Q: I have degenerative joint disease and have had one hip replaced. Should I exercise, and if so, which moves can I do that will be safe for my hips and knees?
A: Degenerative joint disease, or osteoarthritis, is a condition where stiffness, pain and limited flexibility occur as joint structures wear down. The problem with this ailment is that pain limits your ability to move. But the less you move, the weaker the surrounding muscles become, providing less support to and exacerbating the stress—and pain—on the impaired joint.
A common exercise mantra is "If you don't use it, you'll lose it." This holds true for all people including those with rheumatoid or osteoarthritis. So, yes, you absolutely should exercise. The recently released 2008 Physical Activity Guidelines for Americans issued by the U.S. Department of Health and Human Services state that regular physical activity helps arthritis or other rheumatic conditions affecting the joints by improving pain management, function and quality of life.
So, what kind of exercise can you do and should you do? Consulting with your doctor and/or a physical therapist is the best approach when you are first starting out.
But keep in mind you should distinguish between bona fide "exercise" and general physical activity. Physical activity can include all the actions that take place in your daily life, from washing the car, gardening and walking around the supermarket to sports like tennis and exercise like bike riding or lifting weights. Exercise, a subset of physical activity, refers to specific body movements that target a particular body part (to increase muscle strength), or that work the entire body (to improve the function of your heart and lungs).
Therapeutic exercise can strengthen your body in ways that reduces pain as well as improve your ability to function and allow you to be more physically active all day. But sometimes, people who exercise become less physically active. This may be a type of psychological justification— "I've already worked out, so I can sit on the sofa and watch the tube for the rest of the day." For those with arthritis, however, it might be that an exercise session is especially tiring. There's some concern that the inflammation associated with different types of arthritis may boost a person's metabolic rate, causing low levels of physical activity to be more fatiguing than they might normally. (If that's the case, always take it slow and easy.)
The recommend types of exercise are aerobic exercise such as walking, bike riding or swimming and water-exercise classes. Since the buoyancy of the water takes some of the load off the joints, many people with arthritis find this a very comfortable option. Aerobic exercise, also known as cardio, can not only fine-tune how the body functions overall, it can lead to weight loss, which can also help manage joint pain. While swimming is a great option, you do not need to avoid weight-bearing types such as walking. You may enjoy some cardio machines or a group-fitness class such as Silver Sneakers which includes low-impact aerobic routines.
Muscle-strengthening or resistance moves such as calisthenics or exercises using resistance bands or weights can help build and strengthen muscle tissue around joints. While most studies have looked at the effects of exercise on arthritic knees, a 2008 study in the journal Arthritis & Rheumatism found that therapeutic exercise that focused on strengthening the muscles surrounding the hip joint were beneficial in relieving pain in those with hip osteoarthritis. For osteoarthritic knees, strengthening the quadriceps in the front of the thighs has been shown to be beneficial. For ailing hips, strengthening muscles in the glutes in the butt, lower back and thighs can be helpful.
Stretching and gentle "mobility" exercises such as raising each knee up while standing can improve the range of motion around stiff joints. However, both aerobic and muscle-strengthening exercise will also improve muscle and joint flexibility. Balance exercises such as standing on one leg are helpful too, since they can help stabilize weak joints.
But here's one caveat: A 2007 review of the long-term effectiveness of exercise for knee and hip osteoarthritis found that the improved pain and function that resulted from therapeutic exercise did not last long term if patients stopped the exercise. So, be prepared to find a way to make exercise and increased physical activity a daily part of your routine. To keep your joints in the best shape possible, you're going to have to stick with it.
The Arthritis Foundation offers a series of physical-activity programs that are designed to reduce pain, decrease stiffness and increase physical function. Different health clubs and rehab facilities offer these classes; find a location near you.
