Arthritis and other rheumatic conditions are among the most common chronic diseases, affecting 80 million US adults (CDC 2010), and are the leading cause of disability among US adults (CDC 2010). Costs to the US economy total more than $128 billion annually & 
results in 39 million physician visits annually and more than a half million hospitalizations according to The Arthritis Foundation.
Individuals with chronic disease such as arthritis may live normal and productive lives with the help of disease management strategies. The most important strategies for preventing and managing arthritis are proper nutrition, regular exercise, relaxation and stress reduction, medical management, and regular health and medical screenings.
Physical disuse and disability in people with arthritis are major contributors to premature aging. It is clear that disuse is devastating to the physical body. There is no doubt that appropriate and individually designed exercise can enhance the vitality and quality of life for the person with arthritis.
Osteoarthritis (OA) is a degenerative joint disease and is the most common form of arthritis. It is characterized by a gradual loss of cartilage from joints and, in some people, joint inflammation. Although osteoarthritis can affect almost any joint, it most often affects the joints of the hands, knees, hips, and spine. Common symptoms include pain, stiffness, and loss of joint motion. Osteoarthritis is a chronic condition that gradually worsens over time. However, treatment can often reduce the symptoms, sustain a person’s level of physical activity, and possibly slow the progression of the condition.
Rheumatoid arthritis (RA) is a systemic autoimmune inflammatory disease characterized by inflammation of the lining surfaces of joints and the surfaces surrounding the heart and lungs. An individual with rheumatoid arthritis has a defective immune system, which turns against the body, attacking joints (Lewis 1991). The severity may fluctuate, but rheumatoid arthritis most commonly results in development of pain, joint destruction, deformity, and significant decline in functional status (Klippel 2000). The masses of inflammatory cells within the joint cause it to appear swollen, red, warm, and puffy. The inflammatory cells release enzymes that digest bone and cartilage and eventually damage the entire joint. Scar tissue forms, which results in changes to the shape and structure of the bone, sometimes causing the bones to fuse together so that they are permanently rigid and immobile. The peak incidence of rheumatoid arthritis occurs in individuals aged 40 to 60. Symptoms of RA include general fatigue and soreness, pain, stiffness, aching, warmth, redness, and inflammation of one or more joints, almost always symmetrically. The hands and feet are usually affected first. Other joints of the upper and lower limbs, such as elbows, shoulders, ankles, and knees are also commonly affected.
Many psycho-social problems can arise as a result of chronic illness such as arthritis. The condition itself makes activities of daily living (ADLs) more difficult, often resulting in depression, decreased self-esteem, and feelings of anxiety about the future. The cycle begins with a loss of function and mobility accompanied by pain. Chronic pain has been associated with both anxiety and depression.
The goals of management for people with arthritis are to control pain and swelling, minimize disability, improve quality of life, prevent progression of the process, and educate individuals in their role of self-management. Lifestyle modification strategies include:
- Weight reduction
- Rest and relaxation
- Joint protection
- Energy conservation, exercise
Properly designed exercise is an integral part of management for arthritis. Because hyaline cartilage has no blood vessels or nerves, mature cartilage cells receive nourishment only from the diffusion of substances through the cartilage matrix and joint fluid. Physical activity has been shown to enhance this process.
Physical Activity Guidelines for Americans
Adults should get at least 150 min/week of moderate-intensity aerobic activity, 75 min/week of vigorous aerobic activity, or an equivalent combination of both.
For additional and more extensive health benefits, adults should increase their aerobic physical activity to 300 min (5 hours) of moderate-intensity aerobic activity, 150 min/week of vigorous aerobic activity, or an equivalent combination of both.
Adults should also engage in muscle-strengthening activities on 2 or more days a week, as this provides additional health benefits.
Source: 2008 Physical Activity Guidelines for Americans, U.S. Dept. of Health and Human Services
Benefits of Exercise
A supervised exercise program with a medical fitness professional can assist the individual with arthritis in many ways:
- Exercise increases strength and flexibility, which results in more stable joints and reduced pain.
- Performed for sufficient duration, aerobic exercise, in combination with strength training, can contribute to weight loss, which reduces the forces produced at the joints.
- Exercise increases mobility and decreases stiffness, which allows for more independence.
- Regular physical activity has been found to decrease pain and relieve arthritic symptoms.
- Performed regularly, exercise can increase function and reduce disability.
- Exercise can also provide an increased sense of well-being and self-efficacy.
- Regular physical activity can improve energy levels.
Primary Goals of an Exercise Program for those with Arthritis
- Restore or maintain joint range of motion
- Restore or maintain muscle strength
- Interrupt the chronic pain cycle
- Improve or maintain cardiorespiratory endurance
- Improve posture and body awareness
- Relieve stiffness
- Maximize pulmonary function
- Promote relaxation
- Enhance quality of life
Interrupt the Chronic Pain Cycle
It is quite easy for the person with arthritis to fall into the chronic pain cycle. When 
movement of a joint leads to pain, there is a tendency to stop moving the joint. Continued disuse of the joint may cause stiffness and eventually joint contracture,or shortening of muscles and connective tissues, in addition to other deformities, making movements more difficult. The loss of motion can lead to loss of function and disability, resulting in decreased self-esteem and withdrawal from social activities. Depression, stress, and anxiety further aggravate and increase muscle tension, resulting in more pain. Proper exercise on a regular basis is a way of breaking this cycle.
A medical fitness professional can help ensure that you have proper body mechanics throughout an exercise program. Poor posture fatigues the body and can cause joint stress or injury by changing joint mechanics. Balance and coordination activities help the body maintain proper position and spatial orientation. Overall core strength is also needed for postural control. Strength training can relieve symptoms and improve functioning among people with osteoarthritis and rheumatoid arthritis.
The benefits of strength training include:
- Increase muscular strength and stability of joints
- Increased lean body mass
- Increased or maintained bone mineral density
- Increased performance to perform activities of daily living
- Increased independence and self-efficacy
Machines are good for beginners, ensure proper form, isolate specific muscle groups, help with rehabilitation and often provide good back support. Free weights provide a greater range of motion than machines, improve coordination and balance by recruiting synergistic and stabilizing muscles, thereby improving functional strength, and provide a greater diversity of exercises that can be modified.
A Medical Fitness Professional can design a personalized progressive fitness program, monitor your progress and provide supervision and support throughout. They can work with your healthcare provider in getting you started on an exercise program that would be best for you.
