WEBVTT - The Importance of Movement for Osteoarthritis 0:00:02.880 --> 0:00:03.520 Hi everyone. 0:00:03.720 --> 0:00:08.600 I'm Holly Robinson, pete actor, author, advocate, do it all mom, 0:00:08.960 --> 0:00:12.360 and I'm also a caregiver. And this is care Walks, 0:00:12.640 --> 0:00:17.279 a podcast from iHeartRadio and Voltaian Arthritis Pain Gel. It's 0:00:17.320 --> 0:00:20.880 a show for family caregivers who give everything to everyone 0:00:21.200 --> 0:00:25.160 and need to make time for themselves through movement. Every 0:00:25.239 --> 0:00:28.080 episode is designed for you to walk as you listen, 0:00:28.480 --> 0:00:30.600 so just think of me and my guests as your 0:00:30.640 --> 0:00:34.760 weekly walking buddies. We'll hear stories from caregivers and gain 0:00:34.840 --> 0:00:38.440 tips and insights from health experts and advocates who know 0:00:38.479 --> 0:00:41.280 how important it is to take care of yourself and 0:00:41.520 --> 0:00:44.440 manage joint pain due to arthritis that often a companies 0:00:44.479 --> 0:00:49.360 being a caregiver. Together, we'll find community ourselves and maybe 0:00:49.400 --> 0:00:52.479 even alleviate some joint pain in the process as we 0:00:52.640 --> 0:00:55.560 walk together and connect to the best parts of being 0:00:55.600 --> 0:01:02.520 a caregiver. Welcome back to Kara Walks, everyone, and thank 0:01:02.560 --> 0:01:05.280 you for taking time to join us, and thank yourself 0:01:05.440 --> 0:01:09.200 for taking time to make your self care a priority. 0:01:11.319 --> 0:01:14.400 All right now, just a reminder, Right now you're listening 0:01:14.440 --> 0:01:16.679 to the full version of this episode, but if you 0:01:16.680 --> 0:01:19.200 don't have time for a full walk today, then go 0:01:19.319 --> 0:01:22.440 check out our bridged version of the same episode. It's 0:01:22.520 --> 0:01:25.400 like cliff Notes for podcasts, so no matter how much 0:01:25.440 --> 0:01:28.200 time you have, you won't miss out on a great conversation. 0:01:29.360 --> 0:01:33.759 All right, now that's settled, let's dig into the episode. Today, 0:01:34.000 --> 0:01:37.680 we're talking about the importance of movement for caregivers living 0:01:37.680 --> 0:01:41.600 with osteo arthritis. It might seem obvious that we should 0:01:41.640 --> 0:01:45.360 implement exercise and movement into our weekly routine, yet so 0:01:45.520 --> 0:01:48.840 many of us struggle to stick to that habit, and frankly, 0:01:49.040 --> 0:01:52.560 I find that understanding more deeply how movement affects and 0:01:52.600 --> 0:01:55.080 helps joint pain can go a long way, and helping 0:01:55.120 --> 0:01:59.680 solidify new movement habits and keep up with them to 0:01:59.680 --> 0:02:03.080 help le's better understand how joint pain affects caregiving. I 0:02:03.120 --> 0:02:06.520 will be joined by doctor Amanda Nelson, a rheumatologist and 0:02:06.560 --> 0:02:11.639 associate professor at the UNC Thurston Arthritis Research Center. She 0:02:11.880 --> 0:02:15.680 understands both the challenges and the best strategies from managing 0:02:15.720 --> 0:02:19.240 away from her experience working directly with patients, both in 0:02:19.280 --> 0:02:23.200 clinical care and in research. But before we get into 0:02:23.240 --> 0:02:30.960 today's conversation, let's begin our walk. We're going to focus 0:02:30.960 --> 0:02:34.000 on staying present within our bodies and within our movement. 0:02:34.880 --> 0:02:38.000 Think about the contact you're making with the ground. What 0:02:38.120 --> 0:02:44.480 does that feel like? Be sure to relax your shoulders 0:02:44.520 --> 0:02:47.960 as you walk, pull them down from your ears and 0:02:48.040 --> 0:02:52.400 breathe in deeply through your nose. Feel the sensation of 0:02:52.440 --> 0:02:56.240 your stomach and your chest rising with your breath. And 0:02:56.280 --> 0:02:59.600 now breathe out through your mouth and let everything in 0:02:59.600 --> 0:03:06.440 your box. Relax as you breathe. Be aware of the 0:03:06.440 --> 0:03:09.960 air filling in your lungs. Can you feel your chest 0:03:10.160 --> 0:03:16.920 compressing as you slowly release the breath. Take a beat 0:03:17.160 --> 0:03:20.720 to walk through your five senses. What do you see 0:03:20.760 --> 0:03:26.120 around you? What sense or filling the air? What do 0:03:26.200 --> 0:03:28.880 you notice about the way your body moves as you 0:03:28.919 --> 0:03:37.720 set your pace? Now as you settled into your rhythm. 0:03:38.840 --> 0:03:41.520 I'm going to share my conversation with our guest, and 0:03:41.640 --> 0:03:44.120 together we're going to learn a little bit more about 0:03:44.200 --> 0:03:50.960 how we can all benefit from keeping our bodies moving. Today, 0:03:51.040 --> 0:03:55.120 I'm joined by doctor Nelson, a rheumatologist and associate professor 0:03:55.160 --> 0:03:59.800 at the UNC Thurston Arthritis Research Center. She understands both 0:03:59.840 --> 0:04:03.720 the challenges and the best strategies for managing OWAY from 0:04:03.800 --> 0:04:07.640 her experience working directly with patients, both in clinical care 0:04:07.840 --> 0:04:11.280 and in research. Doctor Nelson, thank you so much for 0:04:11.400 --> 0:04:12.920 joining us on care walks. 0:04:13.400 --> 0:04:15.280 Well, thank you very much. I'm happy to be here. 0:04:15.800 --> 0:04:17.080 I'm happy you're here too. 0:04:17.560 --> 0:04:19.400 Could you tell us a little bit about the work 0:04:19.400 --> 0:04:21.640 that you do and how you have helped joint pain 0:04:21.720 --> 0:04:25.640 sufferers improve their symptoms, and can you tell us how 0:04:25.680 --> 0:04:28.119 oway affects the body and its ability to move. 0:04:28.960 --> 0:04:31.400 Yeah, So, as you mentioned, I'm a rheumatologist and I 0:04:31.480 --> 0:04:34.320 see patients one day a week, and those patients have 0:04:34.360 --> 0:04:37.159 a range of arthritic conditions and a lot of them 0:04:37.200 --> 0:04:42.039 have challenges with mobility. I also do research primarily an osteoarthritis, 0:04:42.120 --> 0:04:45.000 which is the most common form of arthritis, around a 0:04:45.000 --> 0:04:49.760 lot of different aspects, risk factors, disparities, issues of imaging 0:04:49.920 --> 0:04:52.680 and biomarkers, how we might tell people do or don't 0:04:52.720 --> 0:04:56.760 have arthritis, how it might progress, and some novel methodologic 0:04:57.040 --> 0:05:00.279 approaches to try and understand it better for future clinical 0:05:00.320 --> 0:05:05.640 trials and clinical care. So the main recommendations around symptomatic improvements. 0:05:05.720 --> 0:05:09.560 So first I would say that there is no drug 0:05:09.720 --> 0:05:13.640 or other intervention that really affects the process. So once 0:05:13.760 --> 0:05:17.479 arthritis has started particularly osteoarthritis. There's really no way to 0:05:17.520 --> 0:05:20.839 make it stop or make the cartilage regrow currently, and 0:05:20.880 --> 0:05:24.320 so we do mainly focus on symptoms and improving those symptoms. 0:05:24.800 --> 0:05:27.360 One of the best ways to do that is exercise, 0:05:27.920 --> 0:05:30.800 and we have shown in a variety of different studies 0:05:30.800 --> 0:05:34.920 that exercise really does improve pain. Often that's not the 0:05:34.960 --> 0:05:37.680 first thing that happens, so people have to work through 0:05:37.720 --> 0:05:41.000 some initial discomfort. A lot of times, maybe they haven't 0:05:41.040 --> 0:05:43.480 been very active and they have to sort of get 0:05:43.480 --> 0:05:46.080 into the routine and get over some initial joint pain. 0:05:46.120 --> 0:05:50.359 But over time, being regularly active does improve the pain 0:05:50.400 --> 0:05:54.920 and symptoms of arthritis. Osteoarthritis primarily affects the joints. It's 0:05:54.920 --> 0:05:58.679 a little bit different than say rheumatoid arthritis or lupus 0:05:58.760 --> 0:06:00.719 that can also cause joint pain but have a lot 0:06:00.760 --> 0:06:04.280 more systemic symptoms. Oste Earthritis really just stays in the 0:06:04.360 --> 0:06:07.159 joints and it affects all of the tissues of the joints. 0:06:07.200 --> 0:06:10.040 So we used to think of it primarily as cartilage loss, 0:06:10.080 --> 0:06:12.479 which is certainly part of it. The cartilage pad that 0:06:12.560 --> 0:06:16.240 cushions the joint thins over time, it gets damaged, especially 0:06:16.279 --> 0:06:18.720 in the knee, there's a moniscus, there's an additional pad 0:06:18.839 --> 0:06:22.400 that gets broken and damaged, there are tendons and muscles 0:06:22.400 --> 0:06:25.360 that the bone itself gets affected, So it's really everything 0:06:25.480 --> 0:06:29.400 about the joint that gets damaged through the process of osteoarthritis. 0:06:29.800 --> 0:06:32.840 And then obviously you need your joints to walk, particularly 0:06:32.839 --> 0:06:35.160 in the lower extremities, So hips and knees are very 0:06:35.200 --> 0:06:39.960 commonly affected by OA, and with that can definitely impact 0:06:40.040 --> 0:06:44.000 people's mobility. Walking often we think of first, but a 0:06:44.000 --> 0:06:46.839 lot of just activities of daily living require weight bearing 0:06:46.839 --> 0:06:50.240 on the lower extremities and that can become difficult over time. 0:06:50.279 --> 0:06:53.520 For a lot of people with OA. Mobility is incredibly important, 0:06:53.520 --> 0:06:57.560 and if we lose mobility, we often become isolated, lose 0:06:57.600 --> 0:07:00.560 support systems, lose a lot of function, and that can 0:07:00.600 --> 0:07:04.160 then contribute to depression, which is also pretty common in arthritis. 0:07:04.560 --> 0:07:08.719 So mobility in general is really important, and reduced mobility 0:07:08.760 --> 0:07:11.480 is actually a marker of reduced to lifespan. So people 0:07:11.520 --> 0:07:15.080 that walk slower are really unable to walk generally just 0:07:15.120 --> 0:07:16.840 don't live as long and they don't have as high 0:07:16.880 --> 0:07:19.680 a quality of life as those who have more normal mobility. 0:07:20.600 --> 0:07:23.400 Right and you know, for a lot of joint pain sufferers, 0:07:23.760 --> 0:07:26.000 movement is such an important part of their self care 0:07:26.080 --> 0:07:29.040 journey and it can be so difficult. A lot of 0:07:29.040 --> 0:07:31.320 our audience are not only folks with joint pain, but 0:07:31.360 --> 0:07:34.800 also people who are caregivers to family members like myself. 0:07:35.480 --> 0:07:38.120 So I'm curious, do you work with patients who are. 0:07:37.960 --> 0:07:40.680 In a similar role and what do you notice about them? 0:07:41.160 --> 0:07:45.400 So the caregiver themselves often is taking on that role 0:07:45.840 --> 0:07:48.880 in a way that sort of reduces their focus on 0:07:48.920 --> 0:07:51.760 their own health. And so if you're extremely focused on 0:07:51.880 --> 0:07:54.240 taking care of someone else who you see as being 0:07:54.400 --> 0:07:57.680 very in need of your services in that way, then 0:07:57.680 --> 0:07:59.800 you often overlook your own stuff, right, So you're not 0:07:59.800 --> 0:08:02.400 going into the doctor, you're not going to exercise, you're 0:08:02.400 --> 0:08:05.520 not eating right as that caregiver. So one thing is 0:08:05.520 --> 0:08:09.120 certainly to encourage those folks to keep a focus on 0:08:09.160 --> 0:08:11.559 their own health, because if they're not healthy, they can't 0:08:11.560 --> 0:08:14.480 take care of the other person either. I think that 0:08:14.920 --> 0:08:18.400 the isolation piece fits in there too. So if a 0:08:18.440 --> 0:08:21.600 person is very focused on their caregiving role, they may 0:08:21.600 --> 0:08:25.440 not interact with friends or do social things or other things. 0:08:25.480 --> 0:08:28.679 They're just so focused on that and then a lot 0:08:28.720 --> 0:08:31.880 of caregivers share a lot of risk factors with the 0:08:31.920 --> 0:08:35.160 person they're giving care too, So if it's a family 0:08:35.200 --> 0:08:37.959 member or a sibling or even a friend, a lot 0:08:38.000 --> 0:08:42.000 of times those sets of people are from similar backgrounds. 0:08:42.000 --> 0:08:44.640 Maybe they share a similar environment, they have a similar diet, 0:08:44.679 --> 0:08:47.640 a similar culture, and all of those things are going 0:08:47.679 --> 0:08:50.480 to put the caregiver at risk as well. So if 0:08:50.520 --> 0:08:54.120 the individual being cared for has ostearthritis of multiple joints 0:08:54.120 --> 0:08:57.400 and limited mobility, it may well be that the caregiver 0:08:57.600 --> 0:09:00.200 also has some joint pain that's limiting their function. And 0:09:00.800 --> 0:09:03.880 on the research front, that feeds right into a lot 0:09:03.880 --> 0:09:06.760 of the interventions now where people are trying to engage 0:09:06.840 --> 0:09:11.079 a caregiver or a support family member, sibling, whoever it is, 0:09:11.520 --> 0:09:14.320 because walking and other interventions are a lot easier if 0:09:14.320 --> 0:09:17.160 there's two people. So maybe you and your sister can 0:09:17.200 --> 0:09:19.240 go out and take a walk and have a chat 0:09:19.280 --> 0:09:22.240 about joint pain rather than just again being isolated and 0:09:22.240 --> 0:09:24.880 trying to do things all by yourself. So engaging the 0:09:24.920 --> 0:09:27.480 caregiver in the interventions can be very helpful. 0:09:29.040 --> 0:09:29.600 Some of our. 0:09:29.520 --> 0:09:32.960 Listeners might be new to incorporating physical activity or movement 0:09:32.960 --> 0:09:35.880 into their routine. And as we all know, I mean 0:09:35.960 --> 0:09:38.400 I speak for myself, but I think also for a 0:09:38.400 --> 0:09:41.920 lot of other people, just the prospect of starting something 0:09:42.040 --> 0:09:45.840 like that it seems intimidating. So what would you say 0:09:45.880 --> 0:09:48.319 is the simplest and best way for them to get started? 0:09:49.160 --> 0:09:51.800 I think a lot of my patients, and certainly in 0:09:51.840 --> 0:09:54.760 our research studies as well, people are often coming from 0:09:54.760 --> 0:09:58.520 a position of no activity. They're very sedentary. They might 0:09:58.640 --> 0:10:00.800 get up and go to the store, otherwise, you know, 0:10:01.000 --> 0:10:04.880 on the couch or not engaged in a regular routine. 0:10:05.320 --> 0:10:07.640 And so there's a lot of ways to approach that. 0:10:07.920 --> 0:10:10.640 It depends a lot on where people start. So if 0:10:10.640 --> 0:10:12.880 we're starting from a place of I do nothing but 0:10:12.960 --> 0:10:16.320 sit on the couch, then the first thing we say 0:10:16.400 --> 0:10:19.160 might be, well, during the commercials on the television, we're 0:10:19.160 --> 0:10:21.640 going to stand up and we're going to move around, 0:10:22.040 --> 0:10:24.120 and we're going to do that every single commercial because 0:10:24.120 --> 0:10:26.640 there's a lot of commercials, and so that can get 0:10:26.679 --> 0:10:29.680 you a long way. If we're from a place of well, 0:10:29.880 --> 0:10:31.840 I move around in the house, but I don't really 0:10:32.200 --> 0:10:34.280 like to go out and walk, you know, then maybe 0:10:34.280 --> 0:10:37.280 I say you should walk for five minutes a day. 0:10:37.440 --> 0:10:40.280 You know, three days a week, and I work very 0:10:40.320 --> 0:10:42.559 slowly up to a goal of maybe thirty minutes a 0:10:42.640 --> 0:10:44.400 day for three to five days a week. And I 0:10:44.440 --> 0:10:46.880 actually have a walking prescription where I can write this 0:10:46.960 --> 0:10:49.480 out for people and say, look, this is the medicine 0:10:49.640 --> 0:10:51.880 for your arthritis. The medicine for your arthritis is to 0:10:51.920 --> 0:10:55.200 get up and walk. But it's extremely important to meet 0:10:55.200 --> 0:10:57.120 people where they're starting, because if I just start with 0:10:57.200 --> 0:10:59.040 thirty minutes five days a week, they're going to have 0:10:59.080 --> 0:11:01.080 that exact reaction and I say, there's no way I 0:11:01.080 --> 0:11:03.079 can do that, and I'm not even going to try. 0:11:03.559 --> 0:11:06.360 And so understanding where people are coming from, what their 0:11:06.400 --> 0:11:08.720 barriers are, you know, do they feel like they're going 0:11:08.800 --> 0:11:10.880 to fall? Are they living on a two mile long 0:11:10.960 --> 0:11:14.520 gravel road and they can't walk, and really coming up 0:11:14.600 --> 0:11:16.480 with a plan that's going to work for that person, 0:11:16.920 --> 0:11:19.679 anyone they're caring for, you know, working around their schedule. 0:11:19.720 --> 0:11:22.480 All those things are very important to getting people started 0:11:22.800 --> 0:11:25.440 and also to maintain because you know, if they do 0:11:25.480 --> 0:11:27.360 it once and then give up, that doesn't help. 0:11:30.320 --> 0:11:33.640 We'll be right back with more from doctor Amanda Nelson, 0:11:41.679 --> 0:11:45.280 and now back to my conversation with doctor Amanda Nelson, 0:11:48.559 --> 0:11:51.040 What would you say is one of the biggest roadblocks 0:11:51.040 --> 0:11:53.840 for patients who are just trying to find the right 0:11:53.880 --> 0:11:55.920 ways to fit that movement into their day. 0:11:57.040 --> 0:12:01.839 Definitely scheduling and not prioritizing it. So this thing about 0:12:01.880 --> 0:12:04.000 putting our own health on the back burner and taking 0:12:04.000 --> 0:12:06.880 care of others, whether that's kids or people we're caring for, 0:12:07.320 --> 0:12:11.440 it's essential to prioritize your own health and say, look, 0:12:11.600 --> 0:12:14.600 I walk from eleven to eleven thirty, and even if 0:12:14.600 --> 0:12:16.640 I don't get my walk, I'm going to do something 0:12:16.640 --> 0:12:20.559 healthy for myself in that time. Or Mondays, Wednesdays and Thursdays, 0:12:20.559 --> 0:12:22.960 I have this half hour, you know. Finding that slot 0:12:23.080 --> 0:12:27.280 and then either scheduling it, blocking it off, telling everyone 0:12:27.360 --> 0:12:31.200 you're not available some way to really make that happen 0:12:31.640 --> 0:12:35.040 can often be very helpful because you would schedule other things. 0:12:35.040 --> 0:12:37.160 So just call it a doctor's appointment, or call it 0:12:37.200 --> 0:12:40.800 a haircut or a dentist cleaning or something, because it's 0:12:40.960 --> 0:12:43.800 just as important as those things. And a lot of 0:12:44.400 --> 0:12:48.200 individuals do like a more structured program. So a lot 0:12:48.240 --> 0:12:51.400 of the courses, like through the Centers for Disease Control 0:12:51.440 --> 0:12:55.160 and the Arthritis Foundation, might have a self directed program 0:12:55.280 --> 0:12:57.480 or you can do it yourself on your own. But 0:12:57.520 --> 0:13:00.400 they also often have group classes that are low cost 0:13:00.480 --> 0:13:03.480 or free where people can go and everyone there is 0:13:03.520 --> 0:13:05.679 going to either have arthritis or be taking care of 0:13:05.679 --> 0:13:08.240 someone with arthritis, and that's a great way to build 0:13:08.240 --> 0:13:10.720 community and see that you're not alone and that there 0:13:10.720 --> 0:13:12.600 are a lot of people dealing with these issues. 0:13:13.559 --> 0:13:17.040 Yes, and you know we're always putting ourselves in the 0:13:17.040 --> 0:13:20.280 back of the line when it comes to caregiving. Sometimes 0:13:20.320 --> 0:13:24.040 we need to put ourselves in the front. Okay, let's 0:13:24.080 --> 0:13:28.000 talk about possible misconceptions about being physically active. I can 0:13:28.080 --> 0:13:31.600 already hear somebody saying, well, woulden movement just add wear 0:13:31.679 --> 0:13:34.840 and tear to my body and potentially make joint pain 0:13:34.880 --> 0:13:35.480 even worse. 0:13:36.280 --> 0:13:38.920 And I get that question all the time because it 0:13:38.960 --> 0:13:41.200 makes sense. Right. You think, well, if the cartilage is 0:13:41.200 --> 0:13:43.280 breaking down, then what I don't want to do is 0:13:43.360 --> 0:13:46.840 use the cartilage. But it's not quite how it works. 0:13:46.840 --> 0:13:50.800 So the cartilage itself doesn't have its own blood vessels, 0:13:50.840 --> 0:13:53.200 it doesn't get nutrients from the body through the blood 0:13:53.240 --> 0:13:55.640 like a lot of other tissues. And the way that 0:13:55.679 --> 0:13:59.679 it gets nutrients in and waste products out is by compression. 0:14:00.120 --> 0:14:03.000 So the actual loading of the cartilage is how the 0:14:03.080 --> 0:14:08.040 cartilage stays healthy. If people are unloaded, you know, for example, 0:14:08.600 --> 0:14:12.560 having a paralysis event where they really cannot walk, the 0:14:12.600 --> 0:14:17.040 cartilage degrades because it can't get nutrients, and so walking 0:14:17.480 --> 0:14:21.680 is healthy for the cartilage. It actually improves the cartilage function. 0:14:22.480 --> 0:14:25.200 And so it's completely counterintuitive, and I get that, and 0:14:25.280 --> 0:14:27.480 so I'm happy to explain that to folks. But the 0:14:27.600 --> 0:14:29.800 joint wants to be loaded now, it doesn't want to 0:14:29.840 --> 0:14:33.800 be It's not a jackhammer, right, So it's not looking 0:14:33.840 --> 0:14:37.080 for high impact major activity, but it does like some 0:14:37.160 --> 0:14:40.720 periodic loading and unloading such as we get with walking. 0:14:41.040 --> 0:14:41.680 And what else? 0:14:41.920 --> 0:14:45.800 What are some other low impact activities that caregivers with 0:14:45.880 --> 0:14:47.720 joint pain can do besides walking. 0:14:48.640 --> 0:14:51.560 Yeah, so walking is certainly the cheapest and easiest we 0:14:51.600 --> 0:14:53.440 can all do it. I have a lot of people 0:14:53.440 --> 0:14:57.600 who benefit greatly from the elliptical system because there's really 0:14:57.640 --> 0:15:01.200 no impact so much as that gliding motion can be 0:15:01.280 --> 0:15:04.800 very helpful. And for people that really have not been moving, 0:15:04.920 --> 0:15:07.640 have a lot of pain, maybe a lot of other 0:15:07.680 --> 0:15:11.160 comorbid conditions, a lot of times water therapy is very helpful. 0:15:11.440 --> 0:15:14.880 Whether that's a PT driven aqua therapy program, or again 0:15:15.040 --> 0:15:18.560 like an arthritis Foundation class at a local pool. Often 0:15:18.600 --> 0:15:21.760 the pool is warm, the buoyancy from the water helps 0:15:21.800 --> 0:15:24.280 to sort of take some of that weight off the joints, 0:15:24.280 --> 0:15:27.160 but still they're being loaded in a useful way for 0:15:27.200 --> 0:15:29.880 the physiology of the joint itself. So there's a lot 0:15:29.880 --> 0:15:32.360 of different modalities and it very much again depends on 0:15:32.400 --> 0:15:34.800 what people want. If you're terrified of the water, then 0:15:34.800 --> 0:15:36.520 I'm not going to tell you to do water therapy, 0:15:37.000 --> 0:15:38.840 but that certainly is a great place to start for 0:15:38.880 --> 0:15:40.800 people that have access and enjoy that. 0:15:42.520 --> 0:15:46.400 Okay, let's talk about self care. How can we help 0:15:46.440 --> 0:15:51.160 caregivers with joint pain see movement as self care. It's 0:15:51.200 --> 0:15:55.160 almost like a psychological exercise, you know, so that we 0:15:55.200 --> 0:15:58.800 don't look at it as this burden of oh gosh, 0:15:58.880 --> 0:16:01.960 I gotta do this, but as actual self care and 0:16:02.000 --> 0:16:04.760 self love. How can we get them to prioritize that. 0:16:05.720 --> 0:16:09.480 Yeah, So education is a huge piece of this, making 0:16:09.520 --> 0:16:12.680 sure that people understand the process of the disease, whatever 0:16:12.760 --> 0:16:15.280 that might be, or if there's multiple diseases at play, 0:16:15.920 --> 0:16:19.960 how the physical activity might benefit them, how it's better 0:16:20.040 --> 0:16:23.080 than a lot of the other choices, and so to say, look, 0:16:23.160 --> 0:16:25.880 exercise is the medicine. This is what you do for 0:16:26.000 --> 0:16:29.640 this problem. This is how you get this better. It's free, 0:16:30.000 --> 0:16:31.920 you can do it whenever you want. You don't have 0:16:31.960 --> 0:16:34.720 to go to the doctor. Like. There's so many benefits, 0:16:34.800 --> 0:16:38.000 and the good news for you today is that all 0:16:38.000 --> 0:16:40.160 you have to do is walk, and walking is going 0:16:40.200 --> 0:16:41.520 to give you the biggest benefit. 0:16:42.360 --> 0:16:45.000 Can a work out be too minimal to see benefits? 0:16:45.680 --> 0:16:48.960 There's two parts to that. One is any movement is 0:16:49.000 --> 0:16:52.400 better than no movement, and so if you're you know, 0:16:52.480 --> 0:16:54.680 just getting up during the commercials or doing those five 0:16:54.720 --> 0:16:57.800 minute walks, that's way better than the sitting on the 0:16:57.840 --> 0:17:00.760 couch was previous to that. We have to start somewhere, 0:17:00.760 --> 0:17:03.160 and we want to encourage people to start where they 0:17:03.200 --> 0:17:06.840 are and move forward. From that point, any movement is 0:17:06.880 --> 0:17:10.840 going to be of benefit over the longer term. There's 0:17:10.880 --> 0:17:13.760 still some debate about how much we need, right so, 0:17:13.800 --> 0:17:16.280 there was the ten thousand steps going around for a while, 0:17:16.320 --> 0:17:19.320 and then one of my colleagues did a study that 0:17:19.359 --> 0:17:22.080 showed that maybe six thousand was probably okay for people 0:17:22.080 --> 0:17:25.560 with osteorthritis. There are guidelines out there for how active 0:17:25.560 --> 0:17:27.399 we need to be. That can be very daunting if 0:17:27.480 --> 0:17:29.720 we start there. So, you know, one hundred and fifty 0:17:29.720 --> 0:17:33.560 minutes a week sounds pretty scary, but again it's it's 0:17:33.600 --> 0:17:37.119 the essential piece of just moving. And if that's a 0:17:37.240 --> 0:17:39.520 very small bit at the beginning and we're working up, 0:17:39.600 --> 0:17:41.520 then that's all we can ask anyone to do. We 0:17:41.560 --> 0:17:45.639 can't leap straight to full maximal healthy adult guidelines and 0:17:46.040 --> 0:17:47.640 go from there. That's just not how it. 0:17:47.600 --> 0:17:51.160 Is, yes, And how do you know when movement pain 0:17:51.359 --> 0:17:54.119 is pushing the limits or over extending? 0:17:54.920 --> 0:17:56.720 So I usually tell people it's okay if you're a 0:17:56.720 --> 0:17:59.520 little sore the next day, that's kind of again to 0:17:59.520 --> 0:18:01.760 be expected if we haven't been doing too much. But 0:18:01.800 --> 0:18:05.080 if it's lasting for a few days, or it's really debilitating, 0:18:05.160 --> 0:18:07.560 like I walked yesterday and I'm in bed today, that 0:18:07.640 --> 0:18:09.640 was either too much or there's something else going on. 0:18:10.440 --> 0:18:13.720 If it's a joint pain issue, we shouldn't have red, warm, swollen, 0:18:13.840 --> 0:18:16.720 angry joints, right, So they might be a little bit 0:18:16.760 --> 0:18:19.000 puffy if we were just up and about more, and 0:18:19.080 --> 0:18:21.960 that's okay, that should go away. But if there's you know, 0:18:22.040 --> 0:18:27.320 acute pain, new redness or warmth, something that's never happened before, 0:18:27.480 --> 0:18:29.679 pain in a place that's never happened before. Those are 0:18:29.720 --> 0:18:32.960 all things to look out for. But generally what we 0:18:33.080 --> 0:18:36.359 expect is that the joints that hurt might hurt a 0:18:36.440 --> 0:18:38.840 little bit more after the activity, and they might be 0:18:38.880 --> 0:18:41.040 a little sore the next day, and then we should 0:18:41.080 --> 0:18:44.119 be back to where we were going or even feeling 0:18:44.160 --> 0:18:46.880 a little bit better by then. So big changes, though, 0:18:47.320 --> 0:18:50.840 or new things that hadn't happened should be at least evaluated. 0:18:50.880 --> 0:18:53.280 It might be okay still, but we just want somebody 0:18:53.280 --> 0:18:54.760 to take a look and make sure that we're not 0:18:55.160 --> 0:18:58.120 causing a new problem, or you know, maybe our gait 0:18:58.280 --> 0:19:02.400 isn't quite right and we're generating some new pain issue 0:19:02.400 --> 0:19:04.639 that we didn't have before. So just being aware of 0:19:04.680 --> 0:19:07.439 our bodies, where we started, where we're going, and what 0:19:07.520 --> 0:19:11.720 to expect. I generally don't recommend jogging. There are people 0:19:11.720 --> 0:19:14.600 that swear by it, and that's fantastic for the people 0:19:14.600 --> 0:19:17.480 that can do it, but I think just the impact 0:19:18.160 --> 0:19:20.439 on the feet and the ankles and the knees and 0:19:20.440 --> 0:19:22.320 the hips and the lower back, which can all be 0:19:22.359 --> 0:19:24.840 affected by osteoth right as it's certainly not where we 0:19:24.880 --> 0:19:27.040 want to start. It may be a place that we 0:19:27.080 --> 0:19:30.320 can get to other things that have a lot of pivoting, 0:19:30.840 --> 0:19:35.840 like individual high level tennis. Right there's so much stress 0:19:35.880 --> 0:19:39.160 on the knees or skiing. Some of those things probably 0:19:39.240 --> 0:19:42.919 are not what we want to aim for, but less 0:19:43.080 --> 0:19:46.120 impactful things that are maybe over a longer period of time, 0:19:46.160 --> 0:19:48.480 are generally going to be okay. And if there's a 0:19:48.600 --> 0:19:52.800 goal that a patient has, I really want to the 0:19:52.880 --> 0:19:54.800 end of this is often play nine holes of golf, 0:19:54.840 --> 0:19:57.320 but I'm sure there are other examples. Then we can 0:19:57.359 --> 0:19:59.320 work up to that. Right, if we know where we're going, 0:19:59.680 --> 0:20:01.960 maybe I can get you started. I can send you 0:20:02.000 --> 0:20:04.560 to a physical therapist and they can get you further along. 0:20:04.800 --> 0:20:07.159 And if it's more elite activity that we're trying to 0:20:07.160 --> 0:20:09.840 get to, maybe it's a younger person with arthritis, which 0:20:09.840 --> 0:20:13.400 also happens, maybe a sports medicine person or a physical 0:20:13.440 --> 0:20:16.400 medicine and rehabiling. There are pathways through which we can 0:20:16.440 --> 0:20:18.280 work to get people to where they need to go 0:20:18.680 --> 0:20:19.600 in most cases. 0:20:20.600 --> 0:20:24.240 And I'm asking for a friend, but what do you 0:20:24.320 --> 0:20:27.520 do when you have a former NFL football player husband 0:20:28.040 --> 0:20:30.680 who has OA and all the joints but he thinks 0:20:30.720 --> 0:20:33.159 he needs to go skiing because he wasn't allowed to 0:20:33.240 --> 0:20:35.600 when he was in the NFL, making up for lost time, 0:20:36.080 --> 0:20:38.480 and just thinks he's competing in the Olympics. 0:20:38.760 --> 0:20:39.600 I just had to. 0:20:39.520 --> 0:20:43.040 Ask because my husband was a professional athlete, and those 0:20:43.119 --> 0:20:45.800 athletes that compete at a very very high level, you know, 0:20:46.320 --> 0:20:48.480 when they're told they have to do something as simple 0:20:48.520 --> 0:20:51.439 as walking to get better, they feel like they have 0:20:51.520 --> 0:20:53.760 to grind it out, you know, walk a marathon. 0:20:54.480 --> 0:20:59.080 So I if he's really enjoying it, then it's probably 0:20:59.080 --> 0:21:02.040 worth doing. But you know, maybe he only needs to 0:21:02.040 --> 0:21:05.480 take the run twice instead of six times. Right, maybe 0:21:05.480 --> 0:21:07.840 he takes it once in the morning, once in the afternoon, 0:21:08.000 --> 0:21:11.440 takes a little break in the middle. We can do 0:21:11.520 --> 0:21:13.800 the things, but we might not can do the things 0:21:13.840 --> 0:21:14.919 at the same intensity. 0:21:15.160 --> 0:21:16.080 Yes, that's right. 0:21:16.720 --> 0:21:19.480 Thank you so much for that. Just needed a little 0:21:19.520 --> 0:21:24.680 wifely encouragement. You betcha well. Thank you so much, doctor 0:21:24.720 --> 0:21:27.600 Amanda Nelson for talking to me today on care walks. 0:21:28.119 --> 0:21:31.159 I love the idea of the commercial movement breaks. I 0:21:31.160 --> 0:21:33.560 think that's a great starting place. If you're not in 0:21:33.600 --> 0:21:36.920 the habit of moving just yet, it's important to take 0:21:36.960 --> 0:21:39.880 it in little bite sized pieces to get yourself going right. 0:21:40.320 --> 0:21:43.400 And I really appreciate having this conversation with you. Thank 0:21:43.440 --> 0:21:44.119 you so much. 0:21:44.680 --> 0:21:46.120