Arthritis patients increasingly are getting a prescription that sounds like the last thing to do when hips and knees are painfully inflamed: Get moving.
Despite years of advice that the arthritic should lay off their joints, doctors and therapists now say proper movement is the best medicine for the nation's leading cause of disability, whether the goal is alleviating pain, or even protecting against the condition.
The Arthritis Foundation, working with the Centers for Disease Control and Prevention, launched a national campaign this year to spread the word. Experts say preliminary research has shown that for many, exercise can relieve pain just as well as over-the-counter drugs such as Tylenol and Aleve, without the dangerous side effects of a number of medications.
Of course, hitting the gym or a trail is easier said than done if your knees are throbbing. But the right kind of exercise can help to loosen stiff joints and strengthen the muscles around them, giving sufferers less pain and more mobility. In the bargain, exercisers get a potent weapon to control heart disease and diabetes, which afflict many arthritic patients in middle age and beyond.
The key, experts agree, is getting people in pain to overcome their reluctance to move.
Pete Conti Jr., a 50-year-old St. Petersburg truck driver who's on medical leave with arthritis and diabetes, is a believer.
After diagnosing Conti with arthritis in his left hip, doctors sent him to physical therapy. After just a week of stretching and strengthening, he was moving more easily in the morning. So Conti didn't blanch when therapists ordered him into an odd-looking tank of warm water outfitted with a treadmill.
His big goal: avoid joint replacement surgery.
"I just didn't want it to get worse," Conti said of his arthritis. "I'm doing everything in my power to stay out from underneath the knife."
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To appreciate the healing powers of exercise, you have to understand the mechanics of joints, body parts that get little attention until they hurt.
Joints don't get their nutrients from large blood vessels, the way muscles and organs do. Synovial fluid, a substance as slick as oil, feeds cartilage, which protects the bones from grinding against each other.
Movement lubricates the process much like squeezing water through a sponge, said Steve Tompkins, manager of outpatient rehabilitation at Bayfront Medical Center in St. Petersburg, where Conti is in therapy.
"You don't want to just sit around and be a couch potato," said Tompkins, who is a physical therapist. "You'll have a dirty sponge."
Exercise also strengthens the muscles around the joint and increases blood flow to the surrounding tissues.
And maintaining a healthy weight, through diet and exercise, is crucial to managing arthritis. For every pound gained, experts note, the pressure across your knees increases by four pounds.
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The good news for the fitness averse: You don't have to knock yourself out to get the positive results of exercise. In fact, you shouldn't. Over time, pounding exercises such as running can wear down the cartilage in the joint, effectively causing osteoarthritis.
"What's hard is that most people think exercise is really going and killing yourself, whether it's running or whatever," said Dr. Patience White, vice president of public health at the Arthritis Foundation, which offers specific fitness guidance on its website and through its local chapters (see box).
"The point here is balance."
John Leanes has learned this lesson the hard way.
A basketball nut since the age of 4, he played three to four times a week until his mid 50s, when his right ankle began swelling up like a balloon. He wrapped his ankles and rubbed soothing ointment on his knees, anything to stay on the court.
When he finally saw a doctor, the St. Petersburg man learned his basketball days were over.
"It's a depressing piece of news to hear. Maybe 15 years ago, if I had this understanding, I could have slowed this process down," said Leanes, now 62. "It was hard for me to say to myself, 'John, you're aging. You need to do some things differently.' "
Where he once ran 5 miles a day, he now power walks for three or four. He still indulges in a monthly pick-up game, but only on indoor basketball courts that better absorb the impact.
"You have to figure out a way not to exercise less, but to exercise with less forces," said Jeff Konin, executive director of the University of South Florida's Sports Medicine and Athletic Related Trauma Institute. "It doesn't take a physician visit to know that there's too much force on whatever joint is involved."
Whether you already suffer from arthritis or hope to prevent it, experts recommend low-impact activities, such as walking, cycling, the elliptical machine and tai chi.
And nothing eases joint pain during exercise better than water.
"When you're walking in the water, you're really exercising all of the muscles you need to walk or run," said Dr. Adam Rosen, a rheumatologist in Clearwater. "You're rehabbing all of those muscles, but don't have your body weight on the hips and knees."
Sore muscles the next day are expected if you haven't exercised in a while. But watch for signs of overdoing it. If you experience more joint pain two hours after exercising than you did before, you should scale back.
Just don't quit. Experts say that can make the arthritis and pain even worse.
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The benefits of exercise extend beyond osteoarthritis, a disease of wear-and-tear, to rheumatoid arthritis, an autoimmune condition that can strike at any age.
For several years in her late 20s, Tyrill Towns felt tired all the time. Doctors ordered a battery of tests to examine the cystlike knots developing in her left hand.
At age 31, she was diagnosed with rheumatoid arthritis.
"I probably spent about two years being in denial about it. I'm like, 'I'm in my 30s. What do you mean I have this disease? What do you mean there's no cure?' " she said.
Towns, now 36, has more energy since she started running. She has lost about 25 pounds, mostly by eating a healthier diet. She occasionally takes steroids when the arthritis flares up.
Now her challenge is moderation, a tough feat when she gets competitive in 5K races, or when her friends urge her to try a half-marathon. The Temple Terrace woman reminds herself that her condition means she's more likely to also develop osteoarthritis if she overdoes it.
"I have a condition that I have to keep in my mind-set," she said. "It's still there. So let's be smart about our choices."
Letitia Stein can be reached at firstname.lastname@example.org or (813) 226-3322.