Saturday, December 31, 2016

Chapter 2:(Part2) Exercise Prevents Premature Death


The American Rheumatism Association has devised the following functional capacity classification scheme to categorize people according to the extent of the disability caused by rheumatoid arthritis. This system also applicable to persons with osteoarthritis and other forms of arthritis.
In Chapter 5, I'll inform you of more precise way to track changes in your functional capacity over time. However, through out this blog I'll refer to the functional capacity classification describe here when providing you with exercise guidelines.

Class 1
Complete functional capacity with the ability to carry on all of the usual duties everyday life without handicaps.

Class 2
Functional capacity that's adequate to conduct normal everyday activities despite the handicap of discomfort or limited mobility of one or more joints.

Class 3
Functional capacity that limits people to performing few or node of the duties of their usual occupation or self care.

Class 4
People are largely or wholly incapacitated-they're bedridden or use wheelchairs, permitting little or no self care.

If you pay attention to the latest health findings, you already know that an inactive lifestyle and low fitness,two traits that characterize many people with arthritis, increase a person's chances of developing several potentially fatal chronic disease, including coronary artery disease, high blood pressure, diabetes, and possibly strokes and cancer. As you may also know, coronary artery disease, which causes heart attacks, is the leading killer in the United States and most other industrialized nations. Though you may not necessarily die as a direct result of your arthritis, it can ease you into a lifestyle that's lethal. People who use their arthritis as an excuse to put their feet up and coddle themselves for the reminder of their days are likely to reduce the number of those days.

In 1987, Dr.Kenneth E. Powell and his colleagues from the Centers for Disease Control in Atlanta scrutinized over 40 respected studies that began early as 1950. The group's goal was to assess how, and if, exercise can prevent deaths from heart disease. They came to the conclusion that physical inactivity is just as strong a risk factor for premature heart disease as the traditional risk factor we hear so much about cigarette smoking, high blood pressure, and a high cholesterol level. Since the publication of Dr.Powell's overview, several more key studies have been completed, and they strongly support the Powell group's conclusions. One of these studies, our Aerobics Center Longitudinal Study, tracked more than 13,000 healthy male and female Cooper Clinic patients whose aerobic fitness varied from low to moderate to high. The results of the 8-year follow up of these 10,224 male and 3,124 female patients found that the death rates of the unfit soared compared with those with moderate and high fitness. Because the statistic were adjusted for age, a person's age was neutralized as a contributory factor in his or her death. The evidence is compelling that regular exercise can reduce the risk, by almost 50%, of dying from heart disease.

How is this applicable to people with arthritis?
To date, no studies have specifically evaluated how exercise can alter, for good or ill, an arthritis person's risk of dying prematurely from heart disease. Yet when you consider that many of the elderly participants in the previously mentioned studies were undoubtedly suffering from osteoarthritis  (because it's almost universal in people over 65 years old), a special study would hardly seem necessary. It seems logical to assume that people with osteoarthritis who exercise regularly will experience the same reduced risk of death from heart disease as active people without this condition. This seem all the more logical considering that there's no direct relationship between osteoarthritis, which is localized to the musculoskeletal system, and coronary artery disease, which involves the cardiovascular system.

Rheumatoid arthritis is another matter. Coronary artery disease is the leading cause of death in rheumatoid arthritis patients, just as it is in general populations. Thus, it seems likely that regular exercise would prove effective in reducing the risk of premature death in anyone with this condition. However, rheumatoid arthritis does not confine its damage to the the musculoskeletal system. In advanced cases, the skin, heart, lungs, nervous system, eyes, blood and blood vessels, spleen, and lymph nodes can be adversely affected. Some of these complications-referred to collectively as systematic complications because they involve various organ systems throughout the body -can heighten a person's risk of dying prematurely. So the effect of regular exercise on the risk of dying from these systematic complications is still partly unknown.

Clearly, there's a wealth of investigation yet to be done in this area. One small-scale, 9-year study of 75 rheumatoid arthritis patients, conducted by Vanderbilt University School of Medicine researchers, sheds a little more light on the situation. During the course of the study, 20 of the 75 subjected died. The causes of their death were similar to those for the general population, but the researchers were surprised by one particular finding: Low functional capacity tripled rheumatoid arthritis patient's risk of dying during the study period. Functional capacity was based on the subject's ability to
a) rise from a chair, walk 25 feet,sit back down in a chair within reasonable length of time
b) undo and redo five buttons as quickly as possible.
The researchers believe that the connection between low functional capacity and premature death "raise the possibility that aggressive therapy directed at improving functional capacity may be appropriate in rheumatoid arthritis." The obvious way to accomplish this is through a program of regular exercise.

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