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Stress and Arthritis

Many people believe that arthritis can only come from physical activity in your body, and it certainly does, but what others tend to forget, or simply don’t know, is that an individual’s mental health is a huge factor in arthritis as well. A study in 2009 by researchers at the Centers for Disease Control and Prevention claimed that people who experienced traumatic events during their childhood, which included physical or emotional abuse, had a much higher risk for developing rheumatoid arthritis compared to individuals who did not experience trauma.

Can Stress and Anxiety Actually Worsen Symptoms of Arthritis?

Some researchers claim that there is a direct relationship between a person’s stress response and inflammation in their body. Author Andrea W.M. Evers, PhD, took blood samples from 80 rheumatoid arthritis patients once every month for six months to measure the correlation between the stress hormone and inflammatory cytokines, and found that it played a main role in the amount of arthritis severity. Releasing cytokines in your body are the cause of inflammation, and exhibiting various levels of stress can also cause these specific molecules to be released, which eventually will promote inflammation and pain. Evers concluded that “patients who have a tendency for more worrying reported slightly more disease activity, more swollen joints, and more pain.”

Identifying the Root of Your Stress

As an individual becomes diagnosed with arthritis, their emotions can become extremely overwhelming. They may grow frustrated, uncomfortable, or in some cases, become very depressed. It becomes harder to perform normal daily tasks like putting on socks, cooking food, climbing stairs, and even just walking for some people. Their daily routine has become altered, and while some people can handle the change in lifestyle, others find it harder to cope and their stress can actually make the physical pain worse. Being able to identify where the arthritis is coming from in the body and developing a plan to improve it is the first step to reducing the stress associated with this disorder.

Tips for Handling Stress with Arthritis

Learning how to cope and finding ways to relieve tension can improve an individual’s quality of life physically and emotionally. One tip to handling stress would be to stay as active as you can throughout the day. Many people who have arthritis are often fearful of performing exercises simply because they worry it might make the pain worse or damage the joints, however, physical activity can actually improve the symptoms of rheumatoid and osteoarthritis. Daily activities like swimming and walking can reduce stiffness and stress on the joints while releasing endorphin hormones, (the hormones that make you feel good), ultimately improving the pain associated with arthritis and putting you in a better mood altogether.

Another tip would be to eat right so your body can fight inflammation. This tip seems like common sense, however many people don’t know which foods to eat and which ones to avoid. Some foods to start including in your every day diet are salmon, berries, and leafy green vegetables. Foods to avoid are red meats and vegetable oils, mainly because they contain omega-6 fatty acids which actually cause inflammation instead of reducing it.

Becoming more aware of your arthritis and coping with it appropriately will relieve pain in the body, resulting in an all-around happier and healthier you.

Lauren Adkins is a senior at Rowan University studying Health Promotion and Wellness Management. She is currently an intern at The Stress Management Institute and has a passion for helping people live a healthier lifestyle and improving their well-being. Lauren has also volunteered for a program at Rowan called “Get-FIT,” where she worked with individuals with developmental disabilities and promoted a happy, healthy, and fit lifestyle for them. Other than working towards a degree, Lauren enjoys spending time with family and friends, painting, and listening to music in her free time.





Beyond Modifications: Bringing all of Yoga’s Tools to People with Arthritis

For over a decade, I have been researching the effects of yoga for people with arthritis. As many people envision, this includes a lot of modifications, adjustments, and extensive use of props. We work with students to find versions of each asana that remain true to the essence of the pose, working within any movement limitations without creating pain or joint discomfort.

But when we teach yoga to people who have arthritis, we don’t strive for a magical asana sequence that will address arthritis in a particular body part.

Yoga is a holistic process. When we make the mistake of thinking about yoga as if it were physical therapy, we lose what makes yoga a unique therapeutic process. Instead, yoga can go hand-in-hand with modalities like PT, as complementary processes.

Researchers lose something when looking only at an asana sequence and its effect on the joints.

Instead, our job is to get the joint issues out of the way, through support, use of props, compassion and awareness, so that yoga can work its magic on the whole person- body, mind, and soul.

Just as yoga can improve overall physical fitness for healthy individuals, it can improve fitness for people with arthritis. But with this population, the stakes are even higher. Yoga can improve balance, which prevents dangerous falls. Yoga practice can enhance flexibility, which allows individuals to maintain mobility over time. Improved strength means greater joint stability. Improved strength means a reduction in the muscle loss that accompanies some forms of arthritis. Improved strength means an increased ability to participate in everyday activities that can be challenging as joints deteriorate.

But a yoga practice has the potential to bring much more to the lives of people with arthritis. Yoga allows those with a chronic, disabling disease to realize what their bodies CAN do. It fosters a connection to their bodies which may have been lost during years of disease progression and reduced activity. Yoga can teach students to be present in the moment, and to adjust to their bodies needs on a particular day, without judgment. Arthritis changes every day, and this skill serves our students every day, even if they don’t get on the mat.

Yoga also helps our students to relax and to be mindful. Having a chronic disease is stressful, and stress can exacerbate that disease. The relaxation and meditation practices of yoga can break the cycle of stress reactivity.

Yoga classes connect people with arthritis to others who are striving and thriving… people who are living a full and active life, whatever journey they have taken to arrive at that place.

And yoga changes other behaviors. When people start to feel connected, they want to do other things in the name of self-care. They eat healthier foods, go for a walk outside, make time for themselves, and some even make an effort to be more adherent with their medical care.

When we think about bringing the tools of yoga to the arthritis community, let’s be sure to look beyond the modification of asana as a goal. Our goal is to make the asanas possible, so the totality of yoga can come through to our students, safely and effectively.

Reprinted with permission from Dr. Steffany Moonaz.

Dr. Steffany Moonaz is a yoga therapist and researcher and serves as Assistant Director of Academic Research at the Maryland University of Integrative Health. Dr. Moonaz is working to bring yoga to people with arthritis in communities around the country, as well as educating yoga teachers and yoga therapists about the unique needs of this population. She currently leads Yoga for Arthritis teacher training programs nationwide and serves as a mentor for several emerging researchers who are working to study the effects of yoga for various health conditions.


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.

treatmentDue 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.

nonsurgicalAs 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”. 

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.


Exercise and Osteoarthritis

Osteoarthritis is a painful condition in the joints of the hands, knees, hips and spine.  It affects millions of people throughout the world and is caused when the cartilage that cushions the joints wears down. There is no cure for this condition but there are some things you can do to strengthen your muscles around the joints. In turn, you may feel better overall.

It is important to consult your doctor before starting any exercise program. Your physician may have specific instructions for you to follow. These guidelines are important for helping to keep you safe. There are many different exercise programs that are safe for individuals with Osteoarthritis.

Locating a gym and setting goals

When looking for a gym choose one close to home, as it will be easier to go on a regular basis. You should also think about when you would like to workout. Individuals with arthritis usually feel better in the afternoon. Getting to the gym in the morning may be harder.

Depositphotos_11402918_xsWater exercise

Water exercise is easy on the joints and may help with pain. Being in the pool will take weight off of your joints and make movement easier. When exercising in the water you can either have a trainer, take a class, or work on your own. If you choose to work on your own having an initial assessment and a training session is beneficial. Initial assessments and training sessions are usually included in a membership.  You should also ask which classes would be suitable for you.

Land Exercise

Individuals can benefit from land exercise as well. Some gyms have land arthritis classes or light classes. Again, having an assessment can help you to figure out which classes are right for you. Like water exercise you can choose to take a class, work on your own, or hire a trainer. Either way, talk to the fitness staff and ask for guidance.  On land, warm up is important. Try to do a 10 to 15 minute warm up on a recumbent bike. It will be easier for you to move after a proper warm up. It is also important not to run, jump, or lift too heavy.

Mind/Body Exercise

Mind/Body exercise is a nice compliment to any workout. It usually incorporates a balance and stress management component. There are many classes to choose from such as Yoga, Pilates, and Tai Chi. Most gyms today, have many variations of these classes. For instance, Gentle Yoga, and Chair Yoga are popular among individuals with arthritis. When searching for a gym ask what types of classes are offered.

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.

Source: http://www.mayoclinic.org/diseases-conditions/arthritis/in-depth/arthritis/art-20047971?pg=1


Exercises That Can Help Prevent and Relieve Arthritis

Arthritis is a disease where the joints of one’s body are chronically inflamed. 46 million (or 21%) Americans have it and it is one of the leading causes of work disability.

They are two major forms of arthritis: osteoarthritis and rheumatoid arthritis. Osteoarthritis is when the cartilage within the joints wears away and causes severe pain and swelling, particularly in the hands, knees, hips and spine. Rheumatoid arthritis, on the other hand, is where one’s immune system mistakenly attacks it’s own tissues. As a result, the body responds with pain and stiffness in areas of the body such as wrists, hands feet and knees. Fortunately, exercise can help provide some relief, pain and discomfort wise, for those suffering with this chronic health condition.

How Exercise Helps to Relieve It

There have been two significant studies that showed exercise could help arthritic people feel better. Strength training and balance exercises were used to provide relief from the pain experienced because it improved flexibility and overall strength. Balance and strength training affect one’s gait, so, at the very minimum, exercise can help to improve this. Also, it is important to keep in mind that arthritis increases muscle loss and lack of flexibility. As a result, it is important for an individual with arthritis to keep their body limber and moving as much as possible.

Exercises That Can Help With Arthritis

According to NASM, the following protocol should be followed by arthritic people for a reduction in pain and overall health improvement. Please keep in mind, that anyone starting an exercise program, should consult with their physician and a qualified fitness professional first.

Cardio Exercise: treadmill walking, stationary cycling and low impact step aerobics. I recommend up to 30 minutes as a general goal to aim for with duration. The intensity should be from a walk in the park to a light job.

senior woman doing exercisesFlexibility: Static stretching and foam rolling may be used as tolerated for the areas of the body that appear to be overactive. These can be performed seated or standing.

Weight Training: Exercises that include core, balance and general overall major muscle groups are recommended. Circuit training is a great way to get all of those things done in one session. I suggest 1-2 sets of 10-12 reps, 2-3 times a week. It is important to keep in mind the following when doing exercise: avoid heavy lifting, with high reps, stay away from movements that cause pain and be prepared to only do five minutes of exercise in a given session until your overall conditioning improves.

Maurice D. Williams is a personal trainer and owner of Move Well Fitness in Bethesda, MD.


1. http://blog.nasm.org/senior-fitness/what-a-pain-in-the-joint-training-guidelines-for-arthritic-clients/
2. http://blog.nasm.org/senior-fitness/modify-training-programs-clients-osteoarthritis/
3. http://www.healthline.com/health-slideshow/8-essential-everyday-exercises-for-ra-pain#8

NASM Essentials of Personal Fitness Training, 4th Edition Revised, 2014.

Senior Man On Cross Trainer In Gym

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 Specialist’s will specialize in a certain area. Some work with individuals with diseases and disabilities and some don’t.

Personal Trainer, Gym, Pull Down Machine, Exercising, AssistanceWhen 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.


A Population in Need of Trainers

No one looks forward to the day when they need to have a joint replaced. It can seem intimidating, and for good reason. Many patients can have a fairly extensive recovery period with some never regaining full use of the joint in question. But this doesn’t have to be the case. If they prepare properly, they can avoid a great deal of pain and frustration from recovery.

Every year in the United States, there are over 600,000 knee replacement surgeries alone. Hip and knee replacements are very common in those suffering from osteoarthritis, and they are in need of a critical professional — personal trainers.

The Need

Osteoarthritis primarily affects older adults over 50. As opposed to most millennials today, this generation of adults didn’t grow up with exercise being a regular part of life. As such, there is a high degree of sedentary people who also suffer from osteoarthritis and needing joint replacement.

The research is pretty clear — those who are more physically fit have fewer complications in surgery and, above all, require significantly less time to recover afterward. The problem is that a significant portion of this population do not exercise and do not know how to do so safely. Thus, the special skillsets that personal trainers have are incredibly valuable to them.

Training Focus

For most people facing joint replacement, there is a two-fold objective: weight reduction and muscle strengthening. This is because the less the patient weighs, the less pressure is placed on the recovering joint. Furthermore, the stronger the supporting muscles are around the rest of the body, the better-able the patient is to regain mobility.

As such, the training program should include:

  • Cardiovascular training
  • Upper and lower body muscular development
  • Core strength
  • Range of motion development

Above all, the key to training these clients is SAFETY FIRST. These clients are already suffering from joint pain, and excessive training can make the situation that much worse.

Helping a Growing Network

The population of older adults suffering from osteoarthritis and needing joint replacement is on the rise. It’s estimated that in 20 years, there will be as many as 4 million procedures a year. There is a definitive need for personal trainers who know enough about osteoarthritis and joints in the body to make a difference in these patients’ lives. Word of mouth referrals from successful outcomes are a likely possibility and the opportunity to collaborate with healthcare professionals is extensive.

Learn the Essentials

I have worked with Dr. Irv Rubenstein to put together a course like none other that will get personal trainers up to speed as quickly as possible on the essentials. We go over what happens in the joints and how they deteriorate as well as what happens during and after joint replacement surgery.

In this course, you will learn:

  • The basics of Osteoarthritis and how it affects the body
  • Exercise programming to prepare the client physically for surgery
  • Contraindications for post-surgery and how to avoid re-injury
  • Programs that will work in the home or at a gym
  • An overall approach to helping clients prepare and recover safely.

Most importantly, we discuss what is safe and effective for this clientele as well as what to avoid at all costs — exercises which increase the likelihood of injury and exacerbation of pain. We look forward to empowering personal trainers to use their skills and expertise to benefit older communities that they wouldn’t normally think about when looking for new clients. This is a population in desperate need of a personal trainer’s ability, especially in the delicate days before surgery and continued work with the client once their physical therapy time has ended.

For more information about this course, click here!

Already an MFN member? Save 20% on this course! Get your discount »

Jane Curth is the co-founder and CEO of FitFixNow. Helping people on their wellness journey is her passion; Jane has helped clients and students with their diet and fitness struggles for over 20 years.