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Coping with Arthritis in Its Many Forms

Use It or Lose It

In the past, doctors often advised arthritis patients to rest and avoid exercise. Rest remains important, especially during flares. But doing nothing results in weak muscles, stiff joints, reduced mobility, and lost vitality. Now, rheumatologists routinely advise a balance of physical activity and rest. Exercise offers physical and psychological benefits that include improved overall fitness and well-being, increased mobility, and better sleep.

For example, twice a week for three years, Elsie Sequeira, 81, of Concord, CA., has attended a water-based exercise class sponsored by the Arthritis Foundation. "It's helped me a lot," she says. Sequeira has rheumatoid arthritis in her shoulders and legs. She had also had a mild stroke and got to her first classes with the help of a walker and an attendant.

A few weeks passed before she saw any improvement, but within a few months she no longer needed either the walker or the attendant. "The warm water is very soothing and we can do things in the water that we couldn't do on land," Sequeira says. She enjoys the social contact, and feels better able to take care of herself. "I don't feel so hamstrung," she says.

Joints require motion to stay healthy. That's why doctors advise arthritis patients to do range-of-motion, or flexibility, exercises every day -- even during flares. Painful or swollen joints should be moved gently, however.

Strengthening and endurance activities are also recommended, but should be limited or avoided during flares. Arthritis patients should consult their doctors before starting an exercise program, and begin gradually. Exercises must be individualized to work the right muscles while avoiding overstressing affected joints. Doctors or physical therapists can teach proper ways to move.

Muscle strength is especially important because strong muscles better support and protect joints. "Several studies show that if you improve muscle strength, you decrease pain," Boulware says. Joints will probably hurt during exercise, but shouldn't still hurt several hours later.

"There's a fine line between doing too much and too little," says rheumatologist William Ginsburg, M.D., of the Mayo Clinic, Jacksonville, FL. "Sometimes people have to be reminded to slow down and listen to their disease."

Support groups and arthritis education can help people learn how to listen to their disease, and cope with it. "The psychological aspects are very important because that's what changes people's lives," Ginsburg says.

Participants learn practical things, such as how to: get up off the floor after a fall, protect joints with careful use and assistive devices, drive a car, get comfortable sleep, use heat and cold treatments, talk with their doctors, and cope with emotional aspects of pain and disability. They may also learn to acquire and maintain what health experts have long touted -- a positive attitude.

Health education not only improves quality of life, but also lowers health-care costs, and the benefits are lasting, according to studies at Stanford University, Palo Alto, Calif. Four years after a short Arthritis Self-Management Program, participants still reported significantly less pain and made fewer physician visits, even though disability increased. The benefits came, not from the specifics taught, but from improved ability to cope with the consequences of arthritis -- in other words, confidence. "It's the same thing that any good coach tries to instill," says Halsted R. Holman, M.D., Stanford University.

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