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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."

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