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May 25, 2022 23 mins

Finding movement that works for you while living with joint pain can feel pretty contradictory. That is why Amanda Nelson - a Rheumatologist and Associate Professor of Medicine - joins us to share the importance of finding movement that works to both help ease joint pain and fit within a busy schedule. Especially for caregivers, fitting in time for movement can be a pain in more ways than one, but ultimately strengthening this pillar of self-care benefits our bodies and our ability to show up for the ones we love.  

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Speaker 1 (00:02):
Hi everyone. I'm Holly Robinson, pete actor, author, advocate, do
it all mom, and I'm also a caregiver. And this
is care Walks, a podcast from My Heart Radio and
volteran arthrightist pain gel. It's a show for family caregivers
who give everything to everyone and need to make time
for themselves through movement. Every episode is designed for you

(00:26):
to walk as you listen, so just think of me
and my guests as your weekly walking buddies. We'll hear
stories from caregivers and gain tips and insights from health
experts and advocates who know how important it is to
take care of yourself and manage joint pain due to
arthritis that often accompanies being a caregiver. Together, we'll find

(00:47):
community ourselves and maybe even alleviate some joint pain in
the process as we walk together and connect to the
best parts of being a caregiver. Welcome back to Kara Walks, everyone,
and thank you for taking time to join us, and
thank yourself for taking time to make your self care

(01:08):
a priority. All right now, just a reminder, Right now
you're listening to the full version of this episode, but
if you don't have time for a full walk today,
then go check out our bridged version of the same episode.
It's like cliff notes for podcasts, so no matter how
much time you have, you won't miss out on a
great conversation. All right, now that's settled, let's dig into

(01:31):
the episode. Today, we're talking about the importance of movement
for caregivers living with ostio arthritis. It might seem obvious
that we should implement exercise and movement into our weekly routine,
yet so many of us struggle to stick to that habit,
and frankly, I find that understanding more deeply how movement

(01:51):
affects and helps joint pain can go a long way,
and helping solidify new movement habits and keep up with
them to help us better understand how joint pain effects caregiving.
I will be joined by Dr Amanda Nelson, a rheumatologist
and Associate professor at the u n C Thurston Arthritis
Research Center. She understands both the challenges and the best

(02:14):
strategies from managing o A from her experience working directly
with patients, both in clinical care and in research. But
before we get into today's conversation, let's begin our walk.
We're going to focus on staying present within our bodies
and within our movement. Think about the contact you're making

(02:36):
with the ground. What does that feel like? Be sure
to relax your shoulders as you walk, pull them down
from your ears and breathe in deeply through your nose.
Feel the sensation of your stomach and your chest rising
with your breath. And now breathe out through your mouth

(02:58):
and let everything in your boy to relax as you breathe.
Be aware of the air filling in your lungs. Can
you feel your chest compressing as you slowly release the breath.
Take a beat to walk through your five senses? What

(03:20):
do you see around you? What sense are filling in
the air? What do you notice about the way your
body moves as you set your pace? Now as you
settled into your rhythm. I'm going to share my conversation

(03:40):
with our guests, and together we're gonna learn a little
bit more about how we can all benefit from keeping
our bodies moving. Today, I'm joined by Dr Nelson, a
rheumatologist and Associate professor at the u n C. Thurston
Arthritis Research Center. She understands both the challenges and the

(04:01):
best strategies for managing away from her experience working directly
with patients, both in clinical care and in research. Dr Nelson,
thank you so much for joining us on care walks. Oh,
thank you very much. I'm happy to be here. I'm
happy you're here too. Could you tell us a little
bit about the work that you do and how you
have helped joint pain sufferers improve their symptoms, and can

(04:24):
you tell us how away affects the body and its
ability to move. Yeah, So, as you mentioned, I'm a
rheumatologist and I see patients one day a week, and
those patients have a range of arthritic conditions and a
lot of them have challenges with mobility. I also do
research primarily and osteoarthritis, which is the most common form
of arthritis, around a lot of different aspects of risk factors, disparities,

(04:48):
issues of imaging and bio markers, how we might tell
people do or don't have arthritis, how it might progress,
and some novel methodologic approaches to try and understand it
better for future cunical trials and clinical care. So the
main recommendations around symptomatic improvements. So first I would say
that there is no drug or other intervention that really

(05:11):
affects the process so once arthritis has started, particularly osteoarthritis,
there's really no way to make it stop or make
the cartilage regrow currently, and so we do mainly focus
on symptoms and improving those symptoms. One of the best
ways to do that is exercise, and we have shown
in a variety of different studies that exercise really does

(05:32):
improve pain. Often that's not the first thing that happens,
so people have to work through some initial discomfort. A
lot of times, maybe they haven't been very active and
they have to sort of get into the routine and
get over some initial joint pain. But over time, being
regularly active does improve the pain and symptoms of arthritis.

(05:52):
Osteoarthritis primarily affects the joints. It's a little bit different
than say room atoid arthritis or lupus that can also
cause joint pain but have a lot more systemic symptoms.
Oste Earthritis really just stays in the joints and it
affects all of the tissues of the joints. So we
used to think of it primarily as cartilage loss, which
is certainly part of it. The cartilage pad that cushions

(06:13):
the joint thins over time. It gets damaged, especially in
the knee, there's a moniscus, there's an additional pad that
gets broken and damaged. There are tendons and muscles that
the bone itself gets affected, So it's really everything about
the joint that gets damaged through the process of osteoarthritis.
And then obviously you need your joints to walk, particularly
in the lower extremities, So hips and knees are very

(06:35):
commonly affected by o A and with that can definitely
impact people's mobility. Walking often we think of first, but
a lot of just activities of daily living require weight
bearing on the lower extremities and that can become difficult
over time. For a lot of people with O WAY.
Mobility is incredibly important, and if we lose mobility, we

(06:55):
often become isolated, lose support systems, you know, lose a
lot of function, and then that can then contribute to depression,
which is also pretty common in arthritis. So mobility in
general is really important, and reduced mobility is actually a
marker of reduced lifespan. So people that walk slower are
really unable to walk generally just don't live as long

(07:15):
and they don't have as high quality of life as
those who have more normal mobility, right, And you know,
for a lot of joint pain sufferers, movement is such
an important part of their self care journey and it
could be so difficult. A lot of our audience are
not only folks with joint pain, but also people who
are caregivers to family members like myself. So I'm curious,

(07:36):
do you work with patients who are in a similar
role and what do you notice about them? So the
caregiver themselves often is taking on that role in a
way that sort of reduces their focus on their own health.
And so if you're extremely focused on taking care of
someone else who you see is being very in need
of your services in that way, then you often overlook

(07:58):
your own stuff, right, So you're not into the doctor,
you're not going to exercise, you're not eating right as
that caregiver. So one thing is certainly to encourage those
folks to keep a focus on their own health, because
if they're not healthy, they can't take care of the
other person either. I think that the isolation piece fits
in there too. So if a person is very focused

(08:19):
on their caregiving role, they may not interact with friends
or do social things or other things they're just so
focused on that. And then a lot of caregivers share
a lot of risk factors with the person they're giving
care too, So if it's a family member or a
sibling or even a friend, a lot of times those

(08:39):
sets of people are from similar backgrounds. Maybe they share
a similar environment, they have a similar diet, a similar culture,
and all of those things are going to put the
caregiver at risk as well. So if the individual being
cared for has osteo arthritis of multiple joints and limited mobility,
it may well be that the caregiver also has some
joint pain that's limiting their function. And on the research front,

(09:02):
that feeds right into a lot of the interventions now
where people are trying to engage a caregiver or a
support family member, sibling, whoever it is, because walking and
other interventions are a lot easier if there's two people.
So maybe you and your sister can go out and
take a walk and have a chat about joint pain
rather than just again being isolated and trying to do

(09:22):
things all by yourself. So engaging the caregiver in the
interventions can be very helpful. Some of our listeners might
be new to incorporating physical activity or movement into the routine.
And as we all know, well, I mean I speak
for myself, but I think also for a lot of
other people, just the prospect of starting something like that
it seems intimidating. So what would you say is the

(09:46):
simplest and best way for them to get started? I
think a lot of my patients, and certainly in our
research studies as well, people are often coming from a
position of of no activity. They're very sedentary. They might
get up and go to the store, but o wise,
you know, on the couch or not engaged in a
regular routine, and so there's a lot of ways to

(10:07):
approach that. It depends a lot on where people start.
So if we're starting from a place of I do
nothing but sit on the couch, then the first thing
we say might be, well, during the commercials on the television,
we're going to stand up and we're going to move around,
and we're going to do that every single commercial, because
there's a lot of commercials, and so that can get
you a long way. If we're from a place of well,

(10:29):
I move around in the house, but I don't really
like to go out and walk, you know, then maybe
I say you should walk for five minutes a day,
you know, three days a week, and I work very
slowly up to a goal of maybe thirty minutes a
day for three to five days a week. And I
actually have a walking prescription where I can write this
out for people and say, look, this is the medicine
for your arthritis. The medicine for your arthritis is to

(10:51):
get up and walk. But it's extremely important to meet
people where they're starting, because if I just start with
thirty minutes five days a week, they're going to have
that exact reaction and I say, there's no way I
can do that, and I'm not even gonna try. And
so understanding where people are coming from, what their barriers are,
you know, do they feel like they're going to fall?
Are they living on a two mile long gravel road
and they can't walk, and really coming up with a

(11:14):
plan that's going to work for that person, anyone they're
caring for, you know, working around their schedule. All those
things are very important to getting people started and also
to maintain because you know, if they do it once
and then give up, that doesn't help. We'll be right
back with more from Dr Amanda Nelson. And now back

(11:42):
to my conversation with Dr Amanda Nelson, what would you
say is one of the biggest roadblocks for patients who
are just trying to find the right ways to fit
that movement into their day. Definitely scheduling and not prioritizing it.
So this thing about putting our own health on the

(12:03):
back burner and taking care of others, whether that's kids
or people were caring for, it's essential to prioritize your
own health and say, look, I walk from eleven to
eleven thirty and even if I don't get my walk,
I'm going to do something healthy for myself in that time.
Or Monday's, Wednesdays and Thursdays, I have this half hour,
you know. Finding that slot and then either scheduling it,

(12:25):
blocking it off, telling everyone you're not available some way
to really make that happen can often be very helpful
because you would schedule other things. So just call it
a doctor's appointment, or call it a haircut or a
dentist cleaning or something, because it's just as important as
those things. And a lot of individuals do like a

(12:46):
more structured program. So a lot of the courses, like
through the centers for disease control, and the Arthritis Foundation
might have a self directed program where you can do
it yourself on your own, but they also often have
group classes that are low cost or free where people
can go and everyone there is going to either have
arthritis or be taking care of someone with arthritis, and

(13:07):
that's a great way to build community and see that
you're not alone and that there are a lot of
people dealing with these issues. Yes, and you know, we're
always putting ourselves in the back of the line when
it comes to caregiving. Sometimes we need to put ourselves
in the front. Okay, let's talk about possible misconceptions about
being physically active. I can already hear somebody saying, well,

(13:30):
wouldn't movement just add where and tear to my body
and potentially make joint pain even worse. And I get
that question all the time because it makes sense. Right.
You think, well, if the cartilage is breaking down, then
what I don't want to do is use the cartilage.
But it's not quite how it works. So the cartilage
itself doesn't have its own blood vessels, it doesn't get

(13:51):
nutrients from the body through the blood like a lot
of other tissues, and the way that it gets nutrients
in and waste products out is by compression. So the
actual loading of the cartilage is how the cartilage stays healthy.
If people are unloaded, you know, for example, having a
paralysis event where they really cannot walk, the cartilage degrades

(14:13):
because it can't get nutrients. And so walking is healthy
for the cartilage and actually improves the cartilage function. And
so it's completely counterintuitive, and I get that, and so
I'm happy to explain that to folks. But the joint
wants to be loaded now, it doesn't want to be
It's not a jackhammer, right, So it's not looking for

(14:33):
high impact, major activity, but it does like some periodic
loading and unloading, such as we get with walking and
what else? What are some other low impact activities that
caregivers with joint pain can do besides walking. Yeah, so
walking certainly the cheapest and easiest we can all do it.
I have a lot of people who benefit greatly from

(14:54):
the elliptical system because there's really no impact so much
as that gliding motion can be very helpful. And for
people that really have not been moving, have a lot
of pain, maybe a lot of other comorbid conditions, A
lot of times water therapy is very helpful, whether that's
a PT driven aqua therapy program or again like an

(15:15):
OAR threatis foundation class at a local pool. Often the
pool is warm, the buoyancy from the water helps to
sort of take some of that weight off the joints,
but still they're being loaded in a useful way for
the physiology of the joint itself. So there's a lot
of different modalities and it very much again depends on
what people want. If if you're terrified of the water,
then I'm not going to tell you to do water therapy,

(15:37):
but that certainly is a great place to start for
people that have access and enjoy that. Okay, let's talk
about self care. How can we help caregivers with joint
pain see movement as self care. It's almost like a
psychological exercise, you know, so that we don't look at
it as this burden of oh gosh, I gotta do this,

(15:59):
but as actual self care and self love. How can
we get them to prioritize that. Yeah, So education is
a huge piece of this, making sure that people understand
the process of the disease, whatever that might be, or
or if there's multiple diseases, at play, how the physical
activity might benefit them, how it's better than a lot

(16:20):
of the other choices, and so to say, look, exercise
is the medicine. This is what you do for this problem.
This is how you get this better. It's free, you
can do it whenever you want. You don't have to
go to the doctor. Like. There's so many benefits. And
the good news for you today is that all you
have to do is walk, and walking is going to
give you the biggest benefit. Can work out be too

(16:43):
minimal to see benefits. There's two parts to that. One
is any movement is better than no movement, and so
if you're, you know, just getting up during the commercials,
are doing those five minute walks, that's way better than
the sitting on the couch was previous to that. We
have to start somewhere, and we want to encourage people
to start where they are and move forward. From that point,

(17:05):
any movement is going to be of benefit over the
longer term. There's still some debate about how much we need,
right so, there was the ten thousand steps going around
for a while, and then one of my colleagues did
a study that showed that maybe six thousand was probably
okay for people with OSTEO worth right, as there are
guidelines out there for how active we need to be

(17:26):
that can be very daunting if we start there. So
you know, a hundred and fifty minutes a week sounds
pretty scary, but again it's it's the essential piece of
just moving. And if that's a very small bit at
the beginning and we're working up, then that's all we
can ask anyone to do. We can't leap straight to
full maximum healthy adult guidelines and and go from there.

(17:46):
That's just not how it is, yes, And how do
you know when movement pain is pushing the limits or
over extending? So I usually tell people it's okay if
you're a little sore the next day, that's kind of
again to be expected it if we haven't been doing
too much. But if it's lasting for a few days
or it's really debilitating, like I walked yesterday and I'm
in bed today, that was either too much or there's

(18:08):
something else going on. If it's a joint pain issue,
we shouldn't have red, warm, swollen, angry joints, right, So
they might be a little bit puffy if we were
just up and about more, And that's okay, that should
go away. But if there's acute pain, new redness or warmth,
something that's never happened before, pain in a place that's
never happened before, those are all things to look out for.

(18:31):
But generally, what we expect is that the joints that
hurt might hurt a little bit more after the activity,
and they might be a little sore the next day,
and then we should be back to where we were
going or even feeling a little bit better by then.
So big changes, though, or or new things that hadn't
happened should be at least evaluated. It might be okay still,

(18:52):
but we just want somebody to take a look and
make sure that we're not causing a new problem or
or you know, maybe our gate isn't quite right and
we're generating some new pain issue that we didn't have before.
So just being aware of our bodies, where we started,
where we're going, and what to expect. I generally don't
recommend jogging. There are people that swear by it, and

(19:12):
that's fantastic for for the people that can do it,
but I think just the impact on the feet and
the ankles and the knees and the hips and the
lower back, which can all be affected by osteo earth. Right,
As it's certainly not where we want to start, it
may be a place that we can get to other
things that have a lot of pivoting, like individual high

(19:32):
level tennis. Right there's so much stress on the knees
or skiing. Some of those things probably are not what
we want to aim for, but less impactful things that
are maybe over a longer period of time, are generally
going to be okay. And if there's a goal that
a patient has, like I really want to the end

(19:52):
of this is often play nine holes of golf, but
I'm sure there are other examples. Um, then we can
work up to that. Right, if we know where we're going,
maybe I can get you started. I can send you
to a physical therapist and they can get you further along.
And if it's more elite activity that we're trying to
get to, maybe it's a younger person with arthritis, which
also happens, maybe a sports medicine person or a physical

(20:13):
medicine and rehabiting. There are pathways through which we can
work to get people to where they need to go.
In most cases, and um, I'm asking for a friend,
but what do you do when you have a former
NFL football player husband who has O A and all
the joints, but he thinks he needs to go skiing
because he wasn't allowed to when he was in the NFL,

(20:34):
making up for lost time, and just thinks he's competing
in the Olympics. I just had to ask because my
husband was a professional athlete, and those athletes that compete
at a very very high level, you know when they're
told they have to do something as simple as walking
to get better, and they feel like they have to
grind it out, you know, walk a marathon. So if

(20:56):
he's really enjoying it, then it's probably worth doing. But
you know, maybe he only needs to take the run
twice instead of six times. Right, maybe he takes it
once in the morning, once in the afternoon, takes a
little break in the middle. Uh, we can do the things,
but we might not can do the things at the
same intensity. Yes, that's right. Thank you so much for that.

(21:18):
I just needed a little wifely encouragement you well. Thank
you so much Dr Amanda Nelson for talking to me
today on care walks. I love the idea of the
commercial movement breaks. I think that's a great starting place.
If you're not in the habit of moving just yet,
it's important to take it in little bite sized pieces

(21:38):
to get yourself going right. And I really appreciate having
this conversation with you. Thank you so much. We thank you, Holly.
It's been fun. I want to thank Dr Nelson again
for being my guest today. I really appreciated our conversation
and I hope you learned as much as I did

(21:59):
about finding ment that will help your joint pain and
the physical benefits of implementing movement as well as what
it does for our mental health. That's it for today's episode.
Thank you once again to Dr Amanda Nelson for joining me,
and don't forget to come back next week for another
walk with our guest actor and caregiver Jenny Garth. We're

(22:21):
going to talk about her experience as a caregiver for
her father and how she now prioritizes self care and
manages her joint pain. And remember keep walking and don't
forget to take care of yourself too. Care Walks is
produced by I Heart Radio in partnership with al Teren
Arthritis Pain Jail and hosted by me Holly Robinson. Pete.

(22:46):
Our executive producer is Molly Sosha. Our head engineer is
Matt Stillo. This episode was written and produced by Sierra Kaiser,
with special thanks to our partners at GSK Platform, GSK,
Weber Shandwick An Edelman,
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