The Importance of Movement for Osteoarthritis

and my guests as your weekly walking buddies. We'll hear stories from caregivers and gain tips and insights from health experts and advocates who know how important it is to take care of yourself and manage joint pain due to arthritis that often accompanies being a caregiver. Together, we'll find community ourselves and maybe even alleviate some joint pain in the process as we walk together and connect to the

best parts of being a caregiver. Welcome back to Kara Walks, everyone, and thank you for taking time to join us, and thank yourself for taking time to make your self care a priority. All right now, just a reminder, Right now you're listening to the full version of this episode, but if you don't have time for a full walk today, then go check out our bridged version of the same episode. It's like cliff notes for podcasts, so no matter how much time you have, you won't miss out on a

great conversation. All right, now that's settled, let's dig into the episode. Today, we're talking about the importance of movement

for caregivers living with ostio arthritis. It might seem obvious that we should implement exercise and movement into our weekly routine, yet so many of us struggle to stick to that habit, and frankly, I find that understanding more deeply how movement affects and helps joint pain can go a long way, and helping solidify new movement habits and keep up with them to help us better understand how joint pain effects caregiving.

I will be joined by Dr Amanda Nelson, a rheumatologist and Associate professor at the u n C Thurston Arthritis Research Center. She understands both the challenges and the best strategies from managing o A from her experience working directly with patients, both in clinical care and in research. But before we get into today's conversation, let's begin our walk. We're going to focus on staying present within our bodies and within our movement. Think about the contact you're making

with the ground. What does that feel like? Be sure to relax your shoulders as you walk, pull them down from your ears and breathe in deeply through your nose. Feel the sensation of your stomach and your chest rising with your breath. And now breathe out through your mouth and let everything in your boy to relax as you breathe. Be aware of the air filling in your lungs. Can you feel your chest compressing as you slowly release the breath. Take a beat to walk through your five senses? What

do you see around you? What sense are filling in the air? What do you notice about the way your body moves as you set your pace? Now as you settled into your rhythm. I'm going to share my conversation with our guests, and together we're gonna learn a little bit more about how we can all benefit from keeping our bodies moving. Today, I'm joined by Dr Nelson, a rheumatologist and Associate professor at the u n C. Thurston

Arthritis Research Center. She understands both the challenges and the best strategies for managing away from her experience working directly with patients, both in clinical care and in research. Dr Nelson, thank you so much for joining us on care walks. Oh, thank you very much. I'm happy to be here. I'm

happy you're here too. Could you tell us a little bit about the work that you do and how you have helped joint pain sufferers improve their symptoms, and can you tell us how away affects the body and its ability to move. Yeah, So, as you mentioned, I'm a rheumatologist and I see patients one day a week, and those patients have a range of arthritic conditions and a

lot of them have challenges with mobility. I also do research primarily and osteoarthritis, which is the most common form of arthritis, around a lot of different aspects of risk factors, disparities, issues of imaging and bio markers, how we might tell people do or don't have arthritis, how it might progress, and some novel methodologic approaches to try and understand it better for future cunical trials and clinical care. So the

main recommendations around symptomatic improvements. So first I would say that there is no drug or other intervention that really affects the process so once arthritis has started, particularly osteoarthritis, there's really no way to make it stop or make the cartilage regrow currently, and so we do mainly focus on symptoms and improving those symptoms. One of the best ways to do that is exercise, and we have shown in a variety of different studies that exercise really does

improve pain. Often that's not the first thing that happens, so people have to work through some initial discomfort. A lot of times, maybe they haven't been very active and they have to sort of get into the routine and get over some initial joint pain. But over time, being regularly active does improve the pain and symptoms of arthritis.

Osteoarthritis primarily affects the joints. It's a little bit different than say room atoid arthritis or lupus that can also cause joint pain but have a lot more systemic symptoms. Oste Earthritis really just stays in the joints and it affects all of the tissues of the joints. So we used to think of it primarily as cartilage loss, which is certainly part of it. The cartilage pad that cushions

the joint thins over time. It gets damaged, especially in the knee, there's a moniscus, there's an additional pad that gets broken and damaged. There are tendons and muscles that the bone itself gets affected, So it's really everything about the joint that gets damaged through the process of osteoarthritis. And then obviously you need your joints to walk, particularly in the lower extremities, So hips and knees are very commonly affected by o A and with that can definitely

impact people's mobility. Walking often we think of first, but a lot of just activities of daily living require weight bearing on the lower extremities and that can become difficult over time. For a lot of people with O WAY. Mobility is incredibly important, and if we lose mobility, we often become isolated, lose support systems, you know, lose a lot of function, and then that can then contribute to depression,

which is also pretty common in arthritis. So mobility in general is really important, and reduced mobility is actually a marker of reduced lifespan. So people that walk slower are really unable to walk generally just don't live as long and they don't have as high quality of life as those who have more normal mobility, right, And you know, for a lot of joint pain sufferers, movement is such an important part of their self care journey and it

could be so difficult. A lot of our audience are not only folks with joint pain, but also people who are caregivers to family members like myself. So I'm curious, do you work with patients who are in a similar role and what do you notice about them? So the caregiver themselves often is taking on that role in a way that sort of reduces their focus on their own health.

And so if you're extremely focused on taking care of someone else who you see is being very in need of your services in that way, then you often overlook your own stuff, right, So you're not into the doctor, you're not going to exercise, you're not eating right as that caregiver. So one thing is certainly to encourage those folks to keep a focus on their own health, because if they're not healthy, they can't take care of the other person either. I think that the isolation piece fits

in there too. So if a person is very focused on their caregiving role, they may not interact with friends or do social things or other things they're just so focused on that. And then a lot of caregivers share a lot of risk factors with the person they're giving care too, So if it's a family member or a sibling or even a friend, a lot of times those

sets of people are from similar backgrounds. Maybe they share a similar environment, they have a similar diet, a similar culture, and all of those things are going to put the caregiver at risk as well. So if the individual being cared for has osteo arthritis of multiple joints and limited mobility, it may well be that the caregiver also has some

joint pain that's limiting their function. And on the research front, that feeds right into a lot of the interventions now where people are trying to engage a caregiver or a support family member, sibling, whoever it is, because walking and other interventions are a lot easier if there's two people. So maybe you and your sister can go out and take a walk and have a chat about joint pain rather than just again being isolated and trying to do

things all by yourself. So engaging the caregiver in the interventions can be very helpful. Some of our listeners might be new to incorporating physical activity or movement into the routine. And as we all know, well, I mean I speak for myself, but I think also for a lot of other people, just the prospect of starting something like that it seems intimidating. So what would you say is the

simplest and best way for them to get started? I think a lot of my patients, and certainly in our research studies as well, people are often coming from a position of of no activity. They're very sedentary. They might get up and go to the store, but o wise, you know, on the couch or not engaged in a regular routine, and so there's a lot of ways to approach that. It depends a lot on where people start.

So if we're starting from a place of I do nothing but sit on the couch, then the first thing we say might be, well, during the commercials on the television, we're going to stand up and we're going to move around, and we're going to do that every single commercial, because there's a lot of commercials, and so that can get

you a long way. If we're from a place of well, I move around in the house, but I don't really like to go out and walk, you know, then maybe I say you should walk for five minutes a day, you know, three days a week, and I work very slowly up to a goal of maybe thirty minutes a day for three to five days a week. And I actually have a walking prescription where I can write this out for people and say, look, this is the medicine for your arthritis. The medicine for your arthritis is to

get up and walk. But it's extremely important to meet people where they're starting, because if I just start with thirty minutes five days a week, they're going to have that exact reaction and I say, there's no way I can do that, and I'm not even gonna try. And so understanding where people are coming from, what their barriers are, you know, do they feel like they're going to fall?

Are they living on a two mile long gravel road and they can't walk, and really coming up with a plan that's going to work for that person, anyone they're caring for, you know, working around their schedule. All those things are very important to getting people started and also to maintain because you know, if they do it once and then give up, that doesn't help. We'll be right

back with more from Dr Amanda Nelson. And now back to my conversation with Dr Amanda Nelson, what would you say is one of the biggest roadblocks for patients who are just trying to find the right ways to fit that movement into their day. Definitely scheduling and not prioritizing it.

So this thing about putting our own health on the back burner and taking care of others, whether that's kids or people were caring for, it's essential to prioritize your own health and say, look, I walk from eleven to eleven thirty and even if I don't get my walk, I'm going to do something healthy for myself in that time. Or Monday's, Wednesdays and Thursdays, I have this half hour,

you know. Finding that slot and then either scheduling it, blocking it off, telling everyone you're not available some way to really make that happen can often be very helpful because you would schedule other things. So just call it a doctor's appointment, or call it a haircut or a dentist cleaning or something, because it's just as important as those things. And a lot of individuals do like a

more structured program. So a lot of the courses, like through the centers for disease control, and the Arthritis Foundation might have a self directed program where you can do it yourself on your own, but they also often have group classes that are low cost or free where people can go and everyone there is going to either have arthritis or be taking care of someone with arthritis, and that's a great way to build community and see that you're not alone and that there are a lot of

people dealing with these issues. Yes, and you know, we're always putting ourselves in the back of the line when it comes to caregiving. Sometimes we need to put ourselves in the front. Okay, let's talk about possible misconceptions about being physically active. I can already hear somebody saying, well, wouldn't movement just add where and tear to my body and potentially make joint pain even worse. And I get that question all the time because it makes sense. Right.

You think, well, if the cartilage is breaking down, then what I don't want to do is use the cartilage. But it's not quite how it works. So the cartilage itself doesn't have its own blood vessels, it doesn't get nutrients from the body through the blood like a lot of other tissues, and the way that it gets nutrients in and waste products out is by compression. So the actual loading of the cartilage is how the cartilage stays healthy.

If people are unloaded, you know, for example, having a paralysis event where they really cannot walk, the cartilage degrades because it can't get nutrients. And so walking is healthy for the cartilage and actually improves the cartilage function. And so it's completely counterintuitive, and I get that, and so

I'm happy to explain that to folks. But the joint wants to be loaded now, it doesn't want to be It's not a jackhammer, right, So it's not looking for high impact, major activity, but it does like some periodic loading and unloading, such as we get with walking and what else? What are some other low impact activities that caregivers with joint pain can do besides walking. Yeah, so walking certainly the cheapest and easiest we can all do it.

I have a lot of people who benefit greatly from the elliptical system because there's really no impact so much as that gliding motion can be very helpful. And for people that really have not been moving, have a lot of pain, maybe a lot of other comorbid conditions, A lot of times water therapy is very helpful, whether that's a PT driven aqua therapy program or again like an

OAR threatis foundation class at a local pool. Often the pool is warm, the buoyancy from the water helps to sort of take some of that weight off the joints, but still they're being loaded in a useful way for the physiology of the joint itself. So there's a lot of different modalities and it very much again depends on what people want. If if you're terrified of the water, then I'm not going to tell you to do water therapy, but that certainly is a great place to start for

people that have access and enjoy that. Okay, let's talk about self care. How can we help caregivers with joint pain see movement as self care. It's almost like a psychological exercise, you know, so that we don't look at it as this burden of oh gosh, I gotta do this, but as actual self care and self love. How can

we get them to prioritize that. Yeah, So education is a huge piece of this, making sure that people understand the process of the disease, whatever that might be, or or if there's multiple diseases, at play, how the physical activity might benefit them, how it's better than a lot of the other choices, and so to say, look, exercise is the medicine. This is what you do for this problem. This is how you get this better. It's free, you can do it whenever you want. You don't have to

go to the doctor. Like. There's so many benefits. And the good news for you today is that all you have to do is walk, and walking is going to give you the biggest benefit. Can work out be too minimal to see benefits. There's two parts to that. One is any movement is better than no movement, and so if you're, you know, just getting up during the commercials, are doing those five minute walks, that's way better than

the sitting on the couch was previous to that. We have to start somewhere, and we want to encourage people to start where they are and move forward. From that point, any movement is going to be of benefit over the

longer term. There's still some debate about how much we need, right so, there was the ten thousand steps going around for a while, and then one of my colleagues did a study that showed that maybe six thousand was probably okay for people with OSTEO worth right, as there are guidelines out there for how active we need to be that can be very daunting if we start there. So you know, a hundred and fifty minutes a week sounds pretty scary, but again it's it's the essential piece of

just moving. And if that's a very small bit at the beginning and we're working up, then that's all we can ask anyone to do. We can't leap straight to full maximum healthy adult guidelines and and go from there. That's just not how it is, yes, And how do you know when movement pain is pushing the limits or over extending? So I usually tell people it's okay if you're a little sore the next day, that's kind of again to be expected it if we haven't been doing

too much. But if it's lasting for a few days or it's really debilitating, like I walked yesterday and I'm in bed today, that was either too much or there's something else going on. If it's a joint pain issue, we shouldn't have red, warm, swollen, angry joints, right, So they might be a little bit puffy if we were just up and about more, And that's okay, that should

go away. But if there's acute pain, new redness or warmth, something that's never happened before, pain in a place that's never happened before, those are all things to look out for. But generally, what we expect is that the joints that hurt might hurt a little bit more after the activity, and they might be a little sore the next day, and then we should be back to where we were going or even feeling a little bit better by then. So big changes, though, or or new things that hadn't

happened should be at least evaluated. It might be okay still, but we just want somebody to take a look and make sure that we're not causing a new problem or or you know, maybe our gate isn't quite right and we're generating some new pain issue that we didn't have before. So just being aware of our bodies, where we started, where we're going, and what to expect. I generally don't

recommend jogging. There are people that swear by it, and that's fantastic for for the people that can do it, but I think just the impact on the feet and the ankles and the knees and the hips and the lower back, which can all be affected by osteo earth. Right, As it's certainly not where we want to start, it may be a place that we can get to other things that have a lot of pivoting, like individual high level tennis. Right there's so much stress on the knees

or skiing. Some of those things probably are not what we want to aim for, but less impactful things that are maybe over a longer period of time, are generally going to be okay. And if there's a goal that a patient has, like I really want to the end of this is often play nine holes of golf, but I'm sure there are other examples. Um, then we can work up to that. Right, if we know where we're going,

maybe I can get you started. I can send you to a physical therapist and they can get you further along. And if it's more elite activity that we're trying to get to, maybe it's a younger person with arthritis, which also happens, maybe a sports medicine person or a physical medicine and rehabiting. There are pathways through which we can work to get people to where they need to go.

In most cases, and um, I'm asking for a friend, but what do you do when you have a former NFL football player husband who has O A and all the joints, but he thinks he needs to go skiing because he wasn't allowed to when he was in the NFL, making up for lost time, and just thinks he's competing

in the Olympics. I just had to ask because my husband was a professional athlete, and those athletes that compete at a very very high level, you know when they're told they have to do something as simple as walking to get better, and they feel like they have to grind it out, you know, walk a marathon. So if he's really enjoying it, then it's probably worth doing. But you know, maybe he only needs to take the run

twice instead of six times. Right, maybe he takes it once in the morning, once in the afternoon, takes a little break in the middle. Uh, we can do the things, but we might not can do the things at the same intensity. Yes, that's right. Thank you so much for that. I just needed a little wifely encouragement you well. Thank you so much Dr Amanda Nelson for talking to me today on care walks. I love the idea of the commercial movement breaks. I think that's a great starting place.

If you're not in the habit of moving just yet, it's important to take it in little bite sized pieces to get yourself going right. And I really appreciate having this conversation with you. Thank you so much. We thank you, Holly. It's been fun. I want to thank Dr Nelson again for being my guest today. I really appreciated our conversation and I hope you learned as much as I did about finding ment that will help your joint pain and the physical benefits of implementing movement as well as what

it does for our mental health. That's it for today's episode. Thank you once again to Dr Amanda Nelson for joining me, and don't forget to come back next week for another walk with our guest actor and caregiver Jenny Garth. We're going to talk about her experience as a caregiver for her father and how she now prioritizes self care and manages her joint pain. And remember keep walking and don't

forget to take care of yourself too. Care Walks is produced by I Heart Radio in partnership with al Teren Arthritis Pain Jail and hosted by me Holly Robinson. Pete. Our executive producer is Molly Sosha. Our head engineer is Matt Stillo. This episode was written and produced by Sierra Kaiser, with special thanks to our partners at GSK Platform, GSK, Weber Shandwick An Edelman,