Make your own free website on
Sock's Toxicity And Drugs In RA:
Physical Care.
Home | Strategies | Life | Summary | Case Histories | Coping With Pain | Side Effects | Herbs | Supplements | Symptoms | Musculoskeletal | Disease Process | Chronic Pain | Management | Effects | Arthritis | Updates | Research | Alerts | Enbrel | Remicade | Arava | Surgery | Lab Tests | Treatment | Clinical Trials | Physical Care. | NSAIDs | Joint Injection | DMARDs | Factors | Steriods

Physiotherapy,and occupational therapy are integral components of the management of many forms of arthritis. Physical and occupational therapists will establish a therapeutic home program and educate patients about the disease and its management. Physical therapy is an essential part of the rheumatoid arthritis maintenance regimen.

Fatigue of rheumatoid arthritis is in a league of its own. People are so tired they are on the verge of tears or ready to tear someone's head off. Patient's haven't got an ounce of energy left. They feel feverish. The arthritis hurts like blazes. Concentration on any activity,big or small, is difficult,let alone make a decision about anything.
Unpredictable,overwhelming and often disabling,chronic fatigue can place a stranglehold on people's life,jeopordizing the treatment plan and destroying quality of life. Everyone experiences differently since its causes are usually a combination of physical and  emotional factors.
Fatigue may result from the disease process itself. This is especially the case of a RA patient. Chronic joint inflammation,a flare in symptoms,or anemia (a drop in the number of red blood cells in the blood stream) frequently contribute to fatigue. Sleep disturbance and non-refreshing sleep can result from the pain of inflammation in the joints.
The constant physical and emotional demands to manage the pain can drain the energy level. When patients "favor" a joint,it  places  additional stress on other healthy joints,one can tire very quickly,since the muscles and tendons of these joints are unaccustomed to extra demands.
If a person is in pain they are less likely to be active physically,which leads to disuse syndrome and more pain and fatigue. Feeling down can make  a person feel tired, experience pain and fatigue leading to depression,creating a vicious cycle that can be difficult to escape.
Managed or co-ordinated mutidisciplinary care is efficacious in maintaining the function and productivetity of patients with RA. depending on the patient's problems,expertise from nursing,physical,and occupational therapy,social work,health,education,clinical psychology,vocational rehabilitation, podiatry, and/or orthopedic surgery perspectives may be needed. e.g., patients with active RA who have comprised joint range of motion or function secondary to the disease,benifit from instruction by rehabilitation specialist on how to protect their joint,maintain range of motion of their joints,conserve energy, strengthen, and maintain their muscles.
The physical therapist will assess the musculoskeletal status of the patient by taking a history and examining ranges in motion,muscle strength,joint status (e.g., stability,alignment),posture and gait. Physical therapists who have additional training in rheumatic diseases will also evaluate the acuteness of the disease. This is necessary in inflammatory diseases,such as RA.,because it relates directly to the extent of physical activity that the patient can tolerate.
Exercise can exacerbate the acuteness of disease if it is not delivered at a level consistent with the condition of a particular joint. An appropriate level of exercise may be followed by a short period (up to 2 hours) of moderate discomfort; however,significant exacerbation of the condition for a longer duration may occur if the assessment of the disease stage was inadequate or the patient has been overzealous or is exercising incorrectly.
Physical therapists specifically trained in the evaluation of rheumatic diseases can be located in some provinces through the Arthritis Society. A single toll-free number (800 321-1433) allows people to contact their local Arthritis Society office for referrals to community care providers.
Physical therapy consists of exercises to improve muscle strength,joint mobility and cardiovascular function. Heat,cold,electrical treatments or hydrotherapy may also be used to achieve temporrary relief of pain and reduction of muscle spasm,but these techniques are used to prepare the patient with arthritis for exercise and should not be viewed as the treatment. The emphasis should be on exercise and education,with the goal of enabling the patient to continue an independent home program after discharge.
Gait training may be required to change poor habits,identify muscle wekness and imbalance and increase strength and walking range. For example, following  total hip arthroplasty,patients have a "Tredelenburg gait" with a lateral shift toward the operated leg in stance phase. This may because of shortness of the leg,weak hip abductors or habit. An assessment of  the strength of the hip and knee musculature,measurement of leg length and observation of gait will allow the therapist to identify which problems need to be corrected and how to do it.
A physical therapist uses posture training and counseling to help patients reduce stress on joints or soft tissue during regular movement work and recreational activities. A patient who uses a cane and has hip problems may not want to use a cane held in th opposite hand unless the therapists spends time demonstrating leverage and how forces on the hip joint can be unloaded when a cane is used properly.
As with most forms of arthritis are chronic,the patient will usually be instructed in a program of exercises that can be carried out at home. In addition to learning the exercises,the patient should also understand the rationale behind them and be given guidelines for progression. Long-term adherence to a program,particularly one as time-consuming sa a exercise regimen will only occurr if the patient understands the reasons for doing the exercises and believes that they will be useful.
The occupational therapist's role is to improve patients' ability to perform daily tasks,help them adapt to disruptions in lifestyle and prevent loss of function. Principles of energy conservation and joint protection,as well as techniques for stress management,are taught to minimize fatigue,reduce stress on joints,reduce pain and increase performance in the activities of daily life.
Patients are trained in alternative methods,and the use of adaptive equiptment for performing daily self-care,work,school,leisure and recreational tasks. Emphasis is placed on evaluating the patient within the context of his or her home,work or school setting so that appropiate,acceptable interventions will enhance the patients capabilitiees.
For example,a grab rail fixed to the wall or bathtub can facilitate entry and exit from the tub. The toilet is often the lowest seat in the house and may be difficult for patients with hip or kee problems to use; a raised toilet seat may mean the difference between independence and institutional care for some patients. an occupational therapist may also help the patient adjust to new or changed roles at work,in the family or community.
Protecting your joints means using your joints in ways that avoid excess mechanical stress from daily tasks. Beniefits include less pain,and greater ease in doing tasks. Three main techniques to protect your joints include: Pacing by alternating heavy or repeated tasks with easier tasks or breaks reduces the stress on painful joints,and allows weakened muscles to relax. Pacing and planning also provides ways to deal with the fatigue that is often associated with RA.
Positioning joints wisely helps to use them in ways that avoid extra stress (e.g.,use larger,stronger joints to carry loads,and change position frequently). Some patients will be given splints or othptic devices that help affected joints such as fingers to rest in a good position. Using assistive devices such as canes,raised chairs,grip and reaching aids can simplify daily tasks.
Developing good relaxation and coping skills can give one a greater feeling of control over the arthritis,and a more positive outlook. Many patients with chronic diseases are on medicines for a long time-possibilty life-time. People need to talk to their health care team to get the best possible results To get the best results,people affected by RA need to form close ties with their health care team,and become full partners in the management of their disease.
People who start their day by brewing a big cup of decafeinated coffee may not be doing themselves any favours, reports the American College of Rhuematology. Research papers presented at the college's Annual Scientific Meeting in November points toward an increased risk of developing RA in older women who drink decaf coffee.
Thirty-one thousand women aged 55 to 69 were studied over 11 years. The data showed that those whose decaf-coffee habit extended to four or more cups per day were more than twice as likely to develop RA than women who drank regular coffee. The University of Alabama Birmingham researchers could find no link between caffeine consumption and RA. The study also showed that drinking more than three cups of tea daily decreased the risk of developing RA by about 60 per cent. Tea contains plenty of antixidant-rich plant pigments known as polyphenols.--ACR.
The toughest and most important step in your exercise program is getting started. Often people think they need to tackle a strenuous program right away to prove they are committed. But in reality, slow and steady is the best way to begin.

You need a workable plan to change your lifestyle from sedentary to physically active. Following some basic guidelines can help establish an exercise program that protects you against disease and disability and insures a healthy, independent and productive life.

Prepare for success

  • Choose a fun exercise activity that can be practiced comfortably year round. Many people choose walking, bicycling, jogging, swimming, rowing or exercising with fitness videos.

  • If you have an existing health problem, contact your physician before beginning any vigorous physical activity. Sometimes, restrictions might have to be placed on the level of your participation.

Start slowly

  • Your goal is to set an exercise habit you enjoy. Make sure your first activity sessions are fun and not tiring. Give your body a chance to get used to it.

  • Give yourself plenty of time to warm up and cool down with walking, bending and gentle stretching exercises. Doing flexibility exercises helps you avoid injuries.

Establish a reasonable schedule

  • Set a weekly exercise schedule that includes days off. For example, you might exercise every other day, with three days off each week.

  • Start with a program of moderate physical activity – 30 minutes a day. Keep it interesting with a balanced program of different activities such as walking, bicycle riding, swimming or working in the garden.

  • If 30 minutes of activity is too difficult or you don’t have enough time, break it up into shorter intervals. For instance, walk for 15 minutes in the morning and work in the garden for 15 minutes later.

  • Don’t stop exercising if you get muscle soreness in the beginning, it will disappear as you exercise regularly. Stop exercising if you experience severe pain and swelling.

  • Choose a comfortable time of day to exercise, not too soon after eating or when the air temperature is too warm.

  • Wear shoes that are comfortable, provide good support and don’t cause blisters or calluses. The shoes should have arch supports and should elevate the heel one-half to three-quarters of an inch above the sole. When choosing a shoe, select one with uppers made of materials that "breathe," such as leather or nylon mesh.

Stick with it

  • Focus on working toward your goals gradually. Consider tracking your progress with a simple chart, perhaps listing the number of minutes you exercise each day.

  • Don’t stop your fitness program; the benefits begin to diminish in two weeks and disappear in two to eight months.

  • Congratulate yourself for each accomplishment. Your progress will develop into a pattern through which you work up to higher levels of exertion over time.
  • Seven tips to prevent injury

    When you exercise, orthopaedic surgeons and CPSC recommend that you follow these tips:

    • Always wear appropriate safety gear. If you bike, always wear a bike helmet. Wear the appropriate shoes for each sport.

    • Warm-up before you exercise. That could be a moderate activity such as walking at your normal pace, while emphasizing your arm movements.

    • Exercise for at least 30 minutes a day. You can break this into shorter periods of 10 or 15 minutes during the day.

    • Follow the 10 percent rule. Never increase your program (i.e., walking or running distance or amount of weight lifted) more than 10 percent a week.

    • Try not to do the exact same routine two days in a row. Walk, swim, play tennis or lift weights. This works different muscles and keeps exercise more interesting.

    • When working out with exercise equipment, read instructions carefully and, if needed, ask someone qualified to help you. Check treadmills or other exercise equipment to be sure they are in good working order. If you are new to weight training, make sure you get proper information before you begin.

    • Stop exercising if you experience severe pain or swelling. Discomfort that persists should always be evaluated.

    There are lots of ways to enhance your life as you age-and staying fit is one of the most important.


Importance Of Exercise:
One of the major element in the treatment of patients with RA is to prevent disability and preserve bodily function. One way to achieve this goal is to develop an exercise routine,based on the specific needs of each patient,that preserves motion,strength,functional activities,and lifestyle.
Maintenance of near range of motion (ROM) in joints is important in preserving  functional ability. Careful evaluation of the available range of motion of each joint should be undertaken during the first contact with the patient. During specific movements,the clinician should identify and note any swelling, warmth or redness,crepitus, or pain in the joint.
Based on the evaluative findings, an exercise program should be developed to maintain or gently increase the ROM of each  joint. Once the specific exercises is developed,the patient and family should be instructed in the exercise program and they should demonstrate competency in carrying out the exercises. Ample rest between exercises or activities is important and should be encouraged. Some discomfort may be encountered with the exercises,but should not persist beyond an hour or two and should not be excessive.
The patient and family should understand the need to carry out the exercise program routinely (usually twice per day) and indefinitely. There may be days when the patient notes significant joint pain or swelling and won't feel much like exercising. It is important for the patient to understand that even on "bad" days the exercise program should be continued,althought it is advisable to decrease the number of repititions to a minimum number.
Likewise,when the patient has a "good" day,she or he must not engage in too much exercise activity because the potential to initiate a flair exists. Therefore, the exercise program must have limits established so that the patient does not under-exercise or over-exercise.
Exercise should become part of the daily routine,but the patient should focus on the joints in which the inflammation and pain are most severe. Each active joint should be taken through its full range of motion daily. Isometric exercises  may maintain muscle strength without exacerbating the condition of the joint. Exercise should stop short of increasing inflammation in the joint (as observed by an increase in pain and warmth or swelling in the joint). Any activity that increases inflammation in the the joint should be avoided. Exercise should be a feeling of pleasance,not pain.
People suffering pain in a joint naturally want to avoid using it. When they do,the msucles and connective tissues surrounding and supporting the joint wither,contract,and weaken, Disuse causes the joint to become progressively unstable and deformed,causing more pain. It sometimes is a vicious cycle that can be avoided in most cases.
The services of physical and occupational therapists will be enhanced if supporting  information is fowarded to them at the time of referral. Copies of radiologic reports or radiographs,for example,can help them tailor treatment and education to the individual patient. 
As the primary care physician,the general practitioner should determine what treatment is being carried out by the therapist and whether it is successful. Regular communication will facilitate the development of a rapport between therapist and will improve treatment for the patient. (Unfortunaely we do not live in an ideal world).
These therapists also expect the primary care physician or specialist to have control of inflammation and pain through pharmacologic means where possible. They do not expect specific instructions or treatment recommendations but generally prefer to be allowed some descretion in developing a treatment plan based on their findings.
Symmetric joint swelling,although not invariable,is characteristic of RA. Careful palpation of the joints help to distinguish the swelling of joint inflammation from the bony enlargement of osteoarthritis. In contrast to gout or septic arthritis, (although present) redness of the joint is not a prominent feature of RA.
 Pain on passive motion is the most sensitive test for inflammation. Occasionally  inflamed joints will feel warm to the touch. Inflammation, structural deformity,both may limit range of motion of the joint. To initiate proper therapy it is important to determine which of these processes is the major limiting joint function.
Permanent deformity is an unwanted result of the inflammatory process Persistent tenosynovitis,and synovitis leads to the formation of synovial cysts,and to displaced or ruptured tendons. Extensor tendon rupture at the dorsum of the hands is a common found problem. Bony erosions seen at the margins of the joint at the attachment of the synovium are the hallmark of RA. Erosions occur rapidly within the first 2 years of the disease. These anatomic changes result in limitations of range of motion,flexion contractures,and subluxation (incomplete dislocation) of articulatine bones.
Typical visible changes include ulnar deviation of the fingers at the MCP joints,hyperextension or hyperflexion of the MCP and PIP joints,flexion contractures of the elbows,and subluxation at the carpel bones and toes (cocked-up).
It is typical of patients with RA that their symptoms wax and wane often making diagnosis,and treatment decisions difficult in certain situations. A typical presentation include intermittent joint inflammation that can be confused with gout or pseudogout,proximal muscle pain,and tenderness mimicking polymyalgia rheumatica or diffuse musculoskeletal pain seen in fibromyalgia.

Number one,is a good night's sleep and rest because if you're not getting adequate sleep,you're going to have more pain. You're going to have more fatigue. It has been proven that the average North American gets about 4 to 5 hours of RESTFUL sleep. And many times,when one has RA,you'll roll over on one side and your hips hurts when you come out of a deep sleep and you're fatigued-you have more pain. Often people pin their wrists or arms under their body during sleep and that could result in pain-all day.
Scientific studies may show that any food,any diet,does nothing for arthritis but many people with RA don't get get a wholesome,all-around-nutritious diet because they don't feel well and as a result nibble at this and that. Good health,regardless of condition,contributes to overall good health,so why not RA patients ?
We are supposed to drink 8 glasses of water a day. The average person only drink 2 glasses of pure water and when we don't drink a lot of water the probability of side effects with all that medication is greater.
Stress management is very important. If it isn't controlled properly the result is more pain and fatigue.
Many times with arthritis we get atrophy of the muscles;deconditioned. The more deconditioned you get,the more pain and fatigue. Patients have to get involved with exercise,because the weaker muscles and ligaments around joints become,the more pain you're going to have.

Growing old is not a passive thing, as though it were merely happening to us. It is indeed growing – it is the act of growing old. And just as we tell our children to act their age, so we must remind ourselves that we are constantly becoming, spurred on by acts of the heart, mind, body and spirit – acts of courage, acts of will, acts of strength or acts of faith: Each is a part of our becoming, our growing old. Perhaps never is this more obvious than when we see such an act, a courageous response to one of life’s random, shattering challenges.
Take the case of U.S. concert pianist Byron Janis, now in his early 60s. He was 45, his career a rising cresco, when he noticed redness and swelling in one of his fingers. To his utter dismay, in a matter of months, the symptoms had spread to all his fingers. Janis had developed psoriatic arthritis. Despite medication and therapy, the joints in nine fingers gradually fused.
By rights, that should have been the end of the musical line for Janis, who had studied with Vladimir Horowitz and made his Carnegie Hall debut at 20, but he refused to call it quits. He adjusted his technique, changing his fingering and hand positioning – and continued playing. “I learned to utilize what I had,”he told Newsweek last March. “I had a total passion for music. It was my life and I had to pursue it. I have arthritis – but it doesn’t have me.”
A remarkable story, decidedly. Exceptional? Only in the details. To take another example: An Ontario woman in her mid-90s was reduced to near-immobility by inactivity and arthritis – not age – but a month after taking up an exercise program under the supervision of a physiotherapist, she was up and walking, albeit with a walker, and her entire outlook had changed.
Then there was the 62-year-old Manitoba woman with one arm already in a sling. She was warned to prepare for the slow onset of arthritis – and a future of relative immobility: Six years later, she is the flexible and energetic leader of a growing t’aichi class.
There are more people over 65 than ever before, and they’re “younger” than any previous generation of so-called elderly people – scaling mountains, running marathons and surfing, spearheading social-action groups, taking up dance and writing books.
Besides age, what these active elderly have in common is exactly that: activity. Healthy or not, they share a practical appreciation of a natural law that can be summed up in a simple dictum: Use it or lose it. In nature, wings atrophy if a bird no longer flies; idle machinery rusts and falls into disrepair; so, too, are our minds and bodies diminished by disuse.
As most people grow older, they become less active – with good reason, of course. Physically we’re in a slow decline from our 20s on; as we age, it gets harder to be active. The peripheral nervous system that sends sensory cues begins to attenuate, and we gradually lose our ability to respond quickly to stimuli. The muscles and bones begin to thin as they lose cell matter, and we are weaker, less resilient, and less able to perform physical activity. It also takes longer to recover from illness and injury.
Even worse, we don’t seem to be as mentally acute. The brain starts to lose cell matter and synapses – the connections between neurons – and it becomes harder to learn things and more difficult to retain them. For every mentally agile artist, scientist or court justice in his or her 70s or 80s, there are countless people of that age who have difficulty comprehending, or remembering names and words.
On top of all that, there is the shrinking social world of the increasingly elderly; as friends and family become fewer, the incentive to stay active collapses. There are fewer people to see and fewer dates to keep; in any case, the discomfort and pain of arthritis, often combined with other chronic illnesses, make it more difficult to get up and get out, and one is increasingly inclined not to try. Yet with each outing we forgo, each activity we give over, our energy for endeavour – mental or physical– seems to shrivel. But that’s the bad news.
The good news is that getting active – mentally, physically and socially – pays measurable dividends. And it’s never too late to start: Anyone, no matter what his or her condition, can – and should – get involved. Let’s start at the top.
Many people say their greatest fear in growing old is “losing their edge,” becoming less mentally astute. That fear is exacerbated by the widespread misconception that older people are not as bright as younger people. But, says neurologist Dr.Richard M. Restak in his  best seller, “The Mind”: “psychological testing of the elderly reveals no change, and, in some instances, even improvements in what we call crystallized intelligence: vocabulary, general information and comprehension. The ‘wisdom’ of the aged is an everyday recognition of the fact that the observations and experiences accumulated over a lifetime can count for a great deal – one of the reasons our Supreme Court justices on the average are in their 60s and 70s and not their 30s or 40s. Only fluid intelligence – memory span and the ability to process information rapidly –decreases significantly with age.”
Restak recounts a study conducted by Dr. Ellen Langer at Harvard University on the residents of a nursing home. “One group of patients was told in essence, ‘It’s your life and you make of it what you want.’ Members were urged to try to change things they didn’t like and pretty much make up their own minds on various matters...the second group was told things like, ‘We feel it’s our responsibility to make this a home that you can be proud of and will make you happy’.”
As might be expected, the group urged to assume responsibility“ became more alert and more active, were happier and healthier, participated in more activities, even lived longer. In general...people did better in a reasonably demanding environment that encouraged them to make use of their cognitive abilities.”
It may even be possible as Restak surmises in his earlier book, “The Brain: The Final Frontier,” that there is a survival value inherent in the stimulation of novelty, that novelty is itself rewarding. A study conducted by psychologist David Hebb, using laboratory rats in a maze, may not exactly replicate the rat race most of us run, but the results are nevertheless interesting. They suggest, says Restak, “that the opportunity to explore is in itself rewarding.
Prior exploration allows an animal to develop new patterns of responses that can later be used to meet future demand situations – e.g., finding food.”
Certainly “making everything old new again” can have a remarkably rejuvenating effect; people often say of a challenging new activity that it makes them feel “ten years younger.” That’s part of the rationale behind Creative Retirement Manitoba (CRM), a fascinating seniors’ program profiled by David Suzuki’s CBC-TV science series, The Nature of Things last spring. Basically CRM is an educational program, with health promotion as a major component, that began in response to seniors ’requests for flexible and affordable education programs.
“If people retire early,” says CRM executive director Farrell Fleming, “say, at 55, and they die at 100 – that’s 45 years, and there’s a lot they’re going to want to learn in that time if they’re interested in life.”
The other part of the mandate, says Fleming, “is to put the wisdom, skills, experience and knowledge of older people to workin the community in an educational role.” The result is alot of older people taking part in teaching and/or learning activities. There are workshops and lectures given to seniors all over the province (including a home-bound learning program specifically for shut-ins), in addition to lectures to school children on everything, says Fleming, “from aging to narrative and oral poetry and what you need to get and hold a job.”
There are classes for seniors on the art of massage and t’ai chi (where the mid-60s arthritic instructor, mentioned earlier,“makes the young people gasp”) and art, history and being older. And out of the classes have come several service groups: Viewers saw the massage team and the barbershop quarteton The Nature of Things, but there’s also a choral reading group called The Phoneticals, says Fleming, “who came out of a dramatic reading course and work mostly in schools. There’s a drama group that at its height did 90 shows; there’s a ‘philharmonica band’ that came out of the harmonica classes and a recorder ensemble that came out of the recorder classes. So, part of it is learning the stuff, but the other partis putting what you’ve learned to use.
“Use it or lose it,” says Fleming. “We talk a lot about that, because it’s true for everything. It’s true in the emotional realm: You use your sensitivity, empathy, friliness, your interest – or you lose them. It’s true in the intellectual realm: Use the mind or lose it. It’s true in the physical realm – it’s true in any realm you want to talk about. The law of life seems to work that way, so it’s very much one of our messages.”
The message seems to be working. People are regaining skills and interests they thought they had lost, while other people, says Fleming, “come to things for which they never had the opportunity – they were too busy raising kids, too busy making endsmeet, a lot of them. Suddenly they get an opportunity to fly, and some of them do. Some of them really start to soar.”
But even for those whose disease makes them feel too earth bound to soar, the message is the same – use it or lose it; get involved. The easiest place to start is with your own body.
Of course, a life long pattern of exercise is ideal, says an associate professor in the Department of Health Studies at the University of Waterloo (Ontario) – “for developing flexibility, muscle strength and bone mass in young adulthood.” But, she says, “the nice part is that you don’t have to ‘use it or lose it’ all through life:You can resume exercising or start it late in life. It’s never too late to begin, so people in their 60s and 70s can start,as long as it’s appropriate to their state of health.
She believes that “low-intensity exercise that’s good for older people is good even for people with osteoporosis and arthritis; it’s very helpful in retaining and improving flexibility, mobility, general range of movement, and obviously it’s very important to mental attitude. There’s no reason why a person with severe arthritis couldn’t do some exercising. Obviously they’d have to do only as much as they could and build up slowly, but I would say flexibility exercises – everything from the hands and shoulders to the legs – would be appropriate and would certainly should show some benefits.”
A properly trained physiotherapist's will also encourage people to be as active as possible,within the constraints of their disease, and in a supported way. They teach people exercises that are appropriate to their type of arthritis. They will create an exercise program tailored to each patient’s needs, and they try to make it interesting for them so they’re motivated to continue it on an ongoing basis.
To some patients, of course, the idea of using mind and body inactivities not specifically goal-directed – in the form of work, say – is a foreign notion. For these industrious people, exercise was what you got while working. When they retired, regular activity all but ceased. But staying active, is acutely important. And it’s anymore important for elderly people than young people to have an attitude toward life that involves activism and being involved and giving to other people and giving back to the community and keeping active physically, mentally, socially, sexually and soon. The bottom line is, all that should be part of life.
And if it’s true that the less you do, the harder it is to do anything at all, it’s also true that the more you do, the easier it is to do more. No segment of the population derives greater benefit from exercise than seniors. In young people, exercise can improve physical function by only about 10 percent; in the elderly, exercise can boost function by as much as 50 percent.
Staying active is especially important for anybody with arthritis. Obviously when you have pain and inflammation in a joint, you’re reluctant to move it, but when you don’t,in a short period of time, the structures around the joint will stiffen and become less flexible, and the muscles that move the joint will become weaker.
Suppose you’re having problems with a particular joint – the shoulder, say. Therapista might look at ways of relieving pain in the joint prior to exercise, so you’ll be able to exercise in a more relaxed manner. A morning shower to help relieve some of the morning stiffness might improve the circulation and relax your muscles.
They may devise a routine to develop flexibility, stretching all the joints within acceptable pain tolerance, to attain maximum range of motion and strengthen the muscles. And it doesn’t stop there: Depending on patient  mobility,they might encourage you to register in a hydrotherapy program and see about getting you involved in an aquafit program, where you’re doing general exercises with other seniors in the community.
Social activity helps keep the mind measurably more active. A nursing-home study that found ,even meeting for an hour or so a week to do nothing more than reminisce about themselves and their families increased health and happiness, and even improved memory in about 40 per cent of the participants.
As some experts say, the main benefit of exercise may be in the mind – in another way, as well: Arthritis leaves many ofits victims feeling helpless; exercise helps them to feel more in charge. People who do exercise consistently feel better about themselves physically and are much more able to cope with their disease. By doing their exercises, they’re monitoring how their disease is progressing, able to keep their doctors informed about any changes taking place in their bodies and to recognize when they need help from the doctor. They actually have mo re control in helping themselves stay well.”
And don’t worry: No one expects you to throw yourself headlong into the fray, or, once given over to it, progress  in leaps and bounds.
A therapist,would look at very small slices, set some very short-term goals. One aspect of that, is dispelling some of the myths about exercise: It used to be thought,"no pain, no gain," that you really have to make it hurt to have a beneficial effect. That’s not true at all. And it used to be thought you had to exercise every day for several hours. Thats a no no. You really only have to exercise for 20 or 30 minutes or less, three times a week, which makes it more acceptable.”
An exercise program – even if it’s only general breathing exercises can be designed for anybody, depending on what your needs are. If they’re wheel-chair dependent, they can exercise in bed or sitting in their chair. Even if they’re simple exercises, the increase in oxygen intake and improved circulation will help their well-being.
 Sally a therapist has seen the results of activity and involvement again and again, but no one struck her so forcefully as the woman in her mid-90s, suffering from severe osteoarthritis, who responded so completely. “I was overwhelmed,” she says. “She was barely walking with a walker, and I gave her some heat treatments and exercises. Because she’s doing them regularly, she increased the mobility in her knees. She was able to decrease the amount of pain she was having, I think because of the increased mobility and the improved strength in her thigh muscles. She was very encouraged, and I feel she’ll be able to keep walking, rather than being totally dependent on a wheelchair.
“She saw herself deteriorating within the space of a year, and her exercise program has put a stop to the rate of deterioration. She feels she’s not going to keep losing her mobility, that perhaps she’ll be able to keep walking with her walker. What it’s done is made her feel more optimistic about the rest of her years.”
The idea, the therapist says,is not so much exercising to try to add years to one’s life; “it’s more along the idea of adding life to years and adding enjoyment to life.”
Certainly if you feel better,if your body is functioning better – you’re not as constipated, your appetite’s better, you sleep better, you move better, you can do more of the things you enjoy – then,for most people that would mentally lift their spirits and, again, improve things like confidence. There’s no one-to-one relationship here, but for most people it’s related to a sense of well-being.
Patients can't count on miracles from activity, but they’ll probably feel better, and feel fitter and more able to participate. If you look at most people who live into their 90s and 100s, they’re either people who never did anything bad – never smoked, drank, had sex or anything – or they were real hellraisers. But the common denominator is that they were usually pretty active.
There is an case of an elderly grandfather who just turned 100, as a primary example. Still tall and erect, with sharp blue eyes, he left Ontario as a teenager to become a businessman in the West. An avid curler, he was inducted into Canada’s Curling Hall of Fame as a “Builder,” and he may be the only golfer in the world to have shot five holes-in-one since his 80th birthday. He finally gave up the game, at age 97.
He is still active, though he limits his gamesmanship these days to competitive bridge. He told friends on his birthday that he still enjoys the odd drink and a good party, “but everything in moderation.”
On his birthday, he advised friends, “You know, you have to stay active.” “He never ‘exercised’ a day in his life,” says his grandson, “but he chopped wood, hiked 50 miles – things like that – but he never did anything he would have called exercise. It was always sport for enjoyment or just darn hard work.”
The grandfather is lucky; despite his age, he has only a touch of osteoarthritis, which makes staying active admittedly easier. For those with more serious arthritis, it’s probably even more important, because muscle strength is protective. But even if you can’t be physically active, you still have those whole other realms of activity, which are social activity and mental activity. You can accentuate the positive.
One of the things the grandfather said on his birthday was that he thinks you really have to put your disappointments behind you and just go on – don’t dwell on them as an approach to life. And for anyone who has a chronic illness, I think that’s good advice

Nih.Gov. Link:Alternate Therapy