Osteoarthritis (OA) is a degenerative disease that affects the articular cartilage of the joint. As a result, there is a decrease in the joint space and an increase in boney development (commonly referred to as “bone spurs”). Onset typically takes years. Risk factors for developing OA include age, trauma, obesity and family history. It can develop in any JOINT but is most commonly seen in the knees, hips and hands. 


What does research say about exercising with arthritis?

• Exercise reduced pain, improved quality of life and increased performance in those with OA. Patients who had better outcomes were typically younger (Siew-Li Goh).
• Those who walked had less knee pain than those who didn't. The study also found that walking helped to slow the progression of OA in the knee (Lo).
• Patient outcomes were improved when exercise was combined with patient education (Goff).

What type of exercise should those with arthritis do? 

• Strength training
• Aerobics 
• Pilates
• Aquatics
• Walking

*All appeared to be helpful when performed for an hour (Raposo)


Takeaway:
Those with osteoarthritis should participate in physical activity. If pain is preventing you from exercising, try to find an activity you enjoy that causes minimal pain. If it is still challenging, reach out to a professional to create a plan to manage your pain. 

References
Goff, Anthony J., et al. "Patient education improves pain and function in people with knee osteoarthritis with better effects when combined with exercise therapy: a systematic review." Journal of Physiotherapy 67.3 (2021): 177-189.

Lo, Grace H., et al. "Association between walking for exercise and symptomatic and structural progression in individuals with knee osteoarthritis: Data from the Osteoarthritis Initiative Cohort." Arthritis & Rheumatology 74.10 (2022): 1660-1667.

Raposo, Filipe, Marta Ramos, and Ana Lúcia Cruz. "Effects of exercise on knee osteoarthritis: A systematic review." Musculoskeletal care 19.4 (2021): 399-435.

Siew-Li Goh, Monica S.M. Persson, Joanne Stocks, Yunfei Hou, Jianhao Lin, Michelle C. Hall, Michael Doherty, Weiya Zhang,Efficacy and potential determinants of exercise therapy in knee and hip osteoarthritis: A systematic review and meta-analysis, Annals of Physical and Rehabilitation Medicine,Volume 62, Issue 5, 2019,

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Inflammation is the body's immune response to an irritant (Informedhealth). White blood cells migrate into the tissues in an effort to “protect” the body from the irritant. Inflammation is categorized as acute or chronic. For an acute period of time inflammation is beneficial, however, chronic inflammation becomes harmful.

How does inflammation cause pain?
During the inflammatory process chemical mediators are released to signal white blood cells to the area. White blood cells release a byproduct that affects the nerves in the area to tell the brain that there is pain. For a short time, this is a protective mechanism. If a body part is injured, reducing movement decreases any further damage. However, long term inflammation to the body is very damaging (Omoigui).

Causes of inflammation: 

• Table Sugar (Havard Health).​
• Ultra-processed foods
• Alcohol
• High fat
• High intensity exercise
• Visceral fat (Kolb). 

*People at higher risk of increased dietary inflammation: male, older, post-menopausal women, those with higher BMI, and those with more body fat.

Ways to reduce inflammation:
Specific foods

• Fatty fish like tuna, salmon, sardines 
• Fruits & vegetables
• Walnuts & almonds
• Flax seeds
• High protein, high fiber, complex carbohydrate foods that help to slow digestion 
• (Havard Health)

Exercise

• Moderate intensity exercise. 
• Walking 

Sleep 

• Sleep promotes recovery and allows the body time to heal from stress. 
• Regulating your circadian rhythm 

Supplements

• Turmeric
• Omega-3 
• Vitamin C
• Zinc

Takeaway:
Inflammation is inevitable, and for short periods of time it is important and beneficial. The problem occurs when inflammation goes uncontrolled for extended periods of time. Take small steps each day to reduce inflammatory habits in your lifestyle. 

Resources 
Foods that fight inflammation - Harvard Health

InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. What is an inflammation? 2010 Nov 23 [Updated 2018 Feb 22]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279298/

Kolb, H. Obese visceral fat tissue inflammation: from protective to detrimental?. BMC Med 20, 494 (2022). https://doi.org/10.1186/s12916-022-02672-y

Omoigui S. The biochemical origin of pain: the origin of all pain is inflammation and the inflammatory response. Part 2 of 3 - inflammatory profile of pain syndromes. Med Hypotheses. 2007;69(6):1169-78. doi: 10.1016/j.mehy.2007.06.033. Epub 2007 Aug 28. PMID: 17728071; PMCID: PMC2771434.

Walking. Yes, it's that simple. With step counters becoming more popular, recent research shows that ALL causes of mortality were reduced in those who walked more (Jayedi). Step intensity did not make a difference (Saint-Maurice PF). 

The risk of cardiovascular disease and dysglycemia were both shown to be reduced in those who took more steps each day (Hall KS). 

The average American takes around 5,000 steps per day (Liu Y). The higher the number, the lower the risk of mortality. So how do you get moving more?

1. Make a goal
   1. Decide how many steps you would like to get each day
   2. Decide how often you want to move
2. Make a plan to reach that goal
   1. Take breaks from the computer every hour
   2. March in place
   3. Take the stairs
   4. Park far away
3. Make it a family activity
   1. Take the kids out for a walk
   2. Walk the dog
   3. Challenge friends to join in

Take away:
Walking is a great way to improve your overall health. If you are having pain that is preventing you from doing an activity, come get it checked out. Challenge yourself today to see how many steps you can get….if it's less than 5,000, think of ways you can do more!

P.S. don’t cheat and put the step counter on the dog…you know who you are. 

Step counters

1. Fitbit: Fitbit Official Site for Activity Trackers & More
2. Alexa watch: Amazon.com: Alexa Smart Watch for Women, Alexa Built-in, RERE Fitness Tracker for Blood Oxygen, Heart Rate, Sleep Monitor, 1.69 inch Smartwatch for Android and iPhone, 5ATM Waterproof, 10 Day Battery Life, Pink : Sports & Outdoors

References

Hall KS, Hyde ET, Bassett DR, Carlson SA, Carnethon MR, Ekelund U, Evenson KR, Galuska DA, Kraus WE, Lee IM, Matthews CE, Omura JD, Paluch AE, Thomas WI, Fulton JE. Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia. Int J Behav Nutr Phys Act. 2020 Jun 20;17(1):78. doi: 10.1186/s12966-020-00978-9. PMID: 32563261; PMCID: PMC7305604.

Jayedi A, Gohari A, Shab-Bidar S. Daily Step Count and All-Cause Mortality: A Dose-Response Meta-analysis of Prospective Cohort Studies. Sports Med. 2022 Jan;52(1):89-99. doi: 10.1007/s40279-021-01536-4. Epub 2021 Aug 21. PMID: 34417979.

Liu Y, Sun Z, Wang X, Chen T, Yang C. Dose-response association between the daily step count and all-cause mortality: A systematic review and meta-analysis. J Sports Sci. 2022 Aug;40(15):1678-1687. doi: 10.1080/02640414.2022.2099186. Epub 2022 Jul 12. PMID: 35819337.

Saint-Maurice PF, Troiano RP, Bassett DR Jr, Graubard BI, Carlson SA, Shiroma EJ, Fulton JE, Matthews CE. Association of Daily Step Count and Step Intensity With Mortality Among US Adults. JAMA. 2020 Mar 24;323(12):1151-1160. doi: 10.1001/jama.2020.1382. PMID: 32207799; PMCID: PMC7093766.

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