When launching an exercise routine with arthritis, look for a custom fit

November 2, 2018

Providence Health Team

Peter Bonafede, MD, a rheumatologist at Providence Arthritis Center at Providence Portland Medical Center, Oregon, knows someone very well who once was a runner.

That’s in the past now, as that runner participated in several marathons and the runner aged and so did the runner’s joints. The runner shifted his physical activity to bicycling, a far less stressful activity on the body than running, but still a vigorous endeavor that provides the multiple benefits of exercise.

Dr. Bonafede can attest to that person's successful transition from running to bicycling because he’s talking about himself.

“Sometimes one does have to make changes later in life,” says the former marathoner. “So, I cycle a lot now, and I'm able to do that.”

Dr. Bonafede is an enthusiastic advocate of exercise for his patients. This applies to patients with osteoarthritis, in which the smooth cartilage joint surface wears out. But it also applies, he says, to patients with rheumatoid arthritis — an autoimmune disease in which several joints can be attacked at one time, along with other debilitating symptoms.

Patients with either condition can still pursue an exercise regimen, Dr. Bonafede says. The key is customizing an exercise program to a patient’s capabilities. And sometimes that takes a professional assessment beyond the doctor’s diagnosis.

“I'm always pleased if a patient wants to exercise and go to the gym,“ Dr. Bonafede says. But “I may send them, first of all, to the physical therapist to give them guidance and then recommend they go to the gym.”

After conferring with a physical therapist, a patient will likely have adjusted their expectations for physical capabilities but will also have a customized exercise routine.

“The benefit to seeing a physical therapist is that what they do in the gym is going to be suitable for them,” he says, “because these patients have a painful, debilitating condition, you need to customize the exercise program for their individual circumstances and preferences.”

Even patients with rheumatoid arthritis — as well as those with the debilitating pain syndrome fibromyalgia or chronic back pain — should experience the benefits of exercise, Dr. Bonafede says.

“In these patients, the most effective form of treatment is not medications,” he says. “In fact, exercise is more beneficial than medications in some of these patients with chronic pain. Folks with chronic back pain, they really need to be exercising. And the less they do, the worse off they are.”

In addition to bicycling, Dr. Bonafede also praised the benefits of swimming or walking or even simply putting joints through a range of motions in an exercise routine. On top of that, proper diet also is important, he says.

“We all should be eating a healthy, balanced diet with the right proportions of carbohydrates, fats, and proteins,” he says. “A healthy balanced diet is good for all of us. But unfortunately, there aren't any specific foods which have been conclusively proven to be helpful for patients with arthritis.”

As much as Dr. Bonafede is an enthusiastic exercise advocate, he emphasizes that one exercise regimen does not fit all of his patients.

“It needs to be a personalized program that tailors the exercise to the individual person,” he says.

Because not every patient will know, on their own, it’s time to transition from miles in a runner’s shoes to miles on a bicycle — like Dr. Bonafede.

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