Healing Through Exercise: Scientifically Proven Ways to Prevent and Overcome Illness and Lengthen Your Life (10 page)

“All of a sudden, people who had founds life’s daily activities more and more challenging and painful as a result of arthritis pain were able to participate in life in ways they hadn’t been able to for years,” states Miriam Nelson. “The exercisers were able to walk, climb stairs, sit, and stand more easily. And they slept more easily.”
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By now, these landmark findings have been confirmed many times. A large survey of 786 patients with worn-out knee joints has also shown that people who exercise the muscles surrounding their affected knee are rewarded with significantly less pain. In order to reap this benefit, it was necessary to work out only 20 to 30 minutes per day with elastic straps.
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The training does more than reduce pain. People adopting an exercise regimen can use their joints much better than before. In a trial of 250 patients aged 60 or older, the participants had chronic pain but were still mobile. They could get up without support, went to the bathroom alone, and dressed themselves. In the study, they were randomly assigned to three different groups. The members of the first one were asked to walk briskly three days per week. After three months, the first part of the program ended, but the volunteers were encouraged to keep their newly acquired walking habit.

The members of the second group were instructed to do nine different exercises at a weight-lifting machine. They, too, were asked to continue after the initial three-month period. Finally, there was a control group who received general information about osteoarthritis but were not prescribed any exercise.

One year later, all participants were examined to see whether they could still keep up with the activities of daily life. The result: In the control group, 53 percent of the people had lost the ability to live without assistance. In the other two groups, that was true only for 37 percent, no matter what type of activity they did. The more diligently a person trained, the better the result. Overall, the success rate could have been even larger had all the volunteers lived up to their resolutions. But after 10 months, only 54 percent of them continued the exercises. The dropouts altered the outcome of the study and, worse, their own health.
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A review of the literature on osteoarthritic knees and exercise suggests that the type of exercise is less important than being active in the first place. Even moderate activities, like doing the Chinese martial art tai chi three days per week, bring promising results, Jean-Michel Brismée and colleagues at the Texas Tech University Health Sciences Center, in Lubbock, Texas, have found.
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In those cases, patients’ pain was relieved after only nine weeks, and the mobility of their joints improved. A recent study in the prestigious
New England Journal of Medicine
showed that arthroscopic surgery for osteoarthritis of the knee “provides no additional benefit to optimized physical and medical therapy.”
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The results are remarkable, given that mainstream medicine strongly favors more aggressive therapy options like drugs or surgical procedures. About 300,000 knee replacement operations and more than 193,000 hip replacement surgeries are performed each year in the United States.
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Even though these interventions are often necessary and a pain-killing godsend for some patients, experts question whether so many are justified. “If we look at the age and objective discomforts of many patients who were advised to get an artificial hip, we cannot resist the impression that this operation was suggested very prematurely—long before the treatment with pills and other means like exercise and physiotherapy would have hit the wall,” says the physician Klaus-Michael Braumann at Hamburg University, Germany.
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There are continuing concerns about the high rate of surgical joint replacement in Germany and in the United States because in both countries these interventions are costly for patients and insurers, and lucrative for doctors and hospitals.

RUNNING WITHOUT REMORSE

Another dangerous myth that keeps people sedentary is that running leads to the premature degradation of knee cartilage. Yet an increasing number of published medical articles indicate the opposite. According to these findings, all these women and men jogging through Central Park in Manhattan or along the Charles River in Boston are not ruining their knees. Actually, it is the large number of sedentary and often obese Americans who sit and lie around whose cartilage is more likely to be in decay.

However, it is very important which type of exercise one chooses. Soccer and downhill skiing are certainly not very good for knees. This is not because of the exercise as such, but because of the high risk of injury to key parts of the knee, such as the capsules under the kneecap, the kneecap itself, and the key ligament in the knee known as the cruciate ligament. Playing competitive sports does indeed increase the likelihood of suffering from osteoarthritis rather early in life. In one survey, doctors examined the knees of 117 men who formerly were elite athletes and found a lot of injuries: 14 percent of the examined soccer players had osteoarthritis, as did 31 percent of weight lifters.

But running is not among the sports with a high risk for getting injured. According to a study of 27 long-distance runners, the human body is capable of running 20 to 40 kilometers per week for 40 years without damage. Compared to 27 non-runners, these endurance athletes did not show any arthritic signs at the joints of hip, knee, and ankle.
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A similar result was found among runners with an average age of 63 who were monitored for five years, again with no sign of increased cartilage loss.
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By contrast, inactive and obese people have a higher incidence of osteoarthritis, and there seems to be a direct correlation. More than 45 percent of patients with severely osteoarthritic knees carry around above-average weight. Obesity triggers the problem. At first a person becomes fat, then subsequently develops ailing knees. The same connection was found for the hip. Being overweight at age 40 significantly increases the risk for developing osteoarthritis of the hip.

We set our course in middle age, around 40. People who stop exercising by this age in order to protect their bones may actually cause the opposite effect. Jogging helps to reduce weight, which then relieves the joints.
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Arthritis patients who are extremely overweight should be a little cautious, however. Instead of running, they should start out with bicycling and walking.

BEING RESTLESS, FIGHTING RHEUMATISM

While osteoarthritis is triggered by physical abrasion, so-called rheumatoid arthritis is a chronic inflammatory disease that at first usually affects one particular joint or a few of them. By the time patients see a doctor, about 50 percent of them are no longer able to use their wrists normally. Within the first two years of the disease, big joints usually become affected, and many patients experience severe symptoms. Pain, swelling, and stiffness make it extremely difficult for them to be physically active. This leads to predictable consequences; people with arthritis frequently lose muscle mass and are 30 to 70 percent weaker than healthy people. Their heart and lungs function worse, and their endurance is reduced by 50 percent.

Physiotherapy under supervision was for a long time the only physical activity that doctors allowed people with rheumatism. These cautious exercises helped the mobility of arthritis sufferers but not their fitness. For this purpose, aerobic training would have been needed—but physicians were reluctant to prescribe it to their patients because they were afraid it might bring even more damage to inflamed joints. However, it is turning out that this fear was unfounded. Many studies have shown that aerobic as well as strength training soothes the pain from rheumatism without showing any “increased disease activity or additional destruction of the joints,” says the orthopedic specialist Stefan Gödde at the University Hospital of Saarland in Hamburg.
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Most of the trials included patients with mild to severe symptoms.

Dutch researchers followed 300 patients with arthritis over the course of two years. One group of the participants received the standard treatment, whereas another group was prescribed exercise for two days per week: 20 minutes’ training on a stationary bike; 20 minutes’ strength training; and 20 minutes of games like soccer, badminton, basketball, and volleyball. The patients were reexamined every six months. Not only had their rheumatism not worsened, inflammatory processes in the joints were apparently soothed. Loss of bone density had slowed down, and overall fitness had improved, which in turn made the patients happier and more satisfied with their mental well-being.

FITNESS FOR FIBROMYALGIA

Fibromyalgia is still a medical mystery. Although some physicians doubt its very existence and think of it as a psychiatric problem, others regard it as a widespread disease that is dramatically underdiagnosed. In the United States, 3 to 5 percent of the population is allegedly affected, mostly women. The patients suffer from fatigue, low muscle strength, insomnia, headaches, and a lack of attentiveness. These symptoms might mean that the affected people need exercise. But it is also conceivable that this feebleness is a consequence of the disease. Fibromyalgia is diagnosed on the basis of 18 so-called tender points on the body. These points cannot be recognized anatomically but apparently hurt a little bit when you press on them.

The therapy options for fibromyalgia appear as arbitrary as the cause is mysterious. In Europe, some doctors put their patients in a warm mud bath, others try a medical cold chamber, but neither approach seems to work. Yet one treatment is emerging: in four studies looking into the effects of endurance training, physical exercise appears to allay the symptoms appreciably. As the fitness became better, the unusual fibromyalgia pain eased. Apparently, getting active helps the patients overcome their sickness because the newly gained muscle strength chases off fatigue, reduces pain, and helps patients handle their daily routine again—thus lifting up their spirits.
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HOPE FOR CHRONIC FATIGUE

Another complex of symptoms is known as Chronic Fatigue Syndrome (CFS), and it is also very mysterious. As with fibromyalgia, some physicians do not believe its very existence, whereas others are alarmed and call it a very serious condition. The affected people themselves report severe physical and mental exhaustion. If it lasts for six months or longer, and if it is accompanied by sleeping disorders, headache, and muscle weakness, the criteria for a CFS diagnosis are met. CFS was once thought to be caused by viruses, but no one has ever proven this.

This peculiar disease has attracted the interest of exercise researchers. CFS patients may simply be in poor physical shape. On the other hand, MRI imaging indicates that CFS patients have a defective muscle tissue—the oxygen consumption seems to be hampered.
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The findings encouraged English doctors to analyze the impact of exercise on this illness. During the course of 12 weeks, CFS patients were asked to walk, bicycle, or swim regularly. Fatigue levels were indeed reduced as the patients got in better shape. Even a year after the study, these positive effects still lasted.
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INACTIVITY AND OSTEOPOROSIS

Of all women age 50 or older, about 20 percent are said to have fragile bones. This statement is based upon bone densitometry, a procedure that pharmaceutical companies, medical instrument-makers, and some pharmacists and gynecologists recommend.

The densitometry is usually carried out through X-rays. The denser the bone tissue, the more the X-rays are attenuated, which can be analyzed with a computer. The results are then compared to the standard bone density of a healthy 35-year-old human. An individual is said to have osteoporosis when her or his readings are 20 to 35 percent below an arbitrary threshold value (which equals 2.5 or more so-called standard deviations under the norm). This measuring system produces results that—if universally applied—would turn the vast majority of older people into osteoporosis patients—and at the same time into consumers for drugs that allegedly increase the density of the bones.

This whole concept would be a great idea, if it reached the actual goal: cutting down the number of broken bones. Alas, there is no reason to believe that that would be the case. Day after day, older people suffer from fractures—even when their bone density measurements produce perfectly normal values. Fifty to 70 percent of the osteoporosis-like fractures actually occur in women showing only a small deficiency in bone density.
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There is an abundance of studies indicating that women who participate in bone densitometries do not benefit at all. Researchers in Sweden, Germany, and the United States have come to this conclusion in independent trials. Over ten years ago experts at the British Columbia Office of Health Technology Assessment, in Vancouver, presented a thorough report on the question of whether diagnosing osteoporosis makes sense at all. Their conclusion: “Research evidence does not support either whole population or selective bone mineral density (BMD) testing of well women at or near menopause as a means to predict future fractures.”
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Consequently, health providers in countries like Germany have stopped paying for this useless procedure.