Exercising alone will not ease that painful arthritis

QUESTION: Can exercise help in dealing with the pain of arthritis? Someone referred me to take yoga sessions to limit pain but that isn't working.

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If I may paraphrase your question, what you really wish to know is whether doing exercise will positively affect the form of arthritis you suffer from.

Before answering your question, please allow me to make the point, often made in this column, which is that there is no wisdom in consulting “a friend” on matters such as this one.

Firstly, your friend might not get the diagnosis right, and secondly even if he does, the treatment options for a condition such as you now describe are so many that a new branch of medicine dealing only with the diseases of the joints has emerged.

Happily, we have in Kenya several rheumatologists who can offer expert advice on the matter that you would like us to address today.

You do, however, raise a more general question regarding the relationship between pain and exercise and this is an area with little or no controversy. You will no doubt have heard of endorphins and the role they play in pain relief.

Indeed, if you engage in any form of sport, you will be familiar with the high that one gets say after a good run in the morning. This so called high is the result of the release of the endogenous morphine-like hormones called endorphins.

Indeed, the name of the hormone tells us that it comes from within the body (endogenous) and that it is morphine-like (orphine).

It might come as a surprise for some to discover that this same hormone is released during sexual activity with the same feel-good effect.

Specific to your question, however, there is evidence that exercise reduces the pain associated with arthritis and the fact that you do not seem to benefit from exercise might be due to some factors that your doctor might help you understand.

For example, are you sure of the diagnosis, or might there be another explanation for what you assume to be arthritis? Do you for example have gouty arthritis or could the joint problems be due to systemic lupus?

Although exercise reduces pain in the joints arising from many conditions, there is no uniformity in this effect in all people and in any case, there is no evidence that exercise alone will give all people all the pain relief they might need in all diseases of the joints. In many cases, the doctor might advise the use of medication plus exercise.

Just to complicate things for you a little, did you know that depression and arthritis are often found together? Indeed, did you know that depression and diabetes often go together? What about the link between heart disease and depression?

What, you might be wondering is the point of all these links. It is simply for the purpose of letting you know how complex the human body can be and how many different diseases sometimes go together.

Going back to arthritis just for a moment, you might not know that not only is it associated with depression, when the two conditions exist together, one must treat both if one expects the patient to get better. Fortunately for you, exercise is good for both depression and arthritis.

Sometimes, the pain of arthritis makes the patient suffer much stress which might lead to further depression and sometimes the depression might reduce the ability of the patient to tolerate the pain due to arthritis, in a sense one condition making the other worse.

There are different types of the condition called arthritis. One of the commonest varieties is the type associated with past trauma such as that seen in rugby players who suffered old trauma in their active days.

Some can be so severe that hip or knee replacement might be the only viable option. In such cases and as your friend might have told you, medication and exercise do not give you adequate pain relief or return of function.

As you can see from this answer, the issues you have raised are numerous and range from the benefits of feeling good from regular exercise to the complexities of the link between heart disease and depression to the surgical field of hip replacement surgery.

The inescapable conclusion is that the doctor you choose to consult must look at you as a whole person and not a series of unrelated organs that are subject of many different and unconnected diseases.

Looked at this way, the doctor and his patient are in a better position to use all the available treatment options which in this case would include physical exercise.