At some point in life most of us suffer from or know someone with back and/or joint pain due to arthritis. Although most commonly associated with pain, a large body of research is pointing to a wider impact of arthritis beyond its direct effect. While for some individuals the pain may be actually quite manageable, it is difficulties and limitations with everyday activities (due to stiffness, increased pain, and/or weakness with attempted activity) that are more problematic. In isolation or in combination, pain and limited activity result in a vicious cycle that can lead to reduced independence; reduced ability to work, play or provide/give care; fatigue or lack of energy; poor balance; increasing social isolation, anxiety and depression. All of which, by the way, can also increase pain.
“I limp constantly and can’t get up my stairs”. “I cannot lift up my small grandchildren any longer”. “ I am afraid of falling, so I don’t go out much anymore”. I can’t even sit through a movie”.
These and many more common patient statements illustrate an inability to fully participate in life. This has a profound negative impact on all aspects of quality of life for the person with arthritis as well as those who care for them. These effects of arthritis are more likely to occur as we get older, and for people with other health problems (particularly heart disease and/or diabetes) regardless of age. In some scenarios, the arthritis and the lack of mobility may aggravate these other health problems. It may also lead to an increase risk of developing other conditions, particularly heart disease, diabetes, obesity and/or depression. Last, but certainly not least, it has now been shown that those with arthritis of the back, hip or knee are more likely to require admission to a nursing home or die sooner then those without arthritis.
Now that I have your attention, not all is doom and gloom! Rather then letting arthritis manage you, identifying and managing your arthritis early can help avoid much of this terrible downstream impact. The most reliable way of accomplishing this is increasing your physical activity. Increased physical activity, and just as important, reduced sedentary time (e.g. “couch time”), have been shown to reduce pain, improve function, improve mood and energy, and help prevent the vicious cycle outlined above. Of course, this also helps other health conditions. It may certainly seems strange to recommend increased activity for something that limits your activity, but the trick is in how you do it.
Many who attempt exercises (with or without supervision) may do too little or try to do too much, or not the best kind of exercises. They may give up because they don’t see any benefit, or because it ends up aggravating their symptoms. The key is to regularly engage in progressive types and duration of exercises/physical activity that work best for your body and energy level or tolerance. For example, the lower your energy level or tolerance, the shorter the duration of exercise should be, but you should then do them more frequently through out the day and gradually increase the duration your as tolerance improves. Just as important, you need to do this in an environment that is convenient and that you enjoy. You will never continue to increase your physical activity and see long-term gains, if you hate what you are doing. The old adage of “no pain, no gain” is not a good principle in this situation. Some of you may benefit from a short period of supervised exercises from a trained professional to get you started. You need to make sure they vary the exercises so that they work for you and that they help you build a home exercise program. For those with significant limitations, you may need, for example, modified exercise in a position that allows you to get moving, or pool-based exercises (e.g. aqua fitness).
The key is to keep moving by whatever means you can and gradually strengthen your body and increase your daily physical activity. There are many resources available at no or little cost in your community that can help you achieve this goal. If you have back or joint symptoms from arthritis speak to your primary care provider and ask him or her to help you get on the path of prevention and maintained physical activity. Your life actually depends on it.
Raja Rampersaud MD,
Arthritis Program, University Health Network
Associate Professor, Division of Orthopaedics, University of Toronto