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Osteoarthritis: Treat with Exercise

A review article from the University of British Columbia in Vancouver shows that exercise does not increase the rate of knee damage in people with osteoarthritis, and usually reduces knee pain and disability (Canadian Family Physician, September 2009).

If you develop pain in your knee that was not caused by an accident or trauma, your doctor will usually check you for known causes of joint damage. If he finds no cause, he will tell you that you have osteoarthritis, which means that he doesn't know why your knee hurts. Most people with osteoarthritis (not associated with trauma) are overweight, do not exercise, and/or have weak muscles that support knee movements.

Osteoarthritis causes a higher incidence of disability than any other chronic condition. It makes exercise difficult, and not exercising increases risk for heart attacks. One in three North Americans over 60 have X ray evidence of osteoarthritis.

People with osteoarthritis should avoid contact sports, but exercise is more effective than any medication to treat this condition. The best activities include swimming and other water- based exercises, stationary cycling or cycling on the road, and muscle strengthening exercises using Nautilus machines or similar equipment at a gym. People with knee osteoarthritis should avoid sports that involve sudden shocks to the knee, such as when the foot hits the ground during running. Inactivity and overweight increase your chances of further knee damage and often lead to a joint replacement.

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Dear Dr. Mirkin: You recommend taking extra carbohydrates to increase endurance during prolonged exercise; won't this raise my triglycerides, increasing heart attack risk?

Usually not. Just walking briskly for 30 minutes can prevent a rise in triglycerides when you increase intake of carbohydrates such as sugar (The British Journal of Nutrition, June 2009).

High triglycerides are usually associated with increased intake of carbohydrates, particularly sugar; and are a sign of increased risk for both heart attacks and diabetes. When you exercise for more than a couple hours, fatigue is caused by a loss of glycogen, sugar stored in muscles. To keep sugar in muscles, you have to take in large amounts of sugar and other carbohydrate sources of sugar while you exercise. If you do that when you are not exercising, blood sugar levels rise and the liver converts that sugar fairly rapidly to triglycerides. However, when you exercise, contracting muscles pull the sugar so rapidly from muscles that blood sugar and the resulting triglycerides levels do not rise high (Circulation, November 2000). This effect lasts maximally during exercise and for a half hour after you stop, gradually declining until it disappears after about 17 hours.

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Dear Dr. Mirkin: Which blood test is a better predictor of heart attacks: CRP or cholesterol?

Both help to measure heart attack risk, but CRP (C-reactive protein) may be more important. CRP measures inflammation which indicates an overactive immunity, while cholesterol measures a type of fat in your blood. Having a high CRP blood test increases your risk of suffering a heart attack or stroke by twice as much as having a high cholesterol (NEJM, November 2002). Everything that activates your immunity can increase risk for heart attacks and everything that damages your body turns on your immunity. Inflammation is part of the immune reaction that protects you from infection. It causes redness, pain and swelling, and can damage the inner lining of arteries or break off clots from arteries to block the flow of blood which can cause strokes and heart attacks.

If you have a high CRP, try to correct the known causes: any type of infection such as chronic gum disease, high blood pressure, alcohol use, smoking, low levels of physical activity, chronic fatigue, eating a high protein/high meat diet, or having elevated triglycerides, insulin resistance or diabetes. People with sleep disturbances, depression, or any of the "auto-immune" diseases such as rheumatiod arthritis or psoriasis are also likely to have a high CRP and are at increased risk for heart attacks.

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Recipe of the Week:

Cuban Mango Salad

You'll find lots of recipes and helpful tips in The Good Food Book - it's FREE

June 22nd, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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