In 2016, 72% of all global deaths were related to chronic disease. That accounts for 39 million people. Although life expectancy has risen for the past two centuries, for the first time, current estimations predict a potential decline due to various chronic diseases. Most people know that regular physical activity and exercise can reduce the disease risk, and the literature supports it. Daily exercise can provide a higher quality of life for individuals with chronic diseases such as rheumatological conditions. This article will offer insights into the value of exercise in rheumatology, the different integrative exercise approaches for these patients, and how to integrate this valuable therapy into a daily routine.

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Understanding Rheumatological Conditions

Rheumatological conditions are comprised of various musculoskeletal diseases and systemic autoimmune conditions. These conditions include osteoarthritis (OA), rheumatoid arthritis (RA), Gout, lupus, and fibromyalgia. Rheumatological disorders often affect joints, bones, and muscles. OA is a degenerative disease of the joint that occurs when there is a loss of cartilage, joint degeneration, and bone spur formation, resulting in joint pain and stiffness. In comparison, RA is an autoimmune condition where the immune system attacks the joints.

On the other hand, Gout is caused by an excessive amount of uric acid in the bloodstream, leading to the formation of crystals made of monosodium urate that build up in the joints. Lupus is another autoimmune condition within rheumatology that impacts various organs and systems within the body and is characterized by connective tissue dysfunction. One other common rheumatic disease is fibromyalgia. Fibromyalgia is a chronic condition indicated by pervasive musculoskeletal pain, fatigue, and sleep disturbances.

These rheumatological conditions can significantly impact patients' physical and mental well-being. Chronic pain, joint stiffness, and limited mobility can affect their daily activities and reduce their overall quality of life, which may lead to frustration and anxiety. Thus, a multidisciplinary approach in rheumatology care that addresses these various factors is crucial in managing these conditions.

The Role of Exercise in Rheumatology

Exercise is an important part of improving symptoms in rheumatology. Here are some of the benefits that exercise provides: 

Physiological Benefits of Exercise

The physiological benefits of exercise include improved joint mobility, flexibility, increased muscle strength and endurance, and enhanced cardiovascular health. These benefits can be helpful as a part of a complex treatment protocol for rheumatoid patients, as the advantages of properly designed programs can be achieved without exacerbating the disease or joint damage. A study revealed that higher-intensity exercise is more effective in enhancing aerobic capacity, muscle strength, joint mobility, and physical function without negatively impacting disease activity in RA patients.

Psychological Benefits of Exercise

Exercise provides not only physical but also critical psychological benefits. Incorporating moderate physical activity improves mood, reduces stress, enhances coping abilities, boosts self-esteem, increases energy levels, decreases symptoms associated with depression, and can reduce pain perception in patients struggling with rheumatological conditions. When patients with these conditions include exercise in their regimen, it can enhance their quality of life.

Role of Exercise in Disease Management and Prevention

Chronic disease is usually the result of genetics, environment, or poor lifestyle. Exercise can be helpful to manage and prevent various chronic diseases such as obesity, cardiovascular disease, and diabetes. The health benefits are not limited to the metabolism or cardiovascular system. It is also helpful in the musculoskeletal system, which can increase muscle strength, bone health, and bone mineral density. Whether managing or preventing diseases, regular exercise can provide a higher quality of life for people with chronic conditions and possibly increase their longevity.

Integrative Approach to Exercise in Rheumatology

An integrative approach in rheumatology includes a personalization to exercise programs. Here are some exercise considerations for long-term compliance:   

Collaboration Between Healthcare Professionals

Rheumatic diseases may require collaboration among multiple healthcare professionals, including functional medicine doctors, rheumatologists, physical therapists, and other pain management specialists. This approach ensures that patients with these conditions receive well-rounded care to address all the underlying factors contributing to their symptoms.

Tailoring Exercise Programs

Every rheumatological patient has different needs, and their treatment protocols should be personalized to address these individual needs, including their exercise programs. Some patients may have limitations based on their disease progression. The exercise program should account for these varying physical capabilities and be aligned with the patient's goals and preferences. Applying this integrative approach optimizes the benefits of exercise for these patients.

Incorporating a Variety of Exercise Modalities

Another integrative approach to exercise is incorporating a variety of exercises. Variety can overcome the "it's too boring" barrier that can occur with a standard exercise protocol. Regardless of participation level, exercise programs typically consist of four primary types of exercise, all of which can contribute to reducing pain and disability associated with rheumatological conditions such as arthritis. 

The four exercises include flexibility, strengthening, aerobic exercise, and body awareness. Flexibility exercises involve AROM (active range of motion) and stretching. AROM should be done daily with 5-10 repetitions, and stretching should be done 4-5 days a week to improve joint and muscle flexibility, posture, and overall function. Strengthening consists of vigorous exercise that targets major muscle groups 4-5 times a week, as strong muscles can provide better joint support, reduce bone loss, and contribute to overall function. Aerobic exercise is also called cardiorespiratory conditioning, as this type of exercise can improve heart, lung, and muscle function. It is recommended to do a150 minutes of moderate-intensity aerobic exercise that is spread out throughout the week. Body awareness is the fourth type of exercise that is helpful for rheumatoid patients. Examples of this group of exercises are Tai chi and yoga. These lower-impact exercises can improve posture, balance, joint position, proprioception, coordination, and relaxation, which help reduce the risk of injury. Being physically active and integrating these exercise options regularly can help these patients live healthier and happier lives.

Overcoming Barriers to Exercise

Barriers can keep us from doing something that we know we should do. In the case of exercise, many people have barriers to starting or continuing exercise, which can be prevalent in rheumatology patients. Helping these patients overcome these barriers should be a priority with these patients due to the benefits exercise can offer. As with managing rheumatology, the approach to help these patients overcome barriers is also multifold and requires addressing their misconceptions, adapting programs, and providing support. 

One of the major barriers that can prevent these patients from starting is the common concern or misperception that they can't exercise because of their condition and the physical limitations that they may have. It will be beneficial to start slowly for these patients to ease their way into an exercise routine. Examples include walking around the block or chair exercises. Everyone has to start somewhere, and it's important just to get started. 

Another barrier is patients may have severe symptoms. Working with a physical therapist to address their mobility and movement can be helpful in this case. These health professionals are trained to be mindful of the patient's symptoms and can adapt the programs to the patient's specific needs. It is also vital to provide education and continued support for these patients, so they have long-term adherence to this beneficial therapy. Practitioners can provide support by helping these patients create and adjust their exercise plans according to their progression. These personalized adjustments can make all the difference in creating variety,  maintaining commitment, and continued improvements.

Functional Medicine Labs to Test That Can Help Monitor Progress in Rheumatology Patients

Here are some commonly used labs by functional medicine practitioners to help monitor progress and adjust treatments in rheumatology patients:  

RF and CRP

The Arthritis Panel will track inflammatory markers like Rheumatoid Factor (RF) and C-reactive protein (CRP). These markers allow practitioners to frequently monitor rheumatology patients' inflammation levels and make necessary treatment adjustments.

hs-CRP

The hs-CRP test can detect even minor CRP level increases that can be associated with inflammation status in rheumatology patients. Elevated levels can indicate a flare allowing for proper management of the condition.

Comprehensive Stool

The comprehensive stool test can analyze the diversity of the gut microbiome. The microbiome balance can significantly affect overall health and inflammatory responses in patients with rheumatological conditions. Assessing gut health enables personalized nutritional plans and treatments.

Organic Acids Test (OAT)

The OAT can assess metabolism, detoxification, energy production, and gut health. This assessment is valuable for rheumatology patients as this is a comprehensive profile that can help manage the pain, energy, inflammation, and overall health of these individuals.

Micronutrient Panel

Inflammation is often associated with rheumatology symptoms. Deficiencies in certain micronutrients, including omega-3s, vitamins C, D, and E, can lead to systemic inflammation making symptoms worse. These insights into the possible imbalances of these nutrients can guide interventions to reduce inflammation, thus improving joint pain in rheumatology.

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Summary

Chronic diseases such as rheumatological conditions can present with extremely debilitating symptoms for patients who struggle with these various disorders. These symptoms can include joint issues, pain, and fatigue, impacting individuals' physical and mental well-being. However, there is hope. Incorporating an exercise program or some sort of therapeutic physical activity regularly can significantly reduce these symptoms, increase fitness levels, and improve the overall quality of life for patients with these conditions. Collaborating with a team of healthcare professionals can address these patients' diverse needs to manage rheumatic disease effectively.