises to support the structures affected as the disease itself causes not just inflammation and pain but damage to the structures that support the joints. Typically we identify arthritis as something that damages cartilage and, in truth, that is often what the standard ‘films’ – X-ray, possibly MRI (magnetic resonance imaging) – show. We now know that the synovial sacs around the joint are also affected and that these and other chemical disturbances affect the muscles and tendons that move and support the joint. In almost all cases of arthritis, pain, inflammation, reduced strength and range of motion (ROM) ensue, diminishing quality of life in many ways and, because some of the drugs used to treat it, potentially reducing quantity of life. (Gastrointestinal bleeding from non-steroidal anti-inflammatories (NSAIDs) or bone loss (osteoporosis) from corticosteroids can lead to fatal outcomes (such as spontaneous fractures leading to falls from osteoporosis) if not treated with other medications.)

When someone is potentially afflicted or actually diagnosed with a form of arthritis, the medical community goes into hyper-drive, encouraging changing one’s habits, be they the types of activities one engages in recreational, competitively, or professionally; or the types of non-activities one currently does, in particular, being inactive.

In some cases, dietary advice is offered as we are learning more about foods that are pro-inflammatory and others that have anti-inflammatory benefits. In the former category, we are learning that excessive sugar or simple carbohydrates, including processed wheat products, may exacerbate inflammation while others, such as salmon, dark, green veggies, and certain oils (e.g., olive oil) are capable of reducing the inflammatory elements circulating throughout our bodies and our joints. Furthermore, in more extreme cases, when arthritis becomes very painful and debilitating, over-the-counter and/or prescription-fitted braces may be offered to defer some of the more end-line procedures such as surgery to fuse the joint or replace it with a prosthetic device.

The most common non-pharmaceutical and non-surgical treatment for arthritis of any sort: exercise.

Note that there are several legitimate ways to integrate exercise through resistance training programs that have proven quite effective in arthritis management. Yoga, Pilates (floor or machine based), Tai Chi, Qigong and water-based, or aqua, exercise are all beneficial to many aspects of the overall arthritis program of strength, ROM, proprioception and ultimately function. Since many of these are quite technical and are often done in class formats, one should ask the instructor(s) as to their experience working with arthritis clients.

As with any form of exercise, by whatever professional instruction, you should be totally aware of your pain levels as going “through” the pain is not recommended; thus, you must assert control over the exercise sessions. There will be some exercises, however, that are not destructive and may be somewhat painful but must be done in order to maintain reasonable levels of function and independence. So long as the pain subsides within a couple of hours – preferably as soon as you stop – and there is no exacerbation of inflammation the next day, you can assume that the exercise was just enough. If symptoms flare up over the next 24 hours, however, assume you did more than you should have and alert your trainer or instructor so that he/she can avoid doing the aggravating exercise(s) as much or as hard next time. For these reasons, along with all the other recommendations so far as exercise interventions are concerned, it is best to seek the counsel and assistance of a fitness professional with a background in medical fitness. This could be someone with a more advanced academic degree, someone with a license to practice rehabilitation exercise (physical therapist, athletic trainer, etc.), or someone who’s taken several educational programs to have a greater understanding of the variety of disorders and diseases that may benefit from exercise interventions.


Dr. Irv Rubenstein graduated Vanderbilt-Peabody in 1988 with a PhD in exercise science, having already co-founded STEPS Fitness, Inc. two years earlier — Tennessee’s first personal fitness training center. One of his goals was to foster the evolution of the then-fledgling field of personal training into a viable and mature profession, and has done so over the past 3 decades, teaching trainers across through country. As a writer and speaker, Dr. Irv has earned a national reputation as one who can answer the hard questions about exercise and fitness – not just the “how” but the “why”. 

trainers-with-senior-clients

Understanding Osteoarthritis

Osteoarthritis (OA), the most common form of arthritis, affects some 27 million adults per year and is on the rise. The Centers for Disease Control and Prevention (CDC) estimates that in 2005, self-reported arthritis or other chronic joint symptoms affected approximately 21.4 million Americans aged 65 years and older. This estimate is expected to reach 41.1 million by 2030. Osteoarthritis makes simple movements and activities of daily life painful and difficult to perform.

Osteoarthritis typically occurs in the hands, knees, spine and hips affecting a multitude of joints. Those affected with OA will typically complain of symptoms of stiffness, low-grade inflammation and pain. This stiffness and pain are most prevalent in the morning which improves with activity and as the day progresses.

Pathology

The cause of OA involves a combination of mechanical, cellular and biochemical changes. The processes involves changes in the composition and mechanical properties of the articular cartilage. Cartilage is comprised of water, collagen and proteoglycans, In healthy cartilage, there is continual remodeling that occurs as chrondocytes (cartilaginous cells) replace macromolecules that are lost through degradation. In Osteoarthritis, this process is disrupted leading to degenerative changes and abnormal repair response. 2 

Contributing Factors

Despite increasing awareness of the negative effects of obesity on health and OA in particular, the prevalence of individuals who are overweight or obese is increasing. Data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2000 show that 64.5% of the US population is overweight, including 30.5% classified as obese. Carrying extra weight places biomechanically places increased stress and force on the weight bearing joints.  Other common risk factors include joint injury, mechanical stress, history of immobilization and trauma.

Medical Management

Arthritis treatment first begins with education. Treatment for osteoarthritis can help relieve pain and stiffness, however the condition can progress. Physicians will tend to focus to help those afflicted with OA by helping patients manage their pain. There are several ways to do this. The first commonly used approach is pharmacologic intervention. Traditional non-steroidal anti-inflammatory drugs(NSAIDs) have been shown to be effective for OA pain, and are perceived as second-line drugs for the treatment of mild to moderate OA.

Physical therapy is very effective in helping those suffering with OA. Where the focus is on helping the patient by improving their muscle flexibility, joint mobility and strengthening the weaker hip musculature. Resulting in improved mobility, function, decrease pain and improved quality of life.

Training Recommendations

Because arthritis is a “process,” the most effective training is education and prevention. From a cardiovascular perspective, a cardiovascular program should be tailored to the client. A recumbent or stationary bike is a great starting point to reduce the load to the hips and knee which can be progressed to the elliptical machine. Stretch the tight (postural) hip flexors and quadriceps seen in figure one will reduce the load to the knee joint. Yoga can also be an effective intervention which will improve flexibility, balance, strength and body awareness. Strength training should focus on targeting the weaker phasic muscles; glute maximus, glute medius/minimus as seen in figure two. These muscles are necessary for everyday movements such as arising from a chair, climbing stairs, and negotiating uneven surfaces.

Figure 1. (left) Anterior muscles of the hip complex
Figure 2. (right) Posterior muscles of the hip complex

Strengthening the core begins with simple exercises such as bridging with the ball (figure three), targeting glute maximus, hamstrings, and the lower back musculature. This can be progressed to having the client hold longer or to perform a single leg bridge. Functional strengthening exercises such as reverse lunges holding a medicine ball that can be progress to either holding overhead or adding trunk rotation will do two things. four and figure five). The use of aqua therapy can also be effective which eliminates gravity resulting in a client’s ability to strengthen their lower body in a relaxed environment.

Figure 3. Bridging with Ball
Figure 4. (left) Reverse lunge with wood chop
Figure 5. (right) Diagonal lunge with trunk rotation with medicine ball

Summary

Arthritis continues to affect many individuals for various reasons. One thing is certain, knowledge, prevention and early screening is fundamental. Understanding the pathological process and medical approach is the first step in helping your clients with OA. Refreshing yourself on anatomy, biomechanics and understanding proper exercise prescription is fundamental. Any exercise program should be individualized resulting in improved function.


Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, C-IASTM, NASM CPT. Chris is the President of Pinnacle Training & Consulting Systems, LLC. A consulting and education company that is committed to creating and providing evidenced based educational material in the form of home study courses, dynamic live seminars, mini-books, DVD’s on the areas of; human movement, fitness and rehabilitation with unique practical application. Chris has 20 years clinical experience having worked with primarily orthopedic patients, spinal injuries, post-surgical conditions, traumatic and sport specific injuries and 20 years as a personal trainer. For more information, please visit www.pinnacle-tcs.com.

REFERENCES

  1. David M Lee et al. Rheumatoid Arthritis. The lancet. Vol. 358.  September 2001. pp: 1240-1242.
  2. Hinton et al. Osteoarthritis: Diagnosis and Therapeutic Considerations. Journal of American Family Physician. 65(5) Pgs: 841-849. 2002.
  3. Weinblatt ME, Maier AL, Fraser PA, Coblyn JS. Long-term prospective study of methotrexate in rheumatoid arthritis: conclusion after 132 months of therapy. Journal of Rheumatology.  25: pp: 238–42. 1998.
  4. Kremer JM. Safety, efficacy, and mortality in a long-term cohort of patients withs rheumatoid arthritis taking methotrexate: follow-up after a mean of 13·3 years. Arthritis Rheumatology. 40: pp: 984–85. 1997.
  5. Tugwell P, Wells G, Strand V, et al. Clinical improvement as reflected in measures of function and health-related quality of life following treatment with leflunomide compared with methotrexate in patients with rheumatoid arthritis: sensitivity and relative efficiency to detect a treatment effect in a twelve-month, placebo-controlled trial. Arthritis Rheum. 43: pp: 506–14. 2000.
  6. Schneider, Rayfel. Et al. Rheumatology Disorders Clinics of North America. 28. pp: 503–530. 2002.
  7. Braun, Jurgen et al. Ankylosing Spondylitis. The Lancet. 369, 9570; Research Library. pp. 1379. 2007.
  8. Ding, T., Deighton, C. Management of Rheumatoid Arthritis. Journal of Medicine. Volume 38. Issue 4. 2009. pp: 172-1769.
  9. Calin, A. Ankylosing Spondylitis.  Journal of Medicine.  Volume 34. Number 10. pp: 396-399. 2006.
  10. Litman, D. Maximizing Success in Osteoarthritic Care: Benefits of a comprehensive Management Approach. Internet Journal of Rheumatology. Volume 5. Issue 2. pp: 1-2. 2008.
Paper-Heart

Are You At Risk? The Link Between Autoimmune Disease & Heart Health

Severe RA Doubles the Risk of Heart Disease1

In the last few decades, researchers discovered that the burden autoimmune diseases like rheumatoid arthritis (RA) puts on the joints during the first year of diagnosis is a strong predictor of heart disease.2 In fact, it is recommended that doctors who diagnose patients with RA should also be addressing potential heart risks.

There have been several new studies from the Mayo Clinic that show a strong connection between inflammation and heart health. Therefore, it is important to address both conditions at the same time.

Dr. Eric Matteson, chair of rheumatology at the Mayo Clinic, says that people with rheumatoid arthritis and other chronic inflammatory conditions are at a much higher risk of heart disease. In fact, people with severe RA are twice as likely to develop heart disease. Matteson believes that the inflammatory process of arthritis plays a key role in maintaining a healthy heart.

Therefore, if you have been diagnosed with an autoimmune disease such as rheumatoid arthritis, it is imperative that you meet with a cardiologist. Autoimmune diseases are known to not only affect the joints in your body by causing painful stiffness and inflammation, but also negatively affect major organs such as the heart.

One symptom that can develop from an autoimmune disease diagnosis such as RA is vasculitis, or inflammation of the blood vessels that move blood throughout the body. “As the blood vessels become inflamed, their walls thicken, limiting how much blood can pass through them. As a result, if blood flow is restricted, this could cause significant damage to tissues and organs.” 3

Because rheumatoid vasculitis (RV) is a non-joint-related inflammatory complication of RA, it can affect anyone.4 If you or a loved one have been suffering with RA for many years and developed severe joint damage and deformity, it is important to make an appointment to get your heart checked.

What causes vasculitis?

Researchers are not sure exactly what causes rheumatoid vasculitis. Like RA itself, most cases of RV can be considered autoimmune diseases. An autoimmune disorder occurs when the body’s immune system mistakenly attacks healthy tissues.

Several factors are thought to play a role in whether a person with RA will go on to develop RV, including whether you have:

  • Severe, long-standing RA for 10 or more years
  • Seropositive RA (a high concentration of rheumatoid factor antibodies and certain proteins in the blood)
  • A history of smoking cigarettes, which can damage the blood vessels’ lining
  • Felty syndrome, a complication of rheumatoid arthritis that results in low white blood cell levels and an enlarged spleen
  • Rheumatoid nodules, firm lumps under the skin that form around the joints

The Facts

According to the CDC:

  • One out of every four people in the United States dies from heart disease.
  • Heart disease is the leading cause of death for men, women and people of most racial and ethnic.
  • One person dies every 36 seconds in the United States from cardiovascular disease.
  • People with autoimmune diseases are at a much greater risk for heart disease.
  • Making lifestyle changes to your diet, exercise, sleep and stress greatly reduces risk.
  • In some cases, medicine reduces risk.5

Therefore, if you or a loved one suffer from an autoimmune disease, be sure to schedule an appointment with a trusted cardiologist for a check-up. The most important step you can take to reduce your risk for developing heart disease is taking action.


Christine M. Conti, M.Ed, BA is and international fitness educator and presenter. She currently sits on the MedFit Education Advisory Board and has been nominated to be the 2020 MedFit Network Professional of the Year. She is the author of the MedFit Classroom Arthritis Fitness Specialist Course and is the CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation. Christine is also the co-host of Two Fit Crazies & A Microphone Podcast and the co-owner of TFC Podcast Production Co.

References

  1. Krans, B. (2013, October 27). Mayo Clinic: Ra can drastically impact heart health. Healthline. Retrieved June 6, 2022, from https://www.healthline.com/health-news/arthritis-ra-raises-your-risk-of-heart-disease-102713
  2. Krans, B. (2013, October 27). Mayo Clinic: Ra can drastically impact heart health. Healthline. Retrieved June 6, 2022, from https://www.healthline.com/health-news/arthritis-ra-raises-your-risk-of-heart-disease-102713
  3. Menard, V., & Teitel, A. D. (2021, May 6). Vasculitis: The risks of ra inflammation. myRAteam. Retrieved June 6, 2022, from https://www.myrateam.com/resources/vasculitis-the-risks-of-ra-inflammation
  4. Menard, V., & Teitel, A. D. (2021, May 6). Vasculitis: The risks of ra inflammation. myRAteam. Retrieved June 6, 2022, from https://www.myrateam.com/resources/vasculitis-the-risks-of-ra-inflammation
  5. Centers for Disease Control and Prevention. (2022, February 7). Heart disease facts. Centers for Disease Control and Prevention. Retrieved June 6, 2022, from https://www.cdc.gov/heartdisease/facts.htm
food-and-vegetable-coop-box

Food and Arthritis

Millions of people suffer from painful and swollen joints caused by arthritis. Unfortunately, health care providers often don’t discuss diet change with patients who have arthritis. This is likely because older research, which tested diets with dairy products, oil, poultry, or meat, showed little benefit. Current research shows that foods can play a substantial role in arthritis.

Different Types of Arthritis

Osteoarthritis is a gradual loss of cartilage and overgrowth of bone in the joints, especially the knees, hips, spine, and fingers. More than 32 million Americans suffer from osteoarthritis, and risk increases with age. The condition usually develops gradually and can cause pain and stiffness.

Rheumatoid arthritis (RA), which affects more than 1.3 million Americans, is a more aggressive form of arthritis. It is an autoimmune disease that causes painful, inflamed joints and can result in permanent damage. RA is one of medicine’s mysteries. The disease does not appear in medical reports until the early 1800s, and some suspect that a virus or bacterium may play a role by setting off an autoimmune reaction. Certain genes can also make people more likely to develop RA.

The Role of Diet

Diet and RA. While not all research has found a connection, multiple studies show that dietary changes can help relieve RA symptoms. For example, one study looked at the effects of a very-low-fat vegan diet on people with RA. After only four weeks, people had less morning stiffness, RA pain, joint tenderness, and joint swelling. A study published in Rheumatology found a gluten-free, vegan diet improved the signs and symptoms of RA. And a systematic review concluded that fasting followed by a vegetarian or vegan diet might be useful in the treatment of RA.

Download the Physicians Committee for Responsible Medicine’s Fact Sheet, Food and Arthritis, to read the rest of this article. Feel free to download and share this free resource.


The Physicians Committee for Responsible Medicine is a 501(c)(3) nonprofit organization, headquartered in Washington, DC. Our efforts are dramatically changing the way doctors treat chronic diseases such as diabetes, heart disease, obesity, and cancer. By putting prevention over pills, doctors are empowering their patients to take control of their own health.

Fact sheet shared with permission from PCRM. Click here to view other PCRM Fact Sheets.

 

female-trainer-senior-client-exercise-ball

Flip the Script: How Fitness Professionals Can Overcome Challenging Clients

If you are a fitness or medical fitness professional, there is a good chance you have heard one or more of the following statements at least once in your career. In fact, there is also a good chance you have heard these statements on a daily basis. 

1. I am a little tired and my muscles are a little sore from our last session, so I am going to cancel today and rest. 

2. I don’t want to do “that exercise” because I have never done it before.

3. My doctor told me that I should not be squatting, bending, reaching, twisting, etc… 

Many of you reading this article can relate to at least one of the above and may have even let out a slight sigh of frustration when it comes to overcoming challenging clients. Overwhelming amounts of research show that exercise can help to improve your health and fitness without hurting your joints.(1) With your current treatment program, exercise can: 

  • Strengthen the muscles around your joints 
  • Help you maintain bone strength 
  • Give you more energy to get through the day 
  • Make it easier to get a good night’s sleep 
  • Help you control your weight 
  • Enhance your quality of life 
  • Improve your balance 

However, many of our clients still believe that exercise will aggravate their joint pain and stiffness, but that is not the case. Lack of exercise actually can make your joints even more painful and stiff.(2) If the muscles and surrounding tissue are strong, it helps to maintain support for your bones. Choosing not to exercise weakens those supporting muscles, creating more stress on your joints. 

While fitness and medical fitness professionals understand the importance of exercise, the way we translate this to our clients is key. Oftentimes, clients receive misinformation along with mixed messages from doctors, family members, friends, and of course, social media. However, after decades of both academic and professional research working with special demographics, I have discovered a powerful technique to increase clients’ willingness to improve their health through exercise. The answer lies not only in showing the client how each exercise emulates real-life situations, but also how it affects their independence.

For example, telling a client, “Today we will be working on how to safely and effectively execute a squat,” is a lot different than saying, “Today we will be practicing our sit to stand movements so that you have the lower body strength and flexibility to rise from your favorite chair without assistance.” 

Most importantly, it is important to reiterate to your client that their lack of strength, mobility, and balance leads to a more sedentary lifestyle that will decrease their ability to function independently as time progresses. Additionally, muscle atrophy, joint immobility and poor flexibility are key indicators that functional movements, or movements that are required to perform everyday tasks, will soon be a thing of the past.

If a client is unwilling to perform various exercises, here are some conversation starters:

  1. Did you know that this is not just an exercise, but one of the foundational movements to support strength, balance and flexibility in your everyday life?
  2. Do you know the definition of functional fitness?
  3. Do you know that this isn’t just an exercise, but will help you walk up and down the stairs, get up from a seat, carry your groceries, and pick up a grandchild?
  4. Are you ready to give up your independence? 

Christine M. Conti, BA, M.Ed, is an international fitness educator and presenter. She currently serves as the Director of Membership for MedFit Network, sits on the MedFit Education Advisory Board and is a course author for MedFit Classroom. She is also CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation and co-host of Two Fit Crazies & A Microphone Podcast

Check out Christine’s online course with MedFit Classroom, Arthritis Fitness Specialist:

References

  1. CDC: Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. (2021, April 5). Benefits of Physical Activity. Center for Disease Control and Prevention. Retrieved September 10, 2021, from https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm
  2. Mayo Clinic. (2021). Exercising With Arthritis: Improve Your Joint Pain and Stiffness. Mayo Clinic. Retrieved September 9, 2021, from https://www.mayoclinic.org/diseases-conditions/arthritis/in-depth/arthritis/art-20047971