Longevity Bloomington Newsletter #25 - Joint Health
Answering your most common questions about arthritis with science
Research Roundup - Joint Health
Joint pain is a very common complaint amongst individuals 50+. There are many reasons that your joints can hurt. This can include (but is not limited to) osteoarthritis, rheumatoid arthritis, gout, tendonitis and lupus. By far, the most common cause of joint pain in individuals 50+ is osteoarthritis. The focus of this newsletter will be on osteoarthritis (referred to as “arthritis” or “OA” from here on).
There is a lot of incorrect or outdated information provided to individuals about arthritis by their healthcare provider, neighbor, friend, family member or found on the internet. This incorrect information can lead to ineffective or unnecessary treatments. More importantly, it can cause people to become inactive and stop doing the things they love. This inactivity can have serious downstream consequences on an individual’s health and quality of life.
In addition to my role at Longevity Bloomington, I am also a full-time physical therapist in an orthopedic clinic. As a result, I see patients with shoulder, hip, knee and spine arthritis every day. I also treat hundreds of patients each year that have undergone joint replacement for advanced knee, hip and shoulder arthritis. During my career, I have seen literally thousands of individuals with arthritis and a lot of them have the same questions. This newsletter is going to answer the most common questions about arthritis I receive in the clinic and during our exercise classes at Longevity Bloomington. The answers provided are not my opinion, but rather are backed by science.
What causes arthritis? Is it a “wear and tear” disease?
Historically, arthritis has been thought of in a very mechanical way. It has been viewed as a “wear and tear” disease in which the joints are “worn out”. A significant amount of research has been published recently looking at the causes of arthritis and it turns out that it is a lot more complicated than previously understood. Your body is not like a machine. Your joints don’t “wear and tear” like an old car. Instead, you are a biological organism that can “wear and repair”. It’s not that mechanics don’t matter at all. Mechanics are still important. It’s just that there is more to the story.
There are many causes of arthritis. It is likely that multiple factors interact to determine whether or not you develop arthritis. Causes of arthritis include obesity, inflammation, metabolic factors, genetics, previous injury, muscle weakness and hormonal changes.
Is it safe for me to exercise with arthritis?
Not only is it safe to exercise with arthritis, it is absolutely critical that you do so. More than 60 high quality research studies have shown that exercise is effective in reducing pain, improving function and improving quality of life in knee arthritis and hip arthritis.
Exercise is as effective as nonsteroidal anti-inflammatory drugs and 2 to 3 times more effective than acetaminophen in reducing pain without any of the side effects! In fact, the side effects of exercise include a reduced risk of heart disease and cancer, improved mental health and a reduction in at least 26 other chronic health conditions.
How much exercise is recommended for arthritis management?
A robust amount of evidence suggests that 150 minutes/week of moderate intensity physical activity or 75 minutes/week of vigorous intensity physical activity provides a significant amount of health benefits. In addition to this, you should also participate in strength training and balance activities at least two days per week.
What role does weight management play in arthritis?
Obesity is a significant risk factor for arthritis. Being obese doubles your risk of having symptomatic knee arthritis. In addition to increasing the mechanical forces on the joint, obesity also increases your risk of arthritis by creating a low-grade inflammatory state in the body. Fat tissue is not just a place to store excess calories. Fat tissue releases a host of inflammatory cells that circulate throughout your body and has wide-ranging effects. This inflammation from fat tissue is a primary cause of OA.
Fortunately, you do not have to lose a lot of weight to make a big impact on your health and your arthritis symptoms. A 2007 study showed that a 5% reduction in weight led to moderate to large improvements in function and pain in folks with arthritis.
If weight loss will help my arthritis pain and improve my function, what is the best diet for weight loss?
The research is clear: there is no “best diet” for weight loss. The single most important factor in determining whether or not a diet will result in weight loss is an energy deficit. You need to burn more calories than you take in to lose weight. Period.
Deficits of 500–750 calories per day have been used for weight loss and are recommended by many obesity societies and guidelines.
What about the differences between low-fat and low-carb diets? The 2018 DIETFITS study found no significant differences in weight loss between the two.
So the best diet for weight loss is a diet that results in a caloric deficit that you can stick with over the long-term.Am I doing more damage to my joint by exercising?
A common concern amongst individuals with arthritis is that exercise may lead to premature “wearing out” of the joints and accelerate the arthritic changes. Nothing could be further from the truth.
The joints in your body are lubricated by a liquid called synovial fluid, and movement encourages the production of this fluid. Think of synovial fluid like oil in a car. It helps the bones to move past one another with less friction. Movement causes our body to “release the grease” to our joints.
“Motion is lotion” refers to the importance of exercise to lubricate our joints with nutrient rich fluid and to maintain and improve range of motion and to decrease pain and stiffness.
How can strength training help in managing arthritis?
Strength training may sound like a bad idea when you have arthritis, but it is actually incredibly important for individuals with joint pain. In addition to improved strength, quality of life, bone health and balance, resistance training helps support arthritic joints. Activities that maintain muscle strength and coordination protect the joint cartilage and help to maintain joint function.
Resistance training strengthens the muscles, ligaments and tendons surrounding the joints. When these tissues are strong, they act like a brace to protect the joint. For example, the quadriceps muscle in your thigh provides support to your knee, and strong muscles in the rotator cuff can protect your shoulder.
By increasing your strength, you improve the shock absorption ability of the muscles to reduce stress on your joints. Having strong muscles decreases the loading on the cartilage and thus has a protective effect.
“Think of your joints like a plant sapling (a young tree). Saplings need strings around them to help them grow straight and strong — just as joints need muscles and ligaments around them for support and stability. If you don’t have enough muscle, joints take a pounding. But as muscles become engaged and strengthen, they absorb some of the force, which takes pressure off weaker, worn-out joints. That shift can translate to a decrease in arthritis symptoms and improvement in day-to-day function.”
- Karen Sutton, MD
Is it safe for individuals with arthritis to engage in high-impact activities, such as running, or should I focus on low-impact options?
It is understandable that you might assume that running is bad for your joints. That “pounding” on the pavement seems like a bad idea. Your health care provider may have even told you stop. And yet, the research is clear: recreational running will not increase your risk of arthritis. Quite the opposite in fact.
A study in 2017 reviewed the existing research on the association between running with knee and hip arthritis. They compared recreational runners and individuals who were not active. What did they find?
10% of the sedentary individuals had knee and hip arthritis
3.5% of the recreational runners had knee and hip arthritis
That is a pretty significant risk reduction! Sedentary individuals were nearly three times MORE likely to have knee and hip arthritis then recreational runners. How could this be? It likely goes back to our discussion earlier about arthritis being more than mechanics. The sedentary individuals likely had weaker muscles and more of the inflammatory chemicals in their joints due to inactivity.One caveat: competitive runners did exhibit a slightly higher (13%) risk of arthritis than did the sedentary individuals. So if you are currently running competitively, should you stop? No again. The innumerable physical and mental health benefits of improved cardiorespiratory fitness FAR OUTWEIGH the slight risk increase.
From the authors of the study:
“Running at a recreational level can be safely recommended as a general health exercise, with the evidence suggesting that it has benefits for hip and knee joint health”
This 2016 article shows that running was associated with a decrease in inflammatory cytokines or the chemicals in the knee related to cartilage wear and degradation.
This 2019 review summed it up nicely. From the authors:
“There is no association or causality between running low and moderate distances and knee OA. There is no causality between running and meniscal injury.”
If you enjoy running, keep it up! Do not stop out of fear it is increasing your risk of arthritis.
Does Increased Activity “Wear Out” Joints?
No. From the authors of a 2024 study:
“The results of this study suggest that there is no significant causal relationship between physical activity and knee OA. In other words, physical activity did not increase the risk of developing knee OA. Therefore, our study can provide support that moderate-to-vigorous physical activity is not a risk factor for knee OA.
Is it ok if I have pain during exercise? Am I damaging my joint more if I have pain during exercise?
Here is a good rule of thumb from a 2018 research study published in the Journal of Orthopedic & Sports Physical Therapy (from the authors):
“Pain during exercise is allowable, as long as the individual finds it to be of an acceptable level, and any increase to normal pain and symptoms following the exercise session has reduced to the same level or lower within 24 hours.”
If an “acceptable level” of pain is a bit too vague for you, the authors provided a useful chart in the study (see below). It appears a 5/10 or less is an “acceptable level” as long as the pain returns to your baseline level within 24 hours.
I have knee arthritis. What muscles should I focus on strengthening to help with this?
source: https://www.experiencept.rehab/blog/quadriceps If you have knee arthritis, you may wonder which muscles you should focus on strengthening to help support the joint. Generally speaking, strengthening all of the major muscles in your leg will be beneficial. But, if you want to narrow it down to one group, focus on the quadriceps.
A 2021 study reviewed the benefits and mechanisms of exercise for knee arthritis. The authors found that having weak quadriceps increases your risk of developing knee arthritis and long term weakness can accelerate the progression of the arthritis. Importantly, a 6 year study showed that increasing quadriceps strength can prevent the development of knee arthritis related dysfunction. From the authors:
“Muscle weakness …. can decrease the stability of the knee and accelerate the progression of knee arthritis. Improving muscle weakness, especially in the quadriceps, is significant for the treatment of knee osteoarthritis”
If I am overweight, is exercise making my arthritis worse?
No. From the authors of a 2012 study looking at more than 30,000 individuals:
“Physical exercise does not increase the risk of osteoarthritis at any level of BMI, suggesting that exercise could be encouraged also among individuals with excessive body mass, without concern for an increased risk of osteoarthritis.”
Delicious and Healthy Snack Options to Keep You Energized Throughout the Day
In the hustle and bustle of our daily lives, it's easy to reach for convenient, but often unhealthy, snack options. However, making mindful choices when it comes to snacking can have a significant impact on our overall health and energy levels. Fortunately, there are plenty of delicious and nutritious snack options to keep you fueled and satisfied throughout the day. Here are four healthy snack ideas to try:
Fresh Fruit and Nut Butter: Pairing fresh fruit like apples, bananas, or strawberries with a serving of nut butter such as almond, peanut, or cashew butter is not only tasty but also provides a good balance of carbohydrates, healthy fats, and protein.
Greek Yogurt with Berries: Greek yogurt is rich in protein and probiotics, making it an excellent choice for a healthy snack. Add some fresh berries like blueberries, raspberries, or strawberries for a dose of antioxidants and natural sweetness. You can also sprinkle some nuts or seeds for added crunch and nutrients.
Vegetable Sticks with Hummus: Crunchy vegetables like carrots, cucumbers, and bell peppers paired with hummus make for a nutritious and satisfying snack. Hummus is made from chickpeas, which are packed with protein and fiber, while vegetables provide essential vitamins and minerals. This snack is not only delicious but also great for keeping hunger at bay between meals.
Homemade Energy Bites: Whip up a batch of homemade energy bites using ingredients like oats, nuts, seeds, dried fruit, and a natural sweetener like honey or maple syrup. These bite-sized snacks are packed with nutrients, including fiber, protein, and healthy fats, making them a perfect choice for a quick energy boost between meals.
Member Spotlight - David Lawler & Jan Grant
David:
How long have you been a member of Longevity?
Ben, I joined Longevity several months after Jan did somewhat hobbled with bilateral hip pain. While it’s taken some time, I feel like I’m living in a different body than the one I started Longevity with. Your guidance and the workouts have really given me new life and I’m really grateful.
What is your favorite exercise at Longevity? Least favorite?
I would say that my favorite exercises are pushups and barbell presses. And I absolutely loathe box pushes!!!!!!
Where are you from originally? Where did you go to school?
I’m from a small rural community somewhat near the Shades state park. Along with my brother (one of the most amazing Longevity members) I attended probably the smallest school in Indiana. I was in a graduation class of 12 and we were by far the largest class in high school.
What do you do for work? If retired, what did you do for work?
Jan and I worked together in my practice of dentistry and this collaboration continues in helping care for grandkids. (It is beyond my comprehension how any “old timer” could put a squirming 2 year old in a car seat without taking Longevity strength training!) Thanks for all that you do in putting together these amazing classes and attracting participants who are so supportive of each other.
Jan:
How long have you been a member of Longevity?
My first session was in early March 2022. Since that time, the friendships and sense of camaraderie in our class have made the experience nothing short of amazing.
What is your favorite exercise at Longevity? Least favorite?
My favorite exercise is the barbell press and my least favorite is split squats with weights.
What is your favorite place you have ever been?
David and I traveled to Scotland a few years ago and standing near the top of the Quiraing on the Isle of Skye is the most extraordinary place I’ve ever been. The photo of us here was taken in Edinburgh.
What do you like to do when you’re not at Longevity?
Since our granddaughter Sophia was born 2 1/2 years ago, followed last September by our grandson Miles, my time outside of Longevity is spent largely with them, playing outdoors, visiting WonderLab, and in the summer time, swimming in the pool.
What is your favorite hobby?
My book club, IU sports, and especially Cardinals Baseball (hoping for a huge turnaround season this year!)
What’s something about you (a fun fact) that not many people know?
My 6th great uncle is Daniel Boone and if you visit the historic Boone Tavern in Berea, Kentucky, you’ll see a massive full length portrait of my uncle in the lobby and, honestly, the resemblance is eery. I’m not sure that should be considered a positive for me, but there it is.
Welcome to Longevity Bloomington! It has been great having you all in class.
Celebrating One Year of Strong and Steady!
This month we are celebrating the one year anniversary of Longevity Bloomington’s yoga class, Strong and Steady!
The year has just flown by.
All of the forearm planks, chair poses, and modified chaturangas (think of them as yoga’s pushups) have helped us build strength. All of the tree poses, one legged balances, and flows have helped us build our balance. Of course, we’ve improved our flexibility and range of motion along the way.
Here are what some of the Longevity yogis have to say:
“Yoga has helped me accomplish activities such as gardening, painting and hiking without having sore muscles the next day!” ~ES
“The ease of getting up from the floor has been life-changing. I’ve learned simple exercises that I can use on my own, and I do them all the time.” ~BF
“I have incorporated yoga into my daily routine. Yoga has helped my body heal, and it helps me stay active.” ~MF
“Yoga keeps me moving and has helped me build more strength and agility. I love it! I can definitely feel the difference if I miss a class.” ~PM
“Patricia does a great job of leading our class and ensures all class members are practicing yoga in the safest manner possible. My balance has improved, and I have learned that I can utilize my yoga moves at home.” ~Susan S.
“Ken and I enjoy yoga classes at Longevity very much. The classes help with balance, strength and agility. Patricia is a great instructor. We respect her love and knowledge of the practice.” ~ Joy S.
“The yoga breathing exercises I’ve learned help me fall asleep at night.” ~JC
“Practicing yoga has helped me become more aware of my posture. It helps me remember to square my shoulders and stand taller.” ~DG
What benefits could you discover from a regular yoga practice? Come and find out! We practice Mondays and Wednesdays, 2:00-3:00pm. No yoga experience is necessary and everyone is welcome!
~Patricia
Well Attended
We would like to recognize the Longevity Bloomington members that made it to all or most of the classes since our most recent newsletter. Well done! Special shoutout to Dean who hasn’t missed a class in 4 months and Dee, Terri and Ginette for having > 2 months without a missed class!
200 Class Club
Please welcome Janet Floyd and Elsie Ellsworth to the 200 Class Club! They have both been with us since day one and are incredibly consistent in their attendance and dedication to their health. We greatly appreciate all of your support over the last 2+ years!