Arthritis is an umbrella term used for the different conditions that affect the joints, bones, and muscles. There are several 100 types of arthritis affecting both children, adolescents, and adults.

Some of the common types of arthritis are Rheumatoid arthritis, Osteoarthritis, Juvenile arthritis, Gout, etc.[1].

Most arthritides are characterized by symptoms like pain, inflammation, swelling, redness, and stiffness of joints.

The conventional treatments to manage these symptoms include painkillers along with lifestyle modifications like diet and physical therapy regimen.

Physical therapy and exercise training is an integral part of arthritis management and remission in case of juvenile arthritis.

Research shows that exercise has many benefits like reduces joint pain and helps combat fatigue and increases strength and flexibility.

Endurance training is any physical activity that helps increase body’s “endurance” i.e. ability to exert more stamina in order to remain active for longer period of time as well as gives the ability to resist, withstand, recover from, and have immunity to trauma, wounds, or fatigue [2].

The main objective of endurance training is to boost the body’s energy production systems in order to improve overall health and fitness.

Research shows that endurance training is not only good for muscles, but it also decreases anxiety, depression, and stress along with improved cardiovascular health [3] [4].

There are four types of endurance training aerobic endurance, anaerobic endurance, speed endurance and strength endurance.

  • Aerobic endurance is the ability of the body to continuously transport oxygen throughout its various systems for extended periods of time so that an individual is able to perform physical activity for longer periods of time without exhausting.
  • Anaerobic endurance is referred to as a form of exercise characterized by the absence of oxygen, it is mostly short-spanned high-interval training like weight lifting, sprinting, push-ups, pull-ups, etc.
  • Speed endurance can be defined as the ability to maintain near maximum velocity for a prolonged time.it is very popular among sports athletes like soccer, basketball and hockey players.
  • Strength endurance is the form of exercise designed to enhance muscle strength and endurance. It is usually done by practicing resistance exercises like weight-lifting, etc.

 Benefits of Endurance Training for Arthritis Patients

Many arthritis sufferers experience muscle loss and pain thus show a significant reduction in physical activity, thereby reducing the strength and endurance of these individual [5] [6].

Physical therapy/activity and exercise is an important aspect of reducing pain, stiffness, and joint tenderness in arthritis patients [7] [8].

Research shows that exercise helps improve muscle function without affecting disease activity.

There is no evidence that even high-intensity exercise, has any adverse effects like increased inflammation or joint damage, although care should be taken with patients with severe baseline damage.

Every physical therapy for arthritis sufferers should include a balance of following three types of exercises; 1. Range-of-motion, strengthening, and endurance training in order to gain the most benefits from it.

A combination of these three exercises together can help relieve the symptoms as well as protect the joints from further degradation.

In a study conducted on women with rheumatoid arthritis showed that the combination of both strength and endurance training increases physical fitness as well as muscle mass along with the decrease in subcutaneous fat thereby reducing the risk of cardiovascular diseases in rheumatoid arthritis patients [9].

Following are the five endurance exercises suitable for arthritis patients to be practiced under expert supervision and tailored modification to an individual patient.

Top 5 Endurance Exercises Best for Arthritis Patients

1. CrossFit endurance training

Cross-fit exercises are a well-rounded program which includes aerobic exercise to both strengthen the muscles and provide flexibility.

These workouts are designed to push one’s limit and burn out calories hence are also helpful in tackling obesity.

Cross-fit exercises include squats, body-weights exercises like push-ups, pull-ups, jumping, running, free weights, etc. Increases anti-inflammatory cytokines and thus help reduce inflammation [10] [11].

It is very important to start with low -intensity work-outs and to gradually work your way up always since these types of exercises are intense it is imperative to get the doctor’s permission and guidance before starting cross fit exercises.

2. High-Intensity Interval Training

It is a type of anaerobic endurance training with a bout of quick and intense activity followed by a slow and mediocre activity with the fixed duration of cooldown or rest period.

The level of intensity, repetition, and duration depends on the disease severity and patient’s psychosocial state of mind

Research suggests that long-term high-intensity exercises are more effective in increasing muscle strength and flexibility in rheumatoid arthritis patients without any adverse effects [12] [13].

Besides improving muscle strength, it is also beneficial in improving cardiovascular health in both healthy and patients with chronic diseases like diabetes type II, hypertension, etc. [14] [15].

Arthritis sufferers too are at greater risk of cardiovascular mortality and hence including HIIT exercises in these patients reduces this risk [16].

Although proper care must be taken before starting this form of exercises a doctor or physical therapist should give a detailed and supervised exercise regimen personalized to the patients’ diseases specificity.

3. Cycling Endurance Training

Cycling both indoors and outdoors is a powerful, low-impact exercise excellent for most arthritis patients. It not only helps strengthen the leg muscles, but it is a good cardiovascular exercise.

The repetitive knee motion is especially good for arthritic knees since it encourages fluid production, lubricating it and flushing away the waste products.

Before starting cycling, it is imperative to consult their doctors to assess their fitness level.

Some of the basic tips to remember are, always wear helmets while cycling outdoors, using a recumbent bicycle can help people with arthritis.

Mounting and dismounting can be tricky for some patients in such cases getting a custom-tailored cycle to one’s height and posture is also advisable.

Slowly and progressively increase the distance, frequency, and speed of your rides.

Since just cycling while seating does not do much to help promote bone-density, experts advise a weight bearing device once you have reached an optimal level of competency.

Many experts suggest that cycling on a regular basis can help prevent muscle atrophy thus delaying the onset of arthritis. Here’s a video link that helps explain the benefits of cycling with arthritis.

4. Water-based Endurance Training

Most arthritis sufferers find it difficult to move let alone exercise when one is sore and stiff due to swelling and inflammation in joints and muscle tissue.

Hence, water exercise is the best bet for people suffering from arthritis due to following reasons;

  • The buoyancy of water supports the body so there is less impact on joints and muscles.
  • Exercising in a heated pool gives an added benefit of warmth, which helps soothe sore joints.
  • Moving in water provides natural resistance giving the muscles a good workout without the need for weights.

In a comparative study between hydrotherapy and land-based therapy in arthritis patients with rheumatoid arthritis reported feeling very much better than those treated with land exercises [17].

It is hypothesized that hydrotherapy is far more superior than the other usual care or land-based therapy for arthritis patients in terms of pain management and improvement in the quality of life [18].

Since every arthritis is different and has a different impact on the individual person it is necessary to consult a doctor and/or a physical therapist for a safe and effective routine.

Start slow and easy in the beginning steadily increasing the pace of movements. It is important to keep in mind to not over-do or stress your already sore joints and muscles.

Here is the link to a beginner’s guide for water aerobics for people with arthritis.

5. Recreational and Leisure Activities

It is a known fact that arthritis makes people handicap both physically and emotionally, it is a life-altering disease. Most people experience difficulties to carry-out their day to day activities as well as any leisurely social activities [19].

A study published is 2011 in reported that incorporation of leisure activities like community sports and group physical activities proved to be more beneficial than only usual care practices for patients with arthritis [20].

Stress can not only induce arthritis but is also a common side effect in arthritis patients [21]. Recreational and Leisure activities play and significant role in both coping with stress and negative expressions [22].

Many arthritis patients partake in games like hiking, yoga, tai chi, marathons, swimming, etc. as part of their endurance training.

Off course all these activities need prior permission and guidance from doctors and physical therapists.

Appropriate modifications are suggested as per the patients need and disease severity. Here is the link to help start with recreational activities for arthritis sufferers.

  • General Precautions to keep in mind before engaging in any form of physical activity.
  • Always consult the doctor and/or physical therapist before starting or modifying any of the activity.
  • Start the day with light stretching since morning stiffness and the sore joint is common in every arthritis.
  • Take warm water baths to soothe muscles and pain eat a healthy diet rich in calcium.
  • Start with low-impact activity like swimming, cycling, walking, yoga, etc.
  • Allow the body to rest during flare-ups.
  • Always wear protective gears while practicing outdoor activities like cycling, hiking, running, etc.
  • Stick to a regular regimen under expert guidance and supervision.

Conclusion

Incorporation of physical activity and regular exercise is an important therapeutic intervention for all types of arthritis.

Since, it can prevent loss of muscle mass, improve joint function and flexibility, decrease pain, enhance aerobic fitness as well as improve balance.

A comprehensive exercise program should include stretching exercises followed by a range-of-motion program for joints, endurance training like muscle strengthening, and aerobic and anaerobic exercise.

Unfortunately, despite these known benefits, most older adults with arthritis do not engage in regular exercise.

The Physical Activities Guidelines Advisory Committee reported that there is strong evidence that endurance exercise provides considerable disease-specific benefits to patients with osteoarthritis and other rheumatic conditions, without exacerbation or disease progression.

There is a piece of strong scientific evidence that most of the endurance activity like aerobic and strengthening exercises etc. are safe and moderately effective for individuals with chronic arthritis.

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