Exercise Precautions for Older Adults with Arthritis

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Exercise can be a double-edged sword if you’re an active older adult. But if you have arthritis you may wonder whether the aches and pains you sometimes feel when exercising—as well as a risk of sustaining an injury or exacerbating your condition—are sometimes worth the effort.

A study last year in Arthritis Care & Research revealed that nearly 80 percent of the participants with osteoarthritis feared movement and physical activity. Most were afraid of worsening joint pain or an injury. Yet exercise is so good for you that its benefits almost always outweigh its risks. Studies repeatedly show that exercise helps adults maintain physical function and mobility well into their golden years.

Strength-training and weight-bearing activities are particularly beneficial for people who have conditions such as arthritis or low bone density because they can improve muscle strength and flexibility, minimize bone loss, improve balance, and reduce fall risk. Aerobic exercise improves heart health and mood and helps keep off excess weight, which can put enormous pressure on joints like the knees and hips.

Exercising precautions
Consult with your doctor or physical therapist before starting a new exercise program. If you have any of the following conditions, double check with your doctor or physical therapist to make sure your chosen activity is suitable.

Osteoarthritis
Try not to let fatigue and joint and muscle pain discourage you from working out. Inactivity can worsen joint pain and decrease function. The discomfort or pain you feel during activity won’t damage your joints (unless the pain is sudden and sharp—then stop your activity immediately), although some people with significant osteoarthritis may have too much pain to exercise the affected joint. Exercise keeps joints healthy by increasing the flow of nutrient-rich blood to them. If you stick with regular activity, you should find that it can help relieve joint pain and stiffness, build stronger muscles that reduce joint stress, improve flexibility, and decrease disease activity.

Low-impact strengthening exercises, such as those that use your body weight, light dumbbells, or resistance bands, help stabilize joints by strengthening surrounding muscles, which helps reduce injury risk. If you have lower-extremity arthritis, try strength training that targets the thigh muscles (quadriceps and hamstrings).

Range-of-motion exercises, such as stretching, yoga, or tai chi, relieve stiffness and restore flexibility. Aerobic or endurance exercise, such as walking, cycling (at low pedal resistance), and water exercise, helps with joint movement.

Fibromyalgia
Characterized by tender points around the back, hips, knees, and shoulders, fibromyalgia is best managed with exercise that involves endurance and gentle stretching. Resistance training with proper supervision has been shown to help relieve some tenderness.

Lupus
Symptoms of this autoimmune disorder include joint discomfort and inflammation, fatigue, shortness of breath, and pain, which make it difficult to exercise. But if you persist with a routine, you may find that regular workouts reduce fatigue. Stretching at bedtime may help lessen joint stiffness in the morning

Exercises to avoid
If you have joint problems: Avoid high-impact exercises like running, exercises that involve twisting and jerky motions, and extreme neck movements. If you have an autoimmune condition like rheumatoid arthritis, take a break from strength training during flares and reduce the intensity and length of your endurance workouts.

If you have low bone density: Steer clear of exercises that involve bending or curving the spine forward (forward flexion), such as abdominal crunches or toe touches, which put too much pressure on the spine. Avoid activities like golf and tennis that involve rotating forcefully at the waist. High-impact activities like running or jumping rope can increase the risk of injuries, falls, and fractures.

If you have back pain: Avoid heavy weight lifting, sit-ups, and leg lifts; activities that require leaning forward for long periods, such as cycling; and excessive bending and twisting, all of which can put pressure on the spine.

Knee guards
If you have a joint or bone condition and want to protect your knees when working out, avoid:

  • Executing deep lunges or full squats
  • Running downhill or on very hard, very soft, or hilly terrain
  • Taking large steps on the stairs of a stair-climbing machine
  • Performing full leg extensions with locked knees
  • Exercising in worn-out shoes
  • Suddenly increasing the intensity or length of your workouts
  • Cycling at a heavy resistance that causes discomfort in your knees or with the seat too low or too high (your leg should have a slight bend when fully extended on the pedal)

More ways to head off injury
If you know that an injury or chronic condition isn’t causing the pain or discomfort associated with exercise, other factors may be at play, including improper execution of an exercise, poor posture, an overuse injury, or muscle imbalance, tightness, or weakness. Consider working with a personal trainer who can help you develop a personalized exercise program. He or she can help identify any muscle imbalances or weaknesses you may have and evaluate your form to ensure you’re performing your exercises correctly and safely.

Following are some do’s and don’ts to keep in mind when working out, especially if you have a musculoskeletal disorder:

Don’t skip the warm-up
Perform a low-intensity activity, such as walking, marching, or side-stepping in place for about five minutes. If you have arthritis, tack on an additional five minutes to reduce joint stiffness. Warming up helps direct blood flow to your limbs and may reduce your injury risk.

Do change things up
Overuse and repetitive stress injuries can affect the tendons, muscles, cartilage, bones, and nerves. Such injuries are often caused by wear and tear from a repetitive motion such as running, cycling, or hitting a tennis ball. Common overuse injuries include tendinitis and bursitis. Avoid injuries by varying workouts and giving your body time to recover between sessions.

Do watch your form
Incorrect technique and poor posture when training can lead to injury. Poor posture is often a problem for some people with arthritis who shift their body or alter their movements in an attempt to protect painful joints.

Don’t overdo it
Take caution when beginning an exercise program such as strength training. Improper technique or an overzealous approach can lead to injury. Start with easy weights and increase the amount of resistance gradually.

Don’t leave your muscles unbalanced
Work all major muscle groups. If one muscle group is much stronger than the opposing group, it can disrupt the joint’s natural range of motion and lead to injury. For example, tight, overdeveloped chest muscles and neglected back muscles can negatively affect your posture, resulting in a rounding of your shoulders. Tight hip flexors inhibit the opposing buttock (gluteal) muscles, which can lead to a destabilization of the lower back. If your lower-back muscles are much weaker than your abdominal muscles, or vice versa, you’re likely to have bad posture and possibly back pain.

Do listen to your body
Stop exercising right away if you feel sudden pain or develop local swelling. See your doctor if the pain persists.

Don’t ask your fitness instructor what may be causing your chronic pain.
While he or she can point out poor exercise technique that may be causing discomfort, your instructor isn’t qualified to diagnose pain.

Don’t forget to stretch.
Stretching after exercise can increase your mobility.