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MagazineFebruary 2015 (Vol. 25 Issue 11)Easy does it

Think exercising with arthritis is out of the question? Think again, says movement expert Paul Chek

Think exercising with arthritis is out of the question? Think again, says movement expert Paul Chek

Exercise is vital if you suffer from arthritis. Not only can it help control your weight, it also boosts strength and flexibility, may alleviate fatigue and could even help reduce joint pain. But if exercise is the last thing you feel like doing with stiff and painful joints, read on for my top tips on how to incorporate exercise into your life-whatever your fitness and mobility level.

What is arthritis?
Arthritis is a common chronic disease that results in inflammation of the joints, particularly the lining of the joint capsules. It affects over 10 million people in the UK, according to the National Health Service (NHS), and over 52 million people in the USA, or about one in five. It is more common in adults over the age of 65, but can present at any age. According to the US Centers for Disease Control and Prevention (CDC), arthritis is more common in women (26 per cent) than in men (19 per cent).

The term 'arthritis' actually applies to more than 100 different rheumatic (joint) diseases and conditions, the two most common ones being:

Rheumatoid arthritis, an autoimmune disease with a strong correlation with genetics and family history. It results from the body attacking and damaging joint tissues, so causing joint degeneration and deformation. It often starts in someone aged between 40 and 50 years, and women are three times more likely to be affected than men. Those with rheumatoid arthritis can also develop problems with other tissues and organs in their body.

Osteoarthritis, the most common form of arthritis in which joints are inflamed, often triggering progressive degenerative changes in the joint tissues and capsule. Common symptoms of inflammation are pain, heat, redness and swelling, and those suffering from inflammation generally have elevated levels of the stress hormone cortisol. The condition most often causes problems in the knees, hips and small joints of the hands, making ordinary activities of daily living difficult for many sufferers. Osteoarthritis is the result of a variety of physical factors, and is heavily influenced by diet and lifestyle factors in general.

Arthritis is more common among the obese than in those who are normal weight or underweight; nearly one-third of obese people are affected. This means that using movement to reverse or prevent obesity is a challenge, as arthritis limits physical activity in many sufferers, preventing them from being able to climb stairs or walk more than short distances.

If you choose the right type and level of activity, though, you can begin to reap the benefits of exercise despite having arthritis.

Diet before exercise
Before you get started with your exercise plan, it's essential to look at your diet to try to reduce levels of inflammation in your body. Arthritis sufferers typically have high levels of inflammation-not just in their joints, but also throughout their entire body.

If an exercise programme is devised for someone with systemic inflammation, the results will be minimal at best. At worst, it could aggravate the condition, as exercise is viewed by the body as yet another form of stress. Exercise generally heats up the body, which produces breakdown products and inflammation as a natural healing response. If the body is already overloaded by coping with stress from multiple sources, including the pain and inflammation of arthritis, systemic inflammation from other causes and other external stressors-a challenging job, for example-then all these 'buckets' of stress will flow into one 'tank'.

Adding an exercise programme to an already overheated and inflamed body is like adding fire to fire. The 'tank' reaches its capacity and overflows.

For exercise to be beneficial in the long term, it's crucial to reduce overall levels of inflammation and stress in the body. In my experience of treating and coaching patients with arthritis, I've found it vital to address the following three dietary issues first.

1- Gluten, dairy and food allergy or intolerance
Renowned Paleo Diet researcher Dr Lorain Cordain has noted that gluten, the protein in many grains, and human synovial tissue, which lines and lubricates the joints, share common gene sequences.3 This can result in a person's immune system attacking its own synovial tissue, triggering an inflammatory response. In my clinical practice, I've found that, with very few exceptions, removing all gluten-containing grains from the diet is essential for optimal healing.

Food intolerances (acquired immune reactions) and food allergies (generic immune reactions) are common sources of inflammation that spread from the gut to the rest of the body. When the small intestine isn't able to effectively control the barrier between food coming from 'out there' to the body 'in here' because of inflammation-damaged cells, the detox systems of the body become overwhelmed.

Soon, undigested food particles (antigens) make their way into the general circulation to settle in the small vessels that form the microcirculation around joints. When this happens, the immune system attacks food antigens with antibodies, resulting in even more inflammation. In such cases, exercise must be carefully monitored by a skilled exercise professional because, if the exercise adds further inflammation to an already inflamed joint system, the condition will get worse, not better.

2- Meat consumption
Eating more meat, fish or 'flesh foods' than your body needs or can digest can also accelerate joint pain. The pain produced in joints comes from the accumulation of uric acid. I've seen many people diagnosed with osteoarthritis heal completely to the point of having no symptoms at all simply by learning to balance their diet properly.

3- Drinking water
Drinking about half your body weight in fluid ounces of water daily (body weight in kg multiplied by 0.033 equals litres of water per day) is another essential step towards reducing arthritis pain and creating a beneficial environment in which your body can respond well to exercise.

If these changes are overlooked, any exercise programme becomes far less effective and may even make arthritis worse. But if the basic exercise approach that follows is used with conscious awareness of these dietary suggestions, then exercise can become very therapeutic.

Exercise guidelines
When I prescribe exercises for people with arthritis, I always follow these essential safety guidelines.

1- Less is more
Start with small doses of exercise at low intensities and see how your body responds; ignore the 'no pain, no gain' fanatics. For example, if walking is your exercise of choice, only walk for about one to three minutes longer than you'd normally walk on any given day.

If your chosen exercise is a new activity for you, then aim to do about 10-15 minutes on the first day. If you don't experience elevated levels of stiffness or soreness the next day or the day after, then you can extend that by one minute per session-but stop when you find the edge of your comfort level. If you do feel increased levels of discomfort after the exercise, decrease the time by two to five minutes next time, or try a different activity.

As your body gets stronger, you can continue to progressively increase the exercise time.

2- Keep intensity low
In resistance training, intensity is measured in relation to the load you can lift at maximum, or for one repetition. So, a load you can lift only four times is a much more intense lift than one you can lift 20 times. People with arthritis should start with exercises they can comfortably perform with at least 16 repetitions at a breathing tempo (see right for my recommended exercises).

As you gain strength and body awareness, the intensity can be increased.

3- Stay horizontal
Exercises in the horizontal position tend to be easier on the joints and allow for a safe exercise progression. The exercises on the right (apart from the Breathing Squat) are great examples of some horizontal exercises you can do to minimize the load on your joints.

Swimming or even just water play are other excellent options for low-load exercise-and ideal ways to start your programme. Begin with 10 minutes of low-stress water exercise (such as breaststroke) and follow the progression suggested in #1 to increase the intensity and time.

4- Use pain-free range of motion only
Whenever exercising with arthritis, it is important to only move through the range of motion that is without pain. Exercising past your range of comfort tends to increase inflammation in joints that are already inflamed, so making the pain worse and, ultimately, weakening the muscles and joints.

For example, in the Breathing Squat exercise (see the final exercise on the right), only go as deep into the squat as is comfortable.

5- Consult a professional
When starting any exercise programme, first get clearance from a qualified medical professional-particularly important for people with chronic conditions like arthritis. Remember, though, that it's not a good idea to avoid exercise or physical activity because of arthritic discomfort, as this can lead to significant loss of muscle, excessive weight gain and, eventually, a poorer quality of life.

By following the lifestyle and exercise guidelines here, you can improve joint mobility, increase muscle strength and overall vitality, as well as maintain a healthy weight.

Exercises

4-Point Tummy Vacuum
1- Assume a kneeling position with hips over knees and shoulders over hands.
2- With your spine in neutral alignment-neither overly flexed nor extended-take a deep breath in and let your belly drop toward the floor.
3- Exhale and draw your belly button in towards your spine while keeping your back in the neutral starting position.
4- Hold the position (belly drawn in) for as long as you comfortably can.
5- When you need to breathe in, relax your abdominal wall as you inhale. Repeat the exercise for 10 reps.

Leg Raiser
1- Start face down on the floor or over a Swiss ball.
2- Raise both legs up in the air.
3- Bring your heels together, with your toes pointed outward.
4- Tighten your hamstrings and gluteal muscles, and hold with good alignment for 10 seconds.
5- Your head should be neither dropped down nor raised up. Repeat up to 10 times.

Swiss Ball Hip Extension
1- Start by sitting on a Swiss ball and roll back so that your upper back, shoulders and head rest on the ball.
2- Pick your hips up so that your shoulders, hips and knees are in a straight line; keep your shins vertical to the floor at all times.
3- Slowly drop your pelvis straight down, as low as you comfortably can, then lift your hips back up towards the ceiling; hold this position for 10 seconds.
4- Keep your head and upper back on the ball at all times.
5- You should neither roll forwards nor backwards on the ball as you do this exercise (but it's okay if the ball rolls slightly forward as you drop down, though your knees should never move in front of your feet).
Repeat up to 10 times.

Feldenkrais Hip/Pelvis Integrator
1- Lie on your back and bend your left leg, keeping your left arm at your side.
2- Gently push onto your left foot so that you just barely lift your pelvis up.
3- You should use as little effort as possible: imagine that a puppet string is attached to the front of your pelvis and is lifting you up.
4- Do 10-20 reps, progressively rolling your pelvis over and lifting just one vertebra off the ground with each repetition. Lower the vertebrae one at a time in the opposite order.
5- Be sure to relax with each rep to allow your hips and chest to open up. Repeat 10-20 times on each side, or until you roll completely onto your side.

Horse Stance Dynamic
1- On your hands and knees, place your wrists directly below the shoulders and your knees directly below the hips.
Your legs should be parallel and your elbows turned back towards your thighs, with your fingers directed forward.
2- Inhale and raise your right arm up and out to a 45-degree angle and lift your left leg as high as you can without your pelvis swaying to the side.
3- Exhale and tuck your elbow and knee in under your torso so that the elbow goes past the knee.
4- Use your abdominal muscles to pull you to the end of the movement. Repeat 10 times on one side at breathing pace, rest and repeat on the other side.

Breathing Squat
This is a great exercise for arthritic patients who are comfortable exercising in a standing position.
1- Take a comfortable stance wide enough to squat down between your legs. Place your arms at your sides or up in front of you.
2- Inhale, then lower yourself down as you exhale. Go as low as you comfortably can, pause, then inhale as you return to standing.
3- Repeat at the pace you naturally breathe, and breathe through your nose. If you need to exhale through your mouth, keep a little tension in your lips.

The Breathing Squat should be limited in depth to only what you are comfortable with. You can do this exercise in sets of 10 squats (one per breath) and expand the number per session as your body positively responds.

REFERENCES
1 www.nhs.uk/Conditions/Arthritis/Pages/Introduction.aspx
2 CDC. Arthritis: Meeting the Challenge of Living Well. At a glance; www.cdc.gov/chronicdisease/resources/publications/aag/arthritis.htm
3 World Rev Nutr Diet, 1999; 84: 19-73
4 Chek P. How to Eat, Move and Be Healthy! San Diego, CA: C.H.E.K Institute, 2004

Internationally acclaimed speaker, author and Holistic Health Practitioner Paul Chek, draws on over 25 years of experience in corrective exercise, high performance conditioning and integrative lifestyle management. Paul is the founder of the C.H.E.K Institute in California (www.CHEKinstitute.com and www.CHEKconnect.com) and the creator of the P~P~S Success Mastery Program (www.ppssuccess.com). In the UK, please visit www.CHEKeurope.com or phone 01924 566 091.

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