Physical Activity: Start Where You Are | Ep. 72

Full Transcript:
Released 2/7/2023
 
 
PODCAST OPEN:                 
You’re listening to the Live Yes! With Arthritis podcast, created by the Arthritis Foundation to help people with arthritis — and the people who love them — live their best lives. If you’re dealing with chronic pain, this podcast is for you. You may have arthritis, but it doesn’t have you. Here, learn how you can take control. Our host is Rebecca Gillett, an arthritis patient and occupational therapist, who is joined by others to help you live your Yes.  
  
MUSIC BRIDGE
 
Rebecca Gillett:
Thanks for joining us on this episode of the Live Yes! With Arthritis podcast. We all know that staying physically active is one of the best things we can do for our arthritis and overall health. But let's be honest, staying active when pain is persistent is really hard and at times it may feel pretty impossible. But we know the research and recommendations for the benefits of physical activity are well documented.
 
The CDC has recommendations for adults with chronic health conditions and disabilities to get at least 150 minutes of moderate intensity aerobic physical activity a week and at least two days a week of muscle strengthening activities. That sounds like a pretty lofty goal to me. And I know personally, it's very lofty right now after dealing with a lot of health issues.
 
What does it actually mean to be physically active? What does that look like? And what if you can't meet those guidelines? In this episode of the Live Yes! With Arthritis podcast, we're going to answer those and many more questions about physical activity and arthritis and the importance of just starting where you are.
 
So, today I’m excited to have as my guest co-host for this episode a longtime Arthritis Foundation volunteer and Patient Leadership Council member. She's also a board member for the Atlanta office, and her name is Stacy Courtnay. Stacy, thanks for joining me today in this conversation.
 
Stacy Courtney:
Thank you for having me.
 
Rebecca Gillett:
You will be able to see her in our Your Exercise Solution videos on our website. Share a little bit about your arthritis journey.
 
Stacy Courtney:
Those videos were so fun to make last year. I live in Atlanta, Georgia with my husband and my 15-year-old son. I was diagnosed with rheumatoid arthritis when I was 24. I've had it about 20 years now.
 
We decided to have a child a little bit sooner than we wanted because back 15 years ago, you know, the safety of biologics, there wasn't a lot of research back then. So, I stayed on prednisone for my whole pregnancy. And then after John was born, I think it took five or six years to find something that really worked for me. Finally, in 2011, I call it my miracle drug that I finally found, and I have been pretty stable since then. Once I started feeling better, I got really involved with the Arthritis Foundation because I like to think that they were part of helping me in finding this miracle drug because of all the millions of dollars of research that they put into finding safer treatments, more effective treatments.
 
So, here I am today. I'm actually the board chair for Georgia and on the Patient Leadership Council, and really enjoy the organization and all that it does for all of us that are trying to find our miracle drug and trying to figure out what works for us along the way. I know we’ll talk about this more later, but staying active is hard even when you're stable like I am. Some days, it just takes a lot to get moving. It takes a lot, and every day is different when you have a chronic illness.
 
Rebecca Gillett:
You have been a longtime advocate for the arthritis community and for the Foundation. Thank you for being here to bring your perspective. I’m excited to welcome our guest, Kirsten Ambrose.
 
Kirsten is the associate director for the Osteoarthritis Action Alliance, located in the Thurston Arthritis Research Center at the University of North Carolina at Chapel Hill. She has a Master's of Science in Exercise Science, and more than 20 years of experience managing multidisciplinary teams toward successful research in chronic, pain-related disorders. Welcome to the podcast, Kirsten.
 
Kirsten Ambrose:
Thank you, Rebecca. Thank you for having me.
 
Rebecca Gillett:
Can you just tell us a little bit about yourself and what you're currently working on?
 
Kirsten:
Sure. Now I'm focused on osteoarthritis awareness from an educational and behavioral standpoint. We want to bring that out to the public, to people every day who struggle with these issues and can't figure out what they're supposed to do. They know they should be active, but they don't know where to start. Or they just want to reaffirm what they are doing to make sure that they're on the right track.
 
Physical activity is extremely important. Regardless of whether you're also taking other medications or have other treatments that you're pursuing, physical activity should be right up there with those treatments as well.
 
Rebecca Gillett:
Let's just get this out of the way because I don't want to focus on this. I mentioned a little bit about what the Physical Activity Guidelines are. Can you just kind of go over that so we can say, "OK, here's what they say."
 
Kirsten Ambrose:
The Physical Activity Guidelines that CDC has put out are a resource, literally a report that is primarily intended for health professionals and policymakers. It provides evidence-based guidance on physical activity.
 
Stacy Courtney:
So, it was talking about 150 minutes of moderate intensity, aerobic physical activity, and then two days a week of muscle strengthening. So, what does that look like for someone who can barely get out of bed?
 
Kirsten Ambrose:
When an individual person looks at these and says, "Well, what the heck does that mean?" Or "There's no way I can do that much." Or, you know, "How should I start? What does this mean for me?" It is up to the individual to figure out where they are, you know. But that's not where you start necessarily.
 
Rebecca Gillett:
Right.
 
Stacy Courtney:
I it’s daunting when you see that 150 minutes and people are like, “Oh my gosh, how in the world could I ever make it up to that?” I think it's important to break it down, and maybe just say, “Hey, I'm going to do 30 minutes a week.”
 
Kirsten Ambrose:
Anything is better than nothing. And I will point out that even though we don’t want to kill ourselves over these guidelines, they do say in there that moving more is the goal. Move more than nothing. Five minutes is good.
 
PROMO:
The Arthritis Foundation’s Walk to Cure Arthritis is back this spring nationwide! Together, we’re raising money for better treatments and a cure for the nearly 60 million Americans with arthritis. Help Rock the Walk. Sign up at https://www.arthritis.org/events/wtca.
 
Rebecca Gillett:
I have, in my conversations over the last several years, moved from talking about exercise to just physical activity. Because in talking to more and more patients: “I don’t like going to a gym to work out. I don't go on a treadmill. I'd rather go outside and go on a walk or on a hike.” I have a friend who belly dances for her physical activity. I have friends who do dance parties every day when they wake up in the morning just to get their body moving and get range of motion.
 
Just move. And move in a way that is going to bring you joy, right? So, I think that message Move Your Way is a good way to take it to heart. It doesn't have to be lifting weights and doing that kind of thing. Eventually, you can get there, right?
 
Kirsten Ambrose:
Absolutely. Doing what you can do. And you know, I think in our culture we hear this phrase: "You do YOU." The key is finding those exercises, those physical activities, however you want to define them, that you enjoy. The very true answer is: Do the exercise that you will do.
 
Whatever the case may be, whatever your circumstances are, finding activities that fit within those circumstances will give you the most success. Things that are convenient. If you have to go out of your way, you'll never do it after maybe the first one or two times.
 
Getting outside that box of thinking you have to go to a gym or do prescribed cardiovascular work or prescribed weight training work. It doesn't have to be that way. Take a walk, walk the dog, walk with a friend. Go swimming, gardening, shoveling.
 
Rebecca Gillett:
Stacy, I know you do a lot of different things. What kinds of things have you found have brought you joy in your movement?
 
Stacy Courtney:
Well, I am not a fan of going to gyms either, but I do have a little home gym set up, and I love doing online classes. I just want to be by myself in front of the TV watching the video. And I love to walk my dog and walk the hills in the neighborhood sometimes. So yeah, I try to mix it up, but I just feel fortunate now because there were so many years that I could not do anything more than just walking.
 
Rebecca Gillett:
You've been navigating this for a long time. You've figured out your limits, right?
 
Stacy Courtney:
Right.
 
Rebecca Gillett:
Stacy is one of the patients in the videos for the Your Exercise Solution videos. We'll have links to that in the show notes. There’s some videos that Stacy is part of where you’re doing just stretches, some it’s just body weight, some you can do in a chair, some you’re using resistance bands or light weights, but that's the beauty of that program. These videos can show you different ways to modify the movement so that you can start where you are.
 
I know another thing that hits me sometimes is the fatigue. I'm just curious about one, from Stacy, how you manage fatigue days when it comes to staying active. And then Kirsten, if you can comment on what people should do when they have fatigue?
 
Stacy Courtney:
For a while, I would say that my fatigue was worse than the pain at times. I mean, it was just to have the energy to get out of bed; it was really, really bad. That in itself was depressing because I didn't have the energy to get out and move. On days that I do feel like that, I do try to do stretching or something like yoga. Fatigue is just something that I think that we all combat even when our pain is well managed. And so it is very difficult.
 
Rebecca Gillett:
Kirsten, explain how physical activity and being physically active can actually help your fatigue.
 
Kirsten Ambrose:
I think a key factor for folks is when you have, whether it is a bout of fatigue or even a pain flare, is to understand how to adjust to that. It can be very mentally draining, emotionally draining, to have those episodes and to keep moving through them is really the key. Finding different activities that are lower intensity.
 
Say you do 20 minutes of walking every day. If you're having a particularly challenging day, scale back on that perhaps to 10 minutes in a day, or even five minutes in a day. Do that for a day or two or three as long as you're having this episode. And then as you start to feel back to your normal self, ramp that time back up again to get back up to your 20 minutes.
 
I think one of the important things to remember is: It's always a good idea to keep moving. There's also an argument to be made for the fact that physical activity helps you through these episodes as well. It may feel counterintuitive, but it's a good thing to stay at least a little bit active. To move your body, to keep your joints mobile, to keep yourself flexible and moving through these episodes, so that you don't increase stiffness or exacerbate pain, making pain worse if you're not moving.
 
It's recognizing within yourself where your limits are and how to make some adjustments day-to-day as you travel through.
 
Rebecca Gillett:
If it's not a day that you can move the way you normally do, scale it back, or do something different, even if it's sitting. Even if it's in bed. I do stretches in bed before I get up all the time because of my back and my OA in my spine. But even if it's just moving while you're watching TV in those, you know, moments where you're just doing some leg lifts while you're sitting on the couch. It's, you're moving, right? And feel good about that.
 
PROMO:
Arthritis Foundation webinars cover topics like Fitness Solutions for arthritis, from cardio/aerobics to balance, flexibility and therapeutic exercises, plus protecting joints and preventing injury. Scroll through our webinars on demand, at https://www.arthritis.org/events/webinars
 
Rebecca Gillett:
What does a well-rounded physical activity routine look like for our listeners?
 
Kirsten Ambrose:
On the days where you're having a pain flare or feeling tired and needing to scale back, part of it is because we want to have a well-rounded physical activity sort of plan or activities that we do. Being kind to yourself and accepting that it's OK to do different activities and to scale back is also a good thing. Including stretching, including yoga, including those kinds of activities that are a little bit lower key, perhaps, depending on the style of yoga that you do. They’re still perfectly acceptable and encouraged in your whole physical activity sort of picture for yourself.
 
To be well rounded, I would say, you would ideally want to be addressing cardiovascular health and fitness activities, such as walking or dancing. Or shoveling sometimes can also bring your heart rate up and get you moving that way. So having physical activities that get your heart rate up, to elevate your heart rate, that will help with not just heart health, but overall fitness and stamina and your ability to manage your everyday life without fatiguing so quickly.
 
Exercises that address muscle strength are also important, so that you can maintain independence. That you can accomplish your everyday activities again without fatiguing or wearing yourself out. Muscle-strengthening activities also help to stabilize joints. So, for those folks who have joint pain or instability from arthritis, and so many forms of arthritis, having or maintaining muscle strength is a great way to maintain stability. Whether that's stability for walking, stability for just moving through life for balance.
 
Speaking of well-rounded physical activity, those activities that emphasize balance so that we can help reduce falls, which is such an enormous risk for poor outcomes. We want to keep people from falling so maintaining balance, flexibility throughout the joint, is also an important factor to a well-rounded physical activity program.
 
Rebecca Gillett:
Thank you for giving kind of that overall picture. And I think one other thing we should probably touch on, too, is: How does being physically active affect our emotional and mental health?
 
Kirsten Ambrose:
We know that when we're physically active, the mere activity releases hormones and markers in our body that directly address depression and anxiety and are known to elevate our mood. Another aspect of physical activity is that it very often improves confidence, self-confidence in our ability to get through our daily lives. Our ability to stay connected with friends and family, our ability to conduct our jobs, to work and be productive as we age and start to lose some agility and the quick reflexes that we once had when we were younger.
 
Improving balance, improving muscle strength and flexibility also helps improve agility. All of this feeds into our self-confidence, our ability to operate in the world the way we want to, our ability to stay independent. That's an enormous factor for all people, especially older adults who may be living on their own and may not have as many social connections, or just struggle to work through their daily life.
 
I think physical activity is really a key for emotional well-being. Physical activity can help improve sleep, which then also has those impacts on improving pain and emotional well-being. So, a lot of times, physical activity can be a good excuse to meet with people. You know, a lot of times being active in a group is more rewarding. Walking with friends, walking with family, working in a community garden, walking the dog in the dog park.
 
Stacy Courtney:
I've always struggled with anxiety about the unknown of chronic illness and the unknown of being on medications for the rest of your life. And so, just getting out there and doing something, it makes me feel confident — like I'm doing all I can do to keep myself healthy, and then it just relieves some my anxiety about all of it.
 
Kirsten Ambrose:
That's a great point, Stacy. It is up to you to do the physical activity, whatever it may be, however you define it. And you do define it. Every person is responsible for their own physical activity. It is something that you can do on your own and then you reap the rewards.
 
And we haven't really touched too much in our conversation about setting goals. And one comment that I'll make with regard to setting goals is: Of course, they keep you on track and keep you focused, keep you motivated. But then when you achieve your goal, that's often quite rewarding.
 
Rebecca Gillett:
Yeah.
 
Kirsten Ambrose:
Whatever your goal is, it's yours. And once you achieve that goal or take the steps along the way towards reaching that goal, those things can also help build your self-confidence and your sense that you're taking control of your own well-being and your own health. And that’s very important I think for a lot of folks.
 
Rebecca Gillett:
Definitely. Having something we can control when you have a chronic disease and when you have something like arthritis, especially rheumatoid arthritis and inflammatory types of arthritis, you often feel like you can't control what happens to you. But the amount you move and how you move and how physically active you are, you can control.
 
PROMO:
Movement is the best medicine. But it can be hard when you hurt. Your Exercise Solution is a resource to help you create a customized physical activity routine based on your specific needs and abilities. Learn more at https://www.arthritis.org/health-wellness/healthy-living/physical-activity/getting-started/your-exercise-solution.
 
Rebecca Gillett:
In this next segment that we have, the listener segment, we post a question on social about: How do you gauge the intensity of your physical activity? We did have some people chime in and say, "It depends on my pain and fatigue levels that day. I like walking because I can choose the length and intensity. And water exercise is helpful when my pain is higher." So, I thought that may be something to touch on, Kirsten.
 
Kirsten Ambrose:
It really is up to every individual to figure out what that means, and it depends on your goals. It depends on your current fitness level. It depends on whether you have challenges from any chronic disease, arthritis or otherwise, and how that impacts how hard you're working out. It also depends on whether you've been physically active much at all in your life before or in a long, long time.
 
I think it's important to pay close attention to how you're feeling. And some normal changes that you can expect with physical activity include an increase in your heart rate. If your heart starts beating faster, generally that is a good thing and should be expected. If it starts racing or it's beating much faster than the activity requires, then perhaps you might want to scale back a little bit.
 
Another response you might notice: Your breathing increases. Another thing that is a perfectly normal response to physical activity. How much you're breathing increases is directly related to how intensely you are working out. And a lot of times a good guideline that you might have heard before is if you can carry on a conversation, even if you're still feeling a little bit out of breath, that's a good marker.
 
If you are completely breathless, almost panting, that can be OK if you're doing that on purpose, if you're working out that hard. For example, if you're sprinting or really pushing yourself. But if you're not, and you find yourself very much out of breath in a way that is not related to how hard you think you should be working, then again that's when you might scale back and pause or rest or tone it down a little bit.
 
Another thing would be your body temperature. Whenever you move, your body temperature goes up, you might start sweating. Also normal responses to exercise, but this is all for you to be paying attention to yourself as you start to move. But if you're just starting out, start low, go slow. And slowly work your way up to more intense or longer times.
 
Rebecca Gillett:
Bionic RA on social, she says, "I'm familiar with my arthritis pain. So, when unfamiliar pain pops up, I change things up. I am unapologetically competitive and drive and frequently overdo it and burn my hair off which..." That's pretty funny (laughing), meaning she's one of those diehards, right? And so she will, you know, push herself more. At what point, when somebody is an intense person who works out or is physically active in a high intensity way, should they pay more attention to maybe scaling back?
 
Kirsten Ambrose:
I think she made a good point about if there is a new pain that emerges, that's an indicator that perhaps something is different and a clue to not continue, to scale back to change what you're doing.
 
Another good guideline that we'd like to share: I know you're familiar at the Arthritis Foundation with the Walk With Ease program, which is an evidence-based program that helps people learn how to walk safely and comfortably. The nice thing about Walk With Ease: It helps people to set goals and learn how to progress slowly and safely.
 
If you have finished working out, finished your physical activity, and two hours later you're still feeling pain, or you have, you know, an increased pain or you're still feeling the aftereffects of that workout, it's probably a good indication that you've overdone it. So, taking the necessary time to recover from that, whether it's a day or two, or the next time you exercise, really scale back and not do that same level again, but to take that into account and scale back.
 
Rebecca Gillett:
Well, thank you so much for all of your insight. We like to end the show with sharing our top three takeaways from our conversation today. I'll start with you, Stacy.
 
Stacy Courtney:
I would say number one is, like we've all said a couple of times, just keep moving, whatever it is. Start small, set realistic goals for yourself. And like I said before, do what you can to control what you can, the things that you can control. And that is taking care of your body and moving as much as you can. And I think that just helps. It eases your anxiety or depression, and it makes you overall healthier.
 
Rebecca Gillett:
I love it. Kirsten?
 
Kirsten Ambrose:
Sure, absolutely. Well, we started our conversation with the Physical Activity Guidelines. So, one takeaway I'll share for me is that those really are just guidelines, and not to get so caught up in trying to meet them, trying to figure out what they mean for you. You start where you are and set your own goals.
 
Another takeaway is that I think exercise really is the best medicine in many ways. We've talked about the physical and emotional benefits that you can get from being physically active. And those benefits show up with so little activity, really.
 
It does not take a lot to start to see changes in your body that are positive in many ways, whether that's reducing pain, whether that's managing anxiety, whether that's improving sleep, whether it's being able to play with your children or grandchildren or walk the dog or attend social functions again. All of these factors really come from being physically active and maintaining your overall health.
 
And then finally, it's up to you to decide how to be physically active. When, where, why, how, all of that is up for you to decide. No one else can do it for you. Seek help if you need to from a fitness professional, from a health care provider, even from trusted organizations like the Arthritis Foundation or the Osteoarthritis Action Alliance. But ultimately, you set your goals, you monitor your progress and you reap the rewards.
 
Rebecca Gillett:
Thank you. And I will put in another plug for the Walk With Ease program and our Your Exercise Solution videos on the Arthritis Foundation website. If you go to arthritis.org, you can get information on both Walk With Ease and the Your Exercise Solution videos, and see Stacy showing you how to modify those exercises and stretches. There'll be some links in the show notes. And thank you both again for this conversation and helping us all get physically active in starting where we are and a reminder to our listeners to just move. Thank you.
 
Stacy Courtney:
Thank you, Rebecca. Thank you, Kirsten.
 
Kirsten Ambrose:
Thank you from me, too. I enjoyed it.
 
PODCAST CLOSE:           
The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation, to help people living with arthritis and chronic pain live their best life. People like you. For a transcript and show notes, go to https://www.arthritis.org/liveyes/podcast. Subscribe and rate us wherever you get your podcasts. And stay in touch!