Speaker 1: Hi everyone.
Speaker 2: I'm Holly Robinson, pete actor, author, advocate, do it all mom,
Speaker 2: and I'm also a caregiver. And this is care Walks,
Speaker 2: a podcast from iHeartRadio and Voltaian Arthritis Pain Gel. It's
Speaker 2: a show for family caregivers who give everything to everyone
Speaker 2: and need to make time for themselves through movement. Every
Speaker 2: episode is designed for you to walk as you listen,
Speaker 2: so just think of me and my guests as your
Speaker 2: weekly walking buddies. We'll hear stories from caregivers and gain
Speaker 2: tips and insights from health experts and advocates who know
Speaker 2: how important it is to take care of yourself and
Speaker 2: manage joint pain due to arthritis that often a companies
Speaker 2: being a caregiver. Together, we'll find community ourselves and maybe
Speaker 2: even alleviate some joint pain in the process as we
Speaker 2: walk together and connect to the best parts of being
Speaker 2: a caregiver. Welcome back to Kara Walks, everyone, and thank
Speaker 2: you for taking time to join us, and thank yourself
Speaker 2: for taking time to make your self care a priority.
Speaker 2: All right now, just a reminder, Right now you're listening
Speaker 2: to the full version of this episode, but if you
Speaker 2: don't have time for a full walk today, then go
Speaker 2: check out our bridged version of the same episode. It's
Speaker 2: like cliff Notes for podcasts, so no matter how much
Speaker 2: time you have, you won't miss out on a great conversation.
Speaker 2: All right, now that's settled, let's dig into the episode. Today,
Speaker 2: we're talking about the importance of movement for caregivers living
Speaker 2: with osteo arthritis. It might seem obvious that we should
Speaker 2: implement exercise and movement into our weekly routine, yet so
Speaker 2: many of us struggle to stick to that habit, and frankly,
Speaker 2: I find that understanding more deeply how movement affects and
Speaker 2: helps joint pain can go a long way, and helping
Speaker 2: solidify new movement habits and keep up with them to
Speaker 2: help le's better understand how joint pain affects caregiving. I
Speaker 2: will be joined by doctor Amanda Nelson, a rheumatologist and
Speaker 2: associate professor at the UNC Thurston Arthritis Research Center. She
Speaker 2: understands both the challenges and the best strategies from managing
Speaker 2: away from her experience working directly with patients, both in
Speaker 2: clinical care and in research. But before we get into
Speaker 2: today's conversation, let's begin our walk. We're going to focus
Speaker 2: on staying present within our bodies and within our movement.
Speaker 2: Think about the contact you're making with the ground. What
Speaker 2: does that feel like? Be sure to relax your shoulders
Speaker 2: as you walk, pull them down from your ears and
Speaker 2: breathe in deeply through your nose. Feel the sensation of
Speaker 2: your stomach and your chest rising with your breath. And
Speaker 2: now breathe out through your mouth and let everything in
Speaker 2: your box. Relax as you breathe. Be aware of the
Speaker 2: air filling in your lungs. Can you feel your chest
Speaker 2: compressing as you slowly release the breath. Take a beat
Speaker 2: to walk through your five senses. What do you see
Speaker 2: around you? What sense or filling the air? What do
Speaker 2: you notice about the way your body moves as you
Speaker 2: set your pace? Now as you settled into your rhythm.
Speaker 2: I'm going to share my conversation with our guest, and
Speaker 2: together we're going to learn a little bit more about
Speaker 2: how we can all benefit from keeping our bodies moving. Today,
Speaker 2: I'm joined by doctor Nelson, a rheumatologist and associate professor
Speaker 2: at the UNC Thurston Arthritis Research Center. She understands both
Speaker 2: the challenges and the best strategies for managing OWAY from
Speaker 2: her experience working directly with patients, both in clinical care
Speaker 2: and in research. Doctor Nelson, thank you so much for
Speaker 2: joining us on care walks.
Speaker 3: Well, thank you very much. I'm happy to be here.
Speaker 1: I'm happy you're here too.
Speaker 2: Could you tell us a little bit about the work
Speaker 2: that you do and how you have helped joint pain
Speaker 2: sufferers improve their symptoms, and can you tell us how
Speaker 2: oway affects the body and its ability to move.
Speaker 3: Yeah, So, as you mentioned, I'm a rheumatologist and I
Speaker 3: see patients one day a week, and those patients have
Speaker 3: a range of arthritic conditions and a lot of them
Speaker 3: have challenges with mobility. I also do research primarily an osteoarthritis,
Speaker 3: which is the most common form of arthritis, around a
Speaker 3: lot of different aspects, risk factors, disparities, issues of imaging
Speaker 3: and biomarkers, how we might tell people do or don't
Speaker 3: have arthritis, how it might progress, and some novel methodologic
Speaker 3: approaches to try and understand it better for future clinical
Speaker 3: trials and clinical care. So the main recommendations around symptomatic improvements.
Speaker 3: So first I would say that there is no drug
Speaker 3: or other intervention that really affects the process. So once
Speaker 3: arthritis has started particularly osteoarthritis. There's really no way to
Speaker 3: make it stop or make the cartilage regrow currently, and
Speaker 3: so we do mainly focus on symptoms and improving those symptoms.
Speaker 3: One of the best ways to do that is exercise,
Speaker 3: and we have shown in a variety of different studies
Speaker 3: that exercise really does improve pain. Often that's not the
Speaker 3: first thing that happens, so people have to work through
Speaker 3: some initial discomfort. A lot of times, maybe they haven't
Speaker 3: been very active and they have to sort of get
Speaker 3: into the routine and get over some initial joint pain.
Speaker 3: But over time, being regularly active does improve the pain
Speaker 3: and symptoms of arthritis. Osteoarthritis primarily affects the joints. It's
Speaker 3: a little bit different than say rheumatoid arthritis or lupus
Speaker 3: that can also cause joint pain but have a lot
Speaker 3: more systemic symptoms. Oste Earthritis really just stays in the
Speaker 3: joints and it affects all of the tissues of the joints.
Speaker 3: So we used to think of it primarily as cartilage loss,
Speaker 3: which is certainly part of it. The cartilage pad that
Speaker 3: cushions the joint thins over time, it gets damaged, especially
Speaker 3: in the knee, there's a moniscus, there's an additional pad
Speaker 3: that gets broken and damaged, there are tendons and muscles
Speaker 3: that the bone itself gets affected, So it's really everything
Speaker 3: about the joint that gets damaged through the process of osteoarthritis.
Speaker 3: And then obviously you need your joints to walk, particularly
Speaker 3: in the lower extremities, So hips and knees are very
Speaker 3: commonly affected by OA, and with that can definitely impact
Speaker 3: people's mobility. Walking often we think of first, but a
Speaker 3: lot of just activities of daily living require weight bearing
Speaker 3: on the lower extremities and that can become difficult over time.
Speaker 3: For a lot of people with OA. Mobility is incredibly important,
Speaker 3: and if we lose mobility, we often become isolated, lose
Speaker 3: support systems, lose a lot of function, and that can
Speaker 3: then contribute to depression, which is also pretty common in arthritis.
Speaker 3: So mobility in general is really important, and reduced mobility
Speaker 3: is actually a marker of reduced to lifespan. So people
Speaker 3: that walk slower are really unable to walk generally just
Speaker 3: don't live as long and they don't have as high
Speaker 3: a quality of life as those who have more normal mobility.
Speaker 2: Right and you know, for a lot of joint pain sufferers,
Speaker 2: movement is such an important part of their self care
Speaker 2: journey and it can be so difficult. A lot of
Speaker 2: our audience are not only folks with joint pain, but
Speaker 2: also people who are caregivers to family members like myself.
Speaker 1: So I'm curious, do you work with patients who are.
Speaker 2: In a similar role and what do you notice about them?
Speaker 3: So the caregiver themselves often is taking on that role
Speaker 3: in a way that sort of reduces their focus on
Speaker 3: their own health. And so if you're extremely focused on
Speaker 3: taking care of someone else who you see as being
Speaker 3: very in need of your services in that way, then
Speaker 3: you often overlook your own stuff, right, So you're not
Speaker 3: going into the doctor, you're not going to exercise, you're
Speaker 3: not eating right as that caregiver. So one thing is
Speaker 3: certainly to encourage those folks to keep a focus on
Speaker 3: their own health, because if they're not healthy, they can't
Speaker 3: take care of the other person either. I think that
Speaker 3: the isolation piece fits in there too. So if a
Speaker 3: person is very focused on their caregiving role, they may
Speaker 3: not interact with friends or do social things or other things.
Speaker 3: They're just so focused on that and then a lot
Speaker 3: of caregivers share a lot of risk factors with the
Speaker 3: person they're giving care too, So if it's a family
Speaker 3: member or a sibling or even a friend, a lot
Speaker 3: of times those sets of people are from similar backgrounds.
Speaker 3: Maybe they share a similar environment, they have a similar diet,
Speaker 3: a similar culture, and all of those things are going
Speaker 3: to put the caregiver at risk as well. So if
Speaker 3: the individual being cared for has ostearthritis of multiple joints
Speaker 3: and limited mobility, it may well be that the caregiver
Speaker 3: also has some joint pain that's limiting their function. And
Speaker 3: on the research front, that feeds right into a lot
Speaker 3: of the interventions now where people are trying to engage
Speaker 3: a caregiver or a support family member, sibling, whoever it is,
Speaker 3: because walking and other interventions are a lot easier if
Speaker 3: there's two people. So maybe you and your sister can
Speaker 3: go out and take a walk and have a chat
Speaker 3: about joint pain rather than just again being isolated and
Speaker 3: trying to do things all by yourself. So engaging the
Speaker 3: caregiver in the interventions can be very helpful.
Speaker 1: Some of our.
Speaker 2: Listeners might be new to incorporating physical activity or movement
Speaker 2: into their routine. And as we all know, I mean
Speaker 2: I speak for myself, but I think also for a
Speaker 2: lot of other people, just the prospect of starting something
Speaker 2: like that it seems intimidating. So what would you say
Speaker 2: is the simplest and best way for them to get started?
Speaker 3: I think a lot of my patients, and certainly in
Speaker 3: our research studies as well, people are often coming from
Speaker 3: a position of no activity. They're very sedentary. They might
Speaker 3: get up and go to the store, otherwise, you know,
Speaker 3: on the couch or not engaged in a regular routine.
Speaker 3: And so there's a lot of ways to approach that.
Speaker 3: It depends a lot on where people start. So if
Speaker 3: we're starting from a place of I do nothing but
Speaker 3: sit on the couch, then the first thing we say
Speaker 3: might be, well, during the commercials on the television, we're
Speaker 3: going to stand up and we're going to move around,
Speaker 3: and we're going to do that every single commercial because
Speaker 3: there's a lot of commercials, and so that can get
Speaker 3: you a long way. If we're from a place of well,
Speaker 3: I move around in the house, but I don't really
Speaker 3: like to go out and walk, you know, then maybe
Speaker 3: I say you should walk for five minutes a day.
Speaker 3: You know, three days a week, and I work very
Speaker 3: slowly up to a goal of maybe thirty minutes a
Speaker 3: day for three to five days a week. And I
Speaker 3: actually have a walking prescription where I can write this
Speaker 3: out for people and say, look, this is the medicine
Speaker 3: for your arthritis. The medicine for your arthritis is to
Speaker 3: get up and walk. But it's extremely important to meet
Speaker 3: people where they're starting, because if I just start with
Speaker 3: thirty minutes five days a week, they're going to have
Speaker 3: that exact reaction and I say, there's no way I
Speaker 3: can do that, and I'm not even going to try.
Speaker 3: And so understanding where people are coming from, what their
Speaker 3: barriers are, you know, do they feel like they're going
Speaker 3: to fall? Are they living on a two mile long
Speaker 3: gravel road and they can't walk, and really coming up
Speaker 3: with a plan that's going to work for that person,
Speaker 3: anyone they're caring for, you know, working around their schedule.
Speaker 3: All those things are very important to getting people started
Speaker 3: and also to maintain because you know, if they do
Speaker 3: it once and then give up, that doesn't help.
Speaker 2: We'll be right back with more from doctor Amanda Nelson,
Speaker 2: and now back to my conversation with doctor Amanda Nelson,
Speaker 2: What would you say is one of the biggest roadblocks
Speaker 2: for patients who are just trying to find the right
Speaker 2: ways to fit that movement into their day.
Speaker 3: Definitely scheduling and not prioritizing it. So this thing about
Speaker 3: putting our own health on the back burner and taking
Speaker 3: care of others, whether that's kids or people we're caring for,
Speaker 3: it's essential to prioritize your own health and say, look,
Speaker 3: I walk from eleven to eleven thirty, and even if
Speaker 3: I don't get my walk, I'm going to do something
Speaker 3: healthy for myself in that time. Or Mondays, Wednesdays and Thursdays,
Speaker 3: I have this half hour, you know. Finding that slot
Speaker 3: and then either scheduling it, blocking it off, telling everyone
Speaker 3: you're not available some way to really make that happen
Speaker 3: can often be very helpful because you would schedule other things.
Speaker 3: So just call it a doctor's appointment, or call it
Speaker 3: a haircut or a dentist cleaning or something, because it's
Speaker 3: just as important as those things. And a lot of
Speaker 3: individuals do like a more structured program. So a lot
Speaker 3: of the courses, like through the Centers for Disease Control
Speaker 3: and the Arthritis Foundation, might have a self directed program
Speaker 3: or you can do it yourself on your own. But
Speaker 3: they also often have group classes that are low cost
Speaker 3: or free where people can go and everyone there is
Speaker 3: going to either have arthritis or be taking care of
Speaker 3: someone with arthritis, and that's a great way to build
Speaker 3: community and see that you're not alone and that there
Speaker 3: are a lot of people dealing with these issues.
Speaker 2: Yes, and you know we're always putting ourselves in the
Speaker 2: back of the line when it comes to caregiving. Sometimes
Speaker 2: we need to put ourselves in the front. Okay, let's
Speaker 2: talk about possible misconceptions about being physically active. I can
Speaker 2: already hear somebody saying, well, woulden movement just add wear
Speaker 2: and tear to my body and potentially make joint pain
Speaker 2: even worse.
Speaker 3: And I get that question all the time because it
Speaker 3: makes sense. Right. You think, well, if the cartilage is
Speaker 3: breaking down, then what I don't want to do is
Speaker 3: use the cartilage. But it's not quite how it works.
Speaker 3: So the cartilage itself doesn't have its own blood vessels,
Speaker 3: it doesn't get nutrients from the body through the blood
Speaker 3: like a lot of other tissues. And the way that
Speaker 3: it gets nutrients in and waste products out is by compression.
Speaker 3: So the actual loading of the cartilage is how the
Speaker 3: cartilage stays healthy. If people are unloaded, you know, for example,
Speaker 3: having a paralysis event where they really cannot walk, the
Speaker 3: cartilage degrades because it can't get nutrients, and so walking
Speaker 3: is healthy for the cartilage. It actually improves the cartilage function.
Speaker 3: And so it's completely counterintuitive, and I get that, and
Speaker 3: so I'm happy to explain that to folks. But the
Speaker 3: joint wants to be loaded now, it doesn't want to
Speaker 3: be It's not a jackhammer, right, So it's not looking
Speaker 3: for high impact major activity, but it does like some
Speaker 3: periodic loading and unloading such as we get with walking.
Speaker 1: And what else?
Speaker 2: What are some other low impact activities that caregivers with
Speaker 2: joint pain can do besides walking.
Speaker 3: Yeah, so walking is certainly the cheapest and easiest we
Speaker 3: can all do it. I have a lot of people
Speaker 3: who benefit greatly from the elliptical system because there's really
Speaker 3: no impact so much as that gliding motion can be
Speaker 3: very helpful. And for people that really have not been moving,
Speaker 3: have a lot of pain, maybe a lot of other
Speaker 3: comorbid conditions, a lot of times water therapy is very helpful.
Speaker 3: Whether that's a PT driven aqua therapy program, or again
Speaker 3: like an arthritis Foundation class at a local pool. Often
Speaker 3: the pool is warm, the buoyancy from the water helps
Speaker 3: to sort of take some of that weight off the joints,
Speaker 3: but still they're being loaded in a useful way for
Speaker 3: the physiology of the joint itself. So there's a lot
Speaker 3: of different modalities and it very much again depends on
Speaker 3: what people want. If you're terrified of the water, then
Speaker 3: I'm not going to tell you to do water therapy,
Speaker 3: but that certainly is a great place to start for
Speaker 3: people that have access and enjoy that.
Speaker 2: Okay, let's talk about self care. How can we help
Speaker 2: caregivers with joint pain see movement as self care. It's
Speaker 2: almost like a psychological exercise, you know, so that we
Speaker 2: don't look at it as this burden of oh gosh,
Speaker 2: I gotta do this, but as actual self care and
Speaker 2: self love. How can we get them to prioritize that.
Speaker 3: Yeah, So education is a huge piece of this, making
Speaker 3: sure that people understand the process of the disease, whatever
Speaker 3: that might be, or if there's multiple diseases at play,
Speaker 3: how the physical activity might benefit them, how it's better
Speaker 3: than a lot of the other choices, and so to say, look,
Speaker 3: exercise is the medicine. This is what you do for
Speaker 3: this problem. This is how you get this better. It's free,
Speaker 3: you can do it whenever you want. You don't have
Speaker 3: to go to the doctor. Like. There's so many benefits,
Speaker 3: and the good news for you today is that all
Speaker 3: you have to do is walk, and walking is going
Speaker 3: to give you the biggest benefit.
Speaker 1: Can a work out be too minimal to see benefits?
Speaker 3: There's two parts to that. One is any movement is
Speaker 3: better than no movement, and so if you're you know,
Speaker 3: just getting up during the commercials or doing those five
Speaker 3: minute walks, that's way better than the sitting on the
Speaker 3: couch was previous to that. We have to start somewhere,
Speaker 3: and we want to encourage people to start where they
Speaker 3: are and move forward. From that point, any movement is
Speaker 3: going to be of benefit over the longer term. There's
Speaker 3: still some debate about how much we need, right so,
Speaker 3: there was the ten thousand steps going around for a while,
Speaker 3: and then one of my colleagues did a study that
Speaker 3: showed that maybe six thousand was probably okay for people
Speaker 3: with osteorthritis. There are guidelines out there for how active
Speaker 3: we need to be. That can be very daunting if
Speaker 3: we start there. So, you know, one hundred and fifty
Speaker 3: minutes a week sounds pretty scary, but again it's it's
Speaker 3: the essential piece of just moving. And if that's a
Speaker 3: very small bit at the beginning and we're working up,
Speaker 3: then that's all we can ask anyone to do. We
Speaker 3: can't leap straight to full maximal healthy adult guidelines and
Speaker 3: go from there. That's just not how it.
Speaker 2: Is, yes, And how do you know when movement pain
Speaker 2: is pushing the limits or over extending?
Speaker 3: So I usually tell people it's okay if you're a
Speaker 3: little sore the next day, that's kind of again to
Speaker 3: be expected if we haven't been doing too much. But
Speaker 3: if it's lasting for a few days, or it's really debilitating,
Speaker 3: like I walked yesterday and I'm in bed today, that
Speaker 3: was either too much or there's something else going on.
Speaker 3: If it's a joint pain issue, we shouldn't have red, warm, swollen,
Speaker 3: angry joints, right, So they might be a little bit
Speaker 3: puffy if we were just up and about more, and
Speaker 3: that's okay, that should go away. But if there's you know,
Speaker 3: acute pain, new redness or warmth, something that's never happened before,
Speaker 3: pain in a place that's never happened before. Those are
Speaker 3: all things to look out for. But generally what we
Speaker 3: expect is that the joints that hurt might hurt a
Speaker 3: little bit more after the activity, and they might be
Speaker 3: a little sore the next day, and then we should
Speaker 3: be back to where we were going or even feeling
Speaker 3: a little bit better by then. So big changes, though,
Speaker 3: or new things that hadn't happened should be at least evaluated.
Speaker 3: It might be okay still, but we just want somebody
Speaker 3: to take a look and make sure that we're not
Speaker 3: causing a new problem, or you know, maybe our gait
Speaker 3: isn't quite right and we're generating some new pain issue
Speaker 3: that we didn't have before. So just being aware of
Speaker 3: our bodies, where we started, where we're going, and what
Speaker 3: to expect. I generally don't recommend jogging. There are people
Speaker 3: that swear by it, and that's fantastic for the people
Speaker 3: that can do it, but I think just the impact
Speaker 3: on the feet and the ankles and the knees and
Speaker 3: the hips and the lower back, which can all be
Speaker 3: affected by osteoth right as it's certainly not where we
Speaker 3: want to start. It may be a place that we
Speaker 3: can get to other things that have a lot of pivoting,
Speaker 3: like individual high level tennis. Right there's so much stress
Speaker 3: on the knees or skiing. Some of those things probably
Speaker 3: are not what we want to aim for, but less
Speaker 3: impactful things that are maybe over a longer period of time,
Speaker 3: are generally going to be okay. And if there's a
Speaker 3: goal that a patient has, I really want to the
Speaker 3: end of this is often play nine holes of golf,
Speaker 3: but I'm sure there are other examples. Then we can
Speaker 3: work up to that. Right, if we know where we're going,
Speaker 3: maybe I can get you started. I can send you
Speaker 3: to a physical therapist and they can get you further along.
Speaker 3: And if it's more elite activity that we're trying to
Speaker 3: get to, maybe it's a younger person with arthritis, which
Speaker 3: also happens, maybe a sports medicine person or a physical
Speaker 3: medicine and rehabiling. There are pathways through which we can
Speaker 3: work to get people to where they need to go
Speaker 3: in most cases.
Speaker 2: And I'm asking for a friend, but what do you
Speaker 2: do when you have a former NFL football player husband
Speaker 2: who has OA and all the joints but he thinks
Speaker 2: he needs to go skiing because he wasn't allowed to
Speaker 2: when he was in the NFL, making up for lost time,
Speaker 2: and just thinks he's competing in the Olympics.
Speaker 1: I just had to.
Speaker 2: Ask because my husband was a professional athlete, and those
Speaker 2: athletes that compete at a very very high level, you know,
Speaker 2: when they're told they have to do something as simple
Speaker 2: as walking to get better, they feel like they have
Speaker 2: to grind it out, you know, walk a marathon.
Speaker 3: So I if he's really enjoying it, then it's probably
Speaker 3: worth doing. But you know, maybe he only needs to
Speaker 3: take the run twice instead of six times. Right, maybe
Speaker 3: he takes it once in the morning, once in the afternoon,
Speaker 3: takes a little break in the middle. We can do
Speaker 3: the things, but we might not can do the things
Speaker 3: at the same intensity.
Speaker 1: Yes, that's right.
Speaker 2: Thank you so much for that. Just needed a little
Speaker 2: wifely encouragement. You betcha well. Thank you so much, doctor
Speaker 2: Amanda Nelson for talking to me today on care walks.
Speaker 2: I love the idea of the commercial movement breaks. I
Speaker 2: think that's a great starting place. If you're not in
Speaker 2: the habit of moving just yet, it's important to take
Speaker 2: it in little bite sized pieces to get yourself going right.
Speaker 2: And I really appreciate having this conversation with you. Thank
Speaker 2: you so much.
Speaker 3: Well, thank you, Holly, It's been fun.
Speaker 2: I want to thank doctor Nelson again for being my
Speaker 2: guest today. I really appreciated our conversation and I hope
Speaker 2: you learned as much as I did about finding move
Speaker 2: that will help your joint pain and the physical benefits
Speaker 2: of implementing movement as well as what it does for
Speaker 2: our mental health.
Speaker 1: That's it for today's episode.
Speaker 2: Thank you once again to doctor Amanda Nelson for joining me,
Speaker 2: and don't forget to come back next week for another
Speaker 2: walk with our guest actor and caregiver Jenny Garth. We're
Speaker 2: going to talk about her experience as a caregiver for
Speaker 2: her father and how she now prioritizes self care and
Speaker 2: manages her joint pain. And remember keep walking and don't
Speaker 2: forget to take care of yourself too. Care Walks is
Speaker 2: produced by iHeartRadio in partnership with voltairean Arthritis Pain Gel
Speaker 2: and hosted by me Holly Robinson Pete. Our executive producer
Speaker 2: is Molly Sosha. Our head engineer is Matt Stillough. This
Speaker 2: episode was written and produced by Sierra Kaiser, with special
Speaker 2: thanks to our partners at GSK Platform, GSK, Weber Shandwick
Speaker 2: An Edelman,