Blood Flow Restriction Training

While keeping our joints active is crucial, with arthritis, we must be mindful not to exert excessive stress and strain on our bodies. When experiencing increased pain and discomfort, it might be necessary to adjust our training approach. For instance, lightening the load and incorporating blood flow restriction (BFR) can be beneficial. BFR, or occlusion training, is a specialized technique that involves applying a cuff or band to the proximal portion of a limb (usually the upper arm or thigh) to restrict blood flow while performing low-intensity resistance exercises. BFR has been studied for its potential benefits in various populations, including individuals with arthritis.

Research by Hughes et al. (2017) suggests that low-load exercise training with BFR can enhance muscle strength and be an effective rehabilitation tool. Compared to low-load training alone, low-load BFR training is more effective, tolerable, and potentially an alternative approach when needed. Further, Dos Santos et al. (2021) found that combining low-intensity resistance training with blood flow restriction could be a novel strategy for individuals with arthritis. In their study, when comparing this approach (LIRTBFR) with low-intensity resistance training without blood flow restriction, LIRTBFR showed higher effectiveness in improving muscle strength, as assessed through the knee extension test. This approach shows promise in promoting muscle strength, mass, and functionality gains, especially in a predominantly female sample with arthritis. This research further supports this training style when dealing with flares of arthritis pain. There are several ways in which BFR training could benefit individuals with this condition, including reduced joint strain, enhanced muscle strength and function, muscle preservation, and improvement in functional outcomes. Thus, it is a technique we should strongly consider as opposed to a complete cessation of resistance training.

Supplements

Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that is used to relieve pain, inflammation, and swelling caused by various conditions. Meloxicam is commonly prescribed to treat conditions like osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. It works by reducing the production of prostaglandins, which are chemicals in the body that cause pain and inflammation in response to injury or certain medical conditions. While there are pain medications, non-steroidal anti-inflammatory drugs, or surgery treatments that a doctor may suggest, we will also discuss alternative supplements. 

First, it’s important to note that glucosamine and chondroitin are the most commonly used supplements to improve joint health, particularly for osteoarthritis. Glucosamine is believed to support cartilage health, while chondroitin may possess anti-inflammatory properties. However, the research on their effectiveness could be more conclusive, as some studies found no additional benefits after supplementation (Babur et al., 2022). 

Omega-3 fatty acids, found in fish oil supplements, have anti-inflammatory effects and benefit people with different types of arthritis where inflammation is the primary feature. For other types of arthritis, studies have shown that omega-3 supplementation can improve tender joint count, morning stiffness, and pain in certain conditions (Chang et al., 2021). Curcumin, a compound found in turmeric, has potential anti-inflammatory properties and has been extensively used in Ayurvedic medicine for centuries. Research suggests curcumin supplementation may reduce joint pain and inflammation in arthritis cases (Bannuru et al., 2018; Mathieu et al., 2022). This supplement has shown beneficial effects in many forms of arthritis, including osteoarthritis where degeneration of the joint and cartilage is present.

Ginger, containing anti-inflammatory compounds, has also been studied for its potential to alleviate different types of arthritis and symptoms, leading to decreased pain as well as systemic inflammation (Mathieu et al., 2022). Lastly, vitamin D is crucial for bone health, and some studies indicate that supplementation may help reduce joint pain and inflammation in certain types of arthritis (Zhao et al., 2021; Mathieu et al., 2022). In osteoarthritis, vitamin D has shown smaller effects.

Based on current research, we can consider vitamin D, ginger, curcumin, and omega-3 as potential supplements to support joint health and manage arthritis symptoms. 

Psychological Interventions 

According to Keefe et al. (2008), pain-coping skills training and cognitive-behavioral therapy (CBT) are the most commonly utilized psychological interventions to manage arthritis pain. This meta-analysis of randomized psychosocial interventions revealed that pain coping skills training and CBT were the primary focus, being tested in 18 out of 26 studies with promising results.

Based on the literature, pain coping skills training and cognitive-behavioral therapy (CBT) are invaluable resources for individuals with arthritis, providing essential tools to manage pain and improve overall well-being effectively. These psychological interventions are designed to equip individuals with the necessary skills and strategies to cope with the challenges posed by arthritis-related pain. Individuals can gain better control over their pain perception by learning relaxation techniques, distraction methods, and cognitive reframing. Additionally, these interventions foster a greater sense of self-efficacy and confidence in managing pain, which translates to increased motivation and adherence to other aspects of arthritis management, including exercise and medication routines. Moreover, arthritis can lead to emotional distress, such as anxiety and depression, due to chronic pain and limitations. Pain coping skills training and CBT help individuals address and cope with the emotional impact of arthritis, promoting a more positive outlook and enhanced emotional well-being. While we generally see significant efforts in other approaches for pain management, the psychological aspect should not be overlooked.

Summary of Considerations

1. continuing resistance training while monitoring pain during and after exercise
2. providing days of rest or alternate sessions when flares occur (BFR)
3. considering added supplements (in addition to high protein diet)
4. considering pain coping skills and psychological interventions

References:

Babur, M. N., Siddiqi, F. A., Tassadaq, N., Arshad Tareen, M. A., & Osama, M. (2022). Effects of glucosamine and chondroitin sulfate supplementation in addition to resistance exercise training and manual therapy in patients with knee osteoarthritis: A randomized controlled trial. JPMA. The Journal of the Pakistan Medical Association, 72(7), 1272–1277. https://doi.org/10.47391/JPMA.2444

Bannuru R.R., Osani M.C., Al-Eid F., Wang C. Efficacy of curcumin and Boswellia for knee osteoarthritis: Systematic review and meta-analysis. Semin. Arthritis Rheum. 2018;48:416–429. doi: 10.1016/j.semarthrit.2018.03.001

Chang C.-K., Chen P.-K., Chen C.-C., Chang S.-H., Chen C.-H., Chen D.-Y. Increased Levels of Omega-3 Fatty Acids and DHA Are Linked to Pain Reduction in Rheumatoid Arthritis Patients Treated with Janus Kinase Inhibitors. Nutrients. 2021;13:3050. doi: 10.3390/nu13093050.

Dos Santos, L. P., Santo, R. C. do E., Ramis, T. R., Portes, J. K. S., Chakr, R. M. da S., & Xavier, R. M. (2021a). The effects of resistance training with blood flow restriction on muscle strength, muscle hypertrophy and functionality in patients with osteoarthritis and rheumatoid arthritis: A systematic review with meta-analysis. PloS One, 16(11), e0259574. https://doi.org/10.1371/journal.pone.0259574

Hughes, L., Paton, B., Rosenblatt, B., Gissane, C., & Patterson, S. D. (2017). Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. British Journal of Sports Medicine, 51(13), 1003–1011. https://doi.org/10.1136/bjsports-2016-097071

Keefe, F. J., Somers, T. J., & Martire, L. M. (2008). Psychologic interventions and lifestyle modifications for arthritis pain management. Rheumatic Diseases Clinics of North America, 34(2), 351–368. https://doi.org/10.1016/j.rdc.2008.03.001

Mathieu, S., Soubrier, M., Peirs, C., Monfoulet, L.-E., Boirie, Y., & Tournadre, A. (2022). A meta-analysis of the impact of nutritional supplementation on osteoarthritis symptoms. Nutrients, 14(8), 1607. https://doi.org/10.3390/nu14081607

Turner, M. N., Hernandez, D. O., Cade, W., Emerson, C. P., Reynolds, J. M., & Best, T. M. (2020). The role of resistance training dosing on pain and physical function in individuals with knee osteoarthritis: A systematic review. Sports Health, 12(2), 200–206. https://doi.org/10.1177/1941738119887183

Westcott, W. L. (2012). Resistance training is medicine: effects of strength training on health: Effects of strength training on health. Current Sports Medicine Reports, 11(4), 209–216. https://doi.org/10.1249/JSR.0b013e31825dabb8

Zhao Z.-X., He Y., Peng L.-H., Luo X., Liu M., He C.-S., Chen J. Does vitamin D improve symptomatic and structural outcomes in knee osteoarthritis? A systematic review and meta-analysis. Aging Clin. Exp. Res. 2021;33:2393–2403. doi: 10.1007/s40520-020-01778-8.