NICE, the National Institute for Care and Health Excellence, recently published new draft guidance on managing osteoarthritis, recommending exercise and healthy eating over pain drugs. Patients who rely on analgesics, and who see joint replacement as their only way forward, are not happy. And I can see why: I enjoy exercise, and yet hip replacement was the only thing that ended my misery from severe osteoarthritis last year.
Perhaps this self-management push is not surprising, given the long wait for joint replacement surgery and the difficulty accessing NHS care. But there is science behind the advice, with an increasing body of evidence that exercise keeps bones and muscles strong as we age and can also ease arthritis pain. We know carrying excess weight also puts pressure on joints.
But things are never that simple. For some people exercise can trigger arthritis pain (it did for me during late stage OA), fatigue can also be overwhelming, and losing weight can be a challenge. There is also conflicting research, most notably around running: some experts say it's good for osteoarthritis, others not.
So what can we do to ensure we are exercising safely? If, like me, you enjoy training at a gym, perhaps it's hiring a personal trainer, someone who will choose exercises for you and keep a watchful eye over your technique.
Having made the decision to work with a trainer the challenge is finding the right one. The industry isn't regulated so it's difficult to tell who is good and who isn't. The required level 3 personal training certification can be acquired in as little as five weeks, according to The Training Room, a full-service fitness careers provider.
It also takes specialist knowledge to understand arthritis. There is a culture in some gyms of training to failure, which isn't helpful when you have arthritis. Having a PT who will push your "lazy ass" might be good if you are a "lazy ass", but if you have a joint problem pushing beyond your comfort zone could lead to injury.
Another point to consider is money. Personal training can be expensive, costing £50 an hour on average, plus there may be monthly gym membership to pay on top (though this is often waived if using the gym for PT sessions only).
We know exercise is important for staying healthy and difficult to navigate when you have a condition like arthritis. Having a personal trainer could be the answer to guiding you through the exercise process safely in the gym, if you have the money to afford one - and the patience to find the right one!
5 tips for finding a personal trainer if you have arthritis:
1) check qualifications. Does the trainer have certifications beyond/supplementary to level 3, any specialism in injury rehab etc?
2) how many years of experience do they have?
3) how good is their knowledge of arthritis?
4) have they trained anyone before with arthritis or other musculoskeletal conditions?
5) seek references if still unsure