It helps to understand the dynamics of how your joints bear weight. Because of the muscles acting across the knee and hip joints, normal walking causes a force across the joints that is equal to approximately four times your body weight.  Therefore, if you are, say, 20 pounds overweight, the force across both the knee and hip joints is increased by almost 80 pounds. Even small amounts of weight loss will decrease this force, slow down the joint’s deterioration and decrease pain. It’s sounds almost too simple, but for many of my patients, weight loss is the essential first step in non-operative treatment of arthritis. And maintaining a healthy body weight now is one of the best ways to decrease your chances of developing arthritis down the road.

Be sure to take the recommended daily requirements of vitamins and minerals. It’s very important to get adequate levels of calcium and vitamin D. The higher your peak bone mass, the less likely you’ll be to have fractures later in life. Maximum peak bone mass depends partly on your inherited ability to make bone, the amount of calcium you consumed over your lifetime and your exercise level. In most cases, bones weaken when you have low levels of calcium, phosphorous and other minerals in your bones. The loss of bone mass, known as osteoporosis, is more prevalent in women, but men get osteoporosis too.  In fact, by age 65, men lose bone mass as fast as women do, and by age 75, one third of men have the disease. 

Premenopausal women and postmenopausal women who use Hormone Replacement Therapy (HRT) should consume at least 1,200 milligrams (mgs) of calcium and 2,000 international units (IU) of vitamin D every day. Postmenopausal women not using HRT and those at risk of steroid-induced osteoporosis should get 1,500 mgs of calcium and 2,000 IU of vitamin D daily. Men should consume 2,000 mgs of calcium every day.

Good food sources of calcium include skim, low-fat and whole milk, low-fat plain yogurt, Swiss, cheddar and ricotta cheese, kale, broccoli, canned salmon with the bones, and orange juice and other products—such as tofu—fortified with calcium. If you find it hard to get the recommended amounts of calcium from your diet because you can’t eat dairy products, for example, try calcium supplements. Supplements—even plain old TUMS–are just as effective as calcium from food, are inexpensive, and generally are well tolerated and well absorbed if taken properly.

If you’re new to the gym, or unfamiliar with weight training, speak with one of the trainers about developing a safe and effective exercise program that preserves muscle tone and maintains range of motion. The key to success with these repetitive weight-training exercises is knowing which muscles need to be strengthened and how to perform the exercises without overstressing your joints. Range of motion exercises and stretching will reduce the stiffness in joints and help make them more flexible. Isometric exercises—in which you tighten your muscles but don’t move your joints—and mild weight-bearing exercises should constitute the strength portion of your workout. These will increase muscle strength, which in turn will stabilize weak joints. Finally, aerobic or endurance exercises that you do for 20 to 30 minutes three times a week will improve cardiovascular fitness, help control weight, improve overall function, and can even reduce inflammation in some joints. It is important to exercise consistently, because the more inactive a person is, the more pain and stiffness he or she will suffer.

Non-impact activities: Start your exercise plan with non-impact activities that give you a cardiovascular workout and keep your joints moving through their normal range of motion. This will keep the cartilage in your joints lubricated and pain-free. Cycling and swimming are great options. Both of these activities use big muscle groups for an aerobic workout without impact on your joints. Swimming deserves special mention for those of you with advanced arthritis or injuries, and those recovering from illness or surgery. The benefit of water-based workouts is that water offers resistance, which strengthens your muscles as you push against it, while the water’s buoyancy supports your weight and significantly reduces stress on your weight-bearing joints, bones and muscles. For those with injuries, the pressure of the water also reduces swelling, and if the water is warm, the heat will relax your muscles and ease joint stiffness. Bicycling, especially on an indoor, stationary bicycle, can help you become more fit without putting too much stress on your hips, knees, and feet.

Low-impact cardio equipment: Elliptical trainers and recumbent bikes are excellent machines that are kinder on the knees than a treadmill. If you’re experiencing joint pain, I’d suggest you avoid the “old-fashioned” stair master. If your knees are already hurting, you’d do well to remember that, pound for pound, few things put more stress on your joints than running.

Exercises to Avoid: The seated leg extension machine would be one to avoid, as it places undue stress on the knee joint; lunges are a better alternative for maintaining quad strength, as long as you’re careful not to bend the knees more than 90 degrees.

It’s important to realize that certain exercises can be a double-edged sword. Remember, arthritis is often a problem of “wear and tear” on the joint, so anything that further stresses the joint, like vigorous exercise or lifting excessively large weights, may actually do more harm than good.  Too much exercise can amplify the joint force about the hip or knee and cause increased pain and more rapid deterioration of the joint.  Lifting very heavy weights is also problematic. As you get older and continue to lift significant weights, you can injure your muscle-tendon junctions and joint surfaces.  That’s because the new muscle becomes stronger than the aging tendons, in particular the patella, quadriceps, biceps and Achilles tendons.  The best prevention as you pass through middle age is to maintain flexibility, and keep the weight training geared toward lower weights and multiple reps. The shoulder is a special case; it’s imperative that you keep the shoulder joints flexible and maintain rotator cuff strength with basic exercises, especially if you want to continue activities that involve overhead arm motions, like golf.

It also goes without saying that you need to pay attention to your body’s signals.  If, after your workout, you feel unusual or persistent fatigue, increased weakness, decreased range of motion, increased joint swelling, or continuing pain that lasts more than one hour after exercising, your exercise program may be too strenuous and should be adjusted.

Researchers looking at the effects of exercise and sports on the development of musculoskeletal disabilities, including arthritis, have found that people who participate in sports with high-intensity, direct joint impact—like football and soccer—are at risk for osteoarthritis. Sports involving repeated joint impact and twisting (such as baseball and soccer) also increase this risk.

Even if you’ve reached middle age with admirably intact joints, a single traumatic injury such as a broken bone, torn ligament, or moderate ankle sprain can promote deterioration of the cartilage and cause the injured joint to become arthritic in the future—even though the joint received proper medical care at the time of injury. When arthritis develops as a result of sport injury, it is generally referred to as “secondary” osteoarthritis.

A sizable number of my younger patients who have developing osteoarthritis first came to see me because of joint injuries they sustained while pushing themselves on the basketball court or overestimating how far they could safely run. A significant number of injuries are sustained near the end of an activity when fatigue begins to set in and balance becomes compromised.

Play it smart. Know your limits and prolong your joint health.