Knee Pain: Treat with Lifestyle Changes
A review of 47 studies on 22,037 patients with knee osteoarthritis treated for at least 12 months showed no clear difference in controlling long-term pain between medications and placebos (JAMA, 2018;320(24):2564-2579). There was a slight time-limited pain control with a non-steroidal (celecoxib) and glucosamine.
With the exception of immune suppressants that have lots of serious side effects, medications and health supplements do not prevent progressive damage to joints and are used only to help lessen pain. The list of medications for osteoarthritis is huge, including:
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and other pain medicines
• bone strengtheners such as bisphosphonates
• joint injections such as hyaluronic acid and corticosteroids
• chemicals found in cartilage such as glucosamine and chondroitin sulfate
• disease-modifying agents such as cindunistat or sprifermin
Know the Cause of Your Joint Pain
If you do not already have a diagnosis, check with a doctor to see if you have rheumatoid arthritis, psoriatic arthritis, gout, reactive arthritis from an infection or some other known cause of joint pain. If you have sudden locking of your joint that gets better and then recurs, you may have “joint mice,” loose pieces of cartilage that slip between your cartilage to cause horrible pain. This can usually be cured by removing the loose pieces with arthroscopic surgery.
Osteoarthritis is the most common cause of chronic and progressive joint pain. It can eventually destroy the cartilage in joints, and is among the most prevalent chronic diseases and a leading cause of disability worldwide (JAMA, 2018;319(14):1444-1472). Eighty percent of North Americans have X-ray evidence of osteoarthritis by age 65, and sixty percent have significant joint pain. More than 700,000 people in North America have their knees replaced each year, mostly for this condition.
What Causes Osteoarthritis?
A diagnosis of osteoarthritis used to mean that your doctor had ruled out other known causes of knee pain and had no idea what was causing your joint pain. Now we know that people with osteoarthritis have high blood levels of galectins that turn on a person’s immune system to cause inflammation, just as in rheumatoid arthritis or reactive arthritis (J of Immunology, Feb 15, 2016;196(4):1910-1921). If your immune system stays overactive, the same chemicals and cells that are used to attack germs can attack and destroy the cartilage in your joints.
A review of 68 studies showed that osteoarthritis is associated with everything that increases inflammation, such as obesity, high blood pressure, high cholesterol, diabetes and metabolic syndrome (Rheumatology, May 1, 2018;57(suppl_4):iv61–iv74; Rheumatology, Jan 1, 2016;55(1):16–24), and that this joint pain is reduced temporarily by anything associated with the control of inflammation:
• omega-3 oils in fish
• leafy green foods such as kale, spinach and parsley
• weight reduction in people who are overweight (but not in thin people
• strengthening and flexibility exercises (Arthritis Care & Research, Dec 5, 2017;69(12) and aerobic exercise (The Knee, January 18, 2018)
• avoidance of smoke
• restriction of alcohol
Several studies have shown that exercise is more effective than surgery (arthroscopic partial meniscectomy) in treating people with knee pain and degenerative meniscal tears (BMJ, July 20, 2016; N Engl J Med, 2013;368:1675-84). See Arthroscopic Knee Surgery is Usually Useless.
Anti-Inflammatory Lifestyle to Treat Osteoarthritis
• Eat an anti-inflammatory diet that includes lots of fruits, vegetables, whole grains, beans, nuts and other seeds, and restricts red meat, processed meats, foods with added sugar, all sugared drinks including fruit juices and fried foods. People who eat an anti-inflammatory Mediterranean-style diet are at reduced likelihood to get osteoarthritis (Clin Nutr, Oct 8, 2016) .
• Lose weight if overweight. Excess weight causes inflammation, and obesity is a major risk factor for osteoarthritis (Int J Obes Relat Metab Disord, 2001;25(5):622-627); Osteoarthritis Cartilage, Oct 27, 2015. S1063-4584(15)01364-3; Arthritis and Rheumatism, Sept 15, 2008;59(9):1207-13). Losing as little as 11 pounds reduced risk of developing knee osteoarthritis among women by 50 percent (Arthritis and Rheumatism, August 1998;41(8):1343-55).
• Move more. Osteoarthritis almost always worsens with inactivity. Exercise increases cartilage quality in osteoarthritis (Med and Sci in Sprts and Ex. Mar 23, 2017), and a review of 55 studies showed that weight bearing exercise reduced pain and improved joint function (British Journal of Sports Medicine, September 24, 2015). Aerobic and strength training for 20 weeks markedly decreased knee pain and increased mobility (Arthritis Care & Research, Aug 30, 2016). A review of six studies of 656 men and women with knee osteoarthritis found that exercise improves symptoms of knee pain in osteoarthritis and that it didn’t make much difference whether the knee exercise program was of low or high intensity (Cochrane Database Syst Rev, 2015 Oct 29;(10):CD010203). However, you need to be guided by pain and always stop if the pain worsens.
• Avoid impact sports. The force of your feet hitting the ground can break off cartilage in your knees. Do not run, jump or participate in sports that involve the strong impact of your foot hitting the ground. Non-impact sports include cycling, swimming, water aerobics and use of machines such as ellipticals or stair-steppers where your feet are supported by the equipment as you move.
All Exercise is Good, and Vigorous Exercise is Better
A new study suggests that the more intensely you exercise, the less likely you are to suffer a heart attack. Researchers followed 403,681 U.S. adults for an average 10 years and found that those who spent a greater proportion of their exercise time exercising intensely had a significantly lower risk of death from heart attacks than those who exercised for the same amount of time but at lower intensity (JAMA Intern Med, Nov 23, 2020). Those who exercised more vigorously also had a lower risk of death from cancer and lower all-cause mortality during the study period.
Other studies show that people who exercise intensely are significantly less likely to die prematurely than casual exercisers (JAMA Intern Med, 2015;175(6):970-977), because vigorous exercise is more effective in:
• preventing weight gain (Prev Med, 2014;60:131-133),
• preventing heart disease (Am J Cardiol, 2006;97(1):141-147),
• preventing diabetes (Int J Epidemiol, 2012;41(4):1132-1140), and
• promoting fitness and the ability to process oxygen (Med Sci Sports Exerc, 2002;34(1):152-157).
The HUNT study from Norway found that the more fit people are, the less likely they were to develop a first heart attack (JAMA, April 19, 2019). The SUN study from Spain found lower heart attack rates in those who exercised intensely compared to those who exercised less vigorously (Am J of Cardio, Dec 1, 2018;122(11):1871–1878).
Any Level of Exercise is Healthful
A regular exercise program of any intensity is associated with reduced death rate (Int J Epidemiol, 2011;40(5):1382-1400), because a regular exercise program is associated with reduced rates of:
• cancer (JAMA Intern Med, 2016;176(6):816-825),
• diabetes (Endocrine, 2016;52(2):226-230), and
• heart disease (Br J Sports Med, 2019;53(22):1405-1411).
Spending long periods of time sitting or lying in bed increases risk for heart disease (Prevent Med, May 02, 2019).
Benefits of Intense Exercise
Intensity makes all muscles stronger, including your heart muscle. All people lose heart muscle as they age, which increases risk for frailty and heart failure. Strengthening your heart muscle helps you to live a more vigorous lifestyle and to protect you from heart failure. Intense exercise stabilizes plaques in arteries and widens heart arteries to help protect you from a heart attack. One study showed that men with the highest levels of VO2max (a test of oxygen use that is a measure of fitness) were least likely to have high blood pressure, high HBA1C (a test for diabetes), high fasting blood sugar levels, obesity, an abnormal treadmill exercise test, and a high 10-year risk for heart attacks (American J of Cardiology, March 2012;109(6):839-843).
Starting a New Exercise Program
I think everyone should have a regular exercise program, and it is never too late to start. First check with your doctor. If you are not a regular exerciser, you should spend your first few months exercising in your chosen activity at a very casual pace. Stop when you feel tired, your muscles feel heavy, or you feel any discomfort, even if you have only exercised for a few minutes. When you can exercise every day for about 30 minutes at a casual pace, you are ready to try exercising at a more intense level. See my article on How to Start an Exercise Program.
Increasing the Intensity of Your Current Exercise Program
All exercise training is done by stressing and recovering. To increase the intensity of your exercise program, start by taking a harder workout on one day and expect to feel sore the next morning. This is called delayed onset muscle soreness, or DOMS. Go slow and easy for as many days as it takes for your muscles to feel fresh again. You should not take your next hard workout until the muscle soreness is gone. You may need to take from one to five or more easy recovery days before you do your next intense workout.
• When you are training properly, your muscles may feel sore every morning. If they don’t feel better after a 10 minute warm-up, take the day off.
• If you feel pain in one spot that does not go away after you slow down, stop that workout immediately for that day. Otherwise you are likely to be headed for an injury.
Your Intense Workout Days
Always warm up your muscles before you exercise more intensely. Start out by going very slowly for the first 10 or more minutes of your workout. To make a muscle stronger, you have to exercise intensely enough to feel a burning or tightness in your muscles. For non-competitive athletes, you should slow down immediately when you feel this discomfort. Most people will start out by picking up the pace for only about 10 seconds. If you are a runner, cyclist or skater, pick up the pace for a few strides or pedal strokes. Then go slow and easy, and when your muscles feel fresh again, pick up the pace and then slow down. Repeat these alternating bursts of intense exercise (called “intervals”) until your muscles just start to feel heavy and tired, then slow down. When your muscles continue to feel heavy and tired after you slow down, you are through for that day. In the beginning, you may be able to do only a few intervals in a workout. However, with practice you will improve until you can do lots of intervals, perhaps 15-20 or more. Then you can extend the time that you stay in each hard interval, gradually going from a few seconds up to about 30 seconds. If you are not a competitive athlete, there is no reason to stay in an intense interval longer than 30 seconds. Most healthy exercisers will be able to work up eventually to 10-20 repeats of 20-30 second intervals. For non-competitive athletes, there is no need to do more than that.
Your Recovery Days
Expect your muscles to feel tired and sore when you get up the morning after an interval workout. You can try to exercise that day, but you should do so at a slow pace and stop when your muscles start to feel heavy and fatigued. If your muscles don’t feel better after a five-minute warmup, or if you feel pain in any area that does not go away when you slow down, you should stop your workout for that day. Do not take your next intense workout until your muscles feel fresh after you warm up for 5-10 minutes. Most people who exercise for fitness will follow each hard day with one or two recovery days. Competitive athletes are likely to take such intense workouts on their hard days that they may require up to five recovery days before their next hard day. See Recovery: the Key to Improvement in Your Sport
CAUTION: Intense exercise can cause a heart attack in a person who has blocked arteries or heart damage. Check with your doctor before you start a new exercise program or increase the intensity of your existing program.
Blood Pressure is Often Higher in Wintertime
If you have high blood pressure in the winter, you are at increased risk for a heart attack, even if your blood pressure is normal in the summertime (Hypertension Research, Sept 6, 2021;44:1363-1372). Blood pressure is often higher in winter and lower in summer (J Hypertens, 2020;38:1235-43), and heart attacks are significantly more common in the winter than in the summer (N Am J Med Sc, Apr 2013;5(4):266-279).
Blood pressure may be higher in the winter because of:
• colder temperatures
• reduced physical activity
• seasonal variations of hormones such as noradrenalin, catecholamine or vasopressin
• reduced vitamin D intake
• vasoconstriction of extremities in cold weather
Exposure to cold temperatures during the winter diminishes blood flow to your arms and legs, which can raise blood pressure (Lancet, 2015;386:369-75).
What is Normal Blood Pressure?
Normal blood pressure is 120/80 mm Hg or lower (systolic/diastolic). If your systolic blood pressure is 121-140 mm Hg or your diastolic blood pressure is 81-90 mm Hg, you should make lifestyle changes to lower your blood pressure to normal. Your doctor will decide if you need to take medications. If your systolic blood pressure is over 140 or your diastolic is over 90, most likely you will need medications in addition to lifestyle changes immediately.
If you have an occasional systolic blood pressure measurement that is greater than 120 or your diastolic is greater than 80, take your blood pressure at home at different times of the day regularly, keep a record and share it with your doctor. See Check Your Own Blood Pressure
If you have high blood pressure only in the winter, your doctor will probably recommend taking medications to lower it. Since cold temperatures raise blood pressure, adjusting the heat in your house and wearing warmer clothing can help to lower it. At any time of the year, people with blood pressure problems should follow all of the lifestyle rules listed below.
Lifestyle Changes to Treat High Blood Pressure
• Follow a plant-based, anti-inflammatory diet such as the DASH diet, and lose excess weight if overweight. Eat lots of fruits, vegetables, whole (unground) grains, beans, nuts and other seeds. Restrict meat, sugar-added foods, fried foods, refined carbohydrates (flour, white rice) and most processed foods. See How Your Diet Affects Your Blood Pressure
• Check for a fatty liver. Even if you are not overweight, if you can pinch more than two inches of fat under the skin near your belly button, you are likely to have excess fat in your liver that can lead to high blood pressure and diabetes. Your doctor can check for fat in your liver with a sonogram that uses no radiation. A fatty liver is a known life-shortener; see A Big Belly Increases Risk for a Heart Attack.
• Decrease Salt Intake. Excess salt raises blood pressure. Restrict salty foods such as chips, French fries, salted nuts and most processed foods; check labels for sodium content.
• Restrict caffeine, found in coffee, tea and many soft drinks.
• Drink plenty of water.
• Exercise. If you are not currently exercising, it would be wise to check first with your doctor and get some instructions from experts on how to start an exercise program with the activities you prefer. Try to work up to at least 30 minutes every day, alternating vigorous and easy days.
• Avoid alcohol in any form (see my report below for the latest studies).
• Avoid smoking and second-hand smoke.
• Keep blood levels of hydroxy vitamin D above 30 ng/mL.
Top 7 Benefits to Keeping Fit and Healthy
Top 7 Benefits to Keeping Fit and Healthy : It is often said that a physically fit body translates to a fit mind and soul. Once your body is in good shape, it also convinces your mind and this reduces a lot of mental stress as well as issues such as anxiety, depression, low self esteem. It can also make a person age less and resolves insomnia issues.
The word “exercise” has one definition according to the dictionary but it is usually done in order to physically keep the body in tip top shape. However, this is also defined by the individual. Most people’s idea of exercise involves weight loss and as such they usually combine exercises with diets. On the other hand, most people believe that exercises are to be done to build up some body muscles.
Do what makes you happy as long as you are not endangering your life by over exerting yourself. Whatever the best version of you is, maintain that. There are numerous benefits of doing exercises and keeping fit. Below are some of the reasons why it is recommended:
- Increased Productivity Level
Whenever you have a big task coming up which you’re sure will be mentally or physically stressful, you can always exercise the stress away. Exercise helps the body and mind by enhancing cognition (this is the process of acquiring, understanding and retaining knowledge using various thought processes). It makes the hippocampus (this is the critical part of the brain which controls learning and memory functions) work more efficiently which in turn increases blood flow to the brain and allows for proper thought assessment.
- Earning Passive Income While Staying Fit
A lot of people don’t know this but you can make a whole lot of money off exercising. You can stay fit and get paid to workout. This is the push you need if you have been procrastinating about starting and maintaining an exercise routine. Start your journey and attain body fitness and money at the same time.
When it comes to exercises, people set fitness targets for themselves and some even draw out plans that are to help them achieve these set targets. Sadly, only a few people actually go through to achieve their goals. The tendency for people to stop their exercise routine after hours, days, weeks, or months is really high. There are mobile applications available now that pay people just to exercise.
These mobile applications help to earn a passive income while driving yourself to attaining a physically fit body. If you’re already following a routine, you can take up exercise challenges and also earn without overexerting or stressing yourself. You can earn money without unnecessarily working out more than you’re used to, using different ways.
- Longer Life
Consistently doing exercises helps to keep the body fit and strong. It promotes growth and strengthening of body parts such as the heart, muscles, bones, immune system as well as the respiratory system. The proper functioning of all these body parts help keep a person living longer due to reduced medical conditions. A good exercise routine promotes sufficient water consumption which is required for all cell growth.
- Improved Mental Health
The more exercises carried out by a person, the more your brain receives blood from the body which aids it in carrying out all its activities. There is growth of all neural cells and this further enhances the brain’s ability to handle a lot of tasks. You will notice a general sense of calm after a good exercise routine. As the brain continues to function properly, it can help to reduce the chances of having depression, anxiety, and stress.
- More Energy to the Body
It is noticed that after a good exercise routine, you get tired and need to rest. However, the solution to fighting constant fatigue is doing more exercise. This may sound funny but the more you exercise your body, the more it increases your stamina level and strengthens your heart. This causes an increase in endorphin hormonal levels which energises the body.
- Faster Metabolism
A very fast way to burn off excess calories is by exercising. This can be done either when you’re moving or not. It is a fact that you burn off calories in your sleep just by the body still carrying out respiratory activities. With regular exercise routines, especially those involving weights, you can take your lean body mass to its highest permissible level and increase the rate at which your body’s metabolism is carried out.
- Better Stress Handling
A workout session also helps to increase adrenaline levels in the body. This is the hormone which makes people more alert and energetic. You’ll be tuned to your environment and adrenaline increase simultaneously causes an increase in (and stimulation of) endorphins which will make you feel good and is used for general mood improvement.