Friday, January 6, 2017

Chapter 2: (Part 3) Exercise Prevent Disability

Of all the chronic disease, arthritis generally results in the most long term disability. I believe this occurs, for one reason, because many physicians are still too cautious and conservative about their exercise prescriptions. Until recently the traditional exercise program for arthritis patients was built exclusively around range-of-motion exercise interspersed with lot of rest. When patients complained to their doctors about weakness and fatigue, they were told to reduce their amount of exercise even more, instead of being encouraged to increase it.

There's no doubt that appropriate rest help joint inflammation. However, it's also an established fact that excessive rest is deleterious to health. Research shows that even in healthy young men 3 weeks of lying prone in bed can reduce their fitness as much as 30 years of normal aging. In just 1 week of immobilization, a muscle can lose some 30% of its bulk!

The negative effects of immobility on the musculoskeletal system include these:

  • Wasting (atrophy) of the muscles, tendons, ligaments, and bones
  • Weakness of muscles, ligaments, tendons, and bones
  • The development of contractures (a shortening or shrinkage of the muscle, tendons, ligaments, and joint capsules that reduces the range of joint's motion and impairs mobility)
  • Degeneration of joint cartilage
  • Greater risk of breaking a bone due to the loss of bones mass,  a condition called osteoporosis
Given these effects, it's somewhat paradoxical for physicians to answer their patient's complaints of fatigue, weakness, and disability with recommendations for more rest, which will further reduce their functional capacity-that is, their ability to perform occupational, recreational, household, and self care activities. Such an approach sets in motion a vicious cycle of even more weakness, fatigue, loss of joint function, and disability. Today, enlightened exercise prescriptions for arthritis patients go beyond mere range-of-motion exercise and now often include muscle strengthening as well as aerobic exercise.

Why muscle straightening? Muscle weakness is common in people with osteo- and rheumatoid arthritis- estimates are that 80% of all patients experience it.You may think the disease of arthritis is the culprit. Yes it's one cause. Another is too little physical activity. If you have been fairly active and then abruptly stop exercising, you'll find that the greatest decline in your strength occurs during the first day days of your immobility. It continue thereafter, of course, but at a slower rate. If your immobility is total, as in the case of bed rest, your loss of strength may proceed at a rate of about 3% per day during the first week.

Fortunately, studies show that arthritis patients can safely improve their strength, and thereby enhance their functional capacity, if they undertake an appropriate muscle strengthening program. A reasonable amount of strength is a prerequisite for performing many everyday activities. In other words, strength translate into good functional capacity and lessened disability. That's one of the reason why it's important.

Why exercise aerobically? Aerobic exercise are endurance activities that din't require speed or strength but do require demands on your cardiovascular system. There are many forms of aerobic exercise. Brisk walking, running, swimming, dancing, and cycling are perhaps the most popular, but there are others too. One objective of this type of exercise is to increase the maximum amount of oxygen that your body can process for energy production during physical activity. This enable you to perform more exercise with less fatigue.

There have been several major European and American aerobic exercise studies involving hundreds of people with osteo- and rheumatoid arthritis. Some of the studies lasted as long as 8 years. Dr. Robert W. Ike and his colleagues from the University of Michigan Medical Center reviewed the findings and came to these conclusions about typical osteo- and rheumatoid arthritis patient:

  • Their poor endurance and aerobic fitness levels are due as much to inactivity as to the disease. For many patients, traditional recommendations to reduce physical activity are inappropriate and may, in fact, contribute to their feelings of weakness and fatigue, as well as their impaired functional capacity.
  • Some patients can perform aerobic exercise without harming their joints.
  • These patients are often capable of substantially improving their aerobic fitness by participating in a supervised exercise program.
  • Those who do participate in an aerobic exercise training program report improvements in many areas of functional capacity.