I am amazed at how much health can change dramatically in one year.
Last fall, I was in excruciating pain from osteoarthritis. After learning that I have grade 2-3 cartilage loss in the left knee, my orthopedic doctor gave me three hyaluronic acid injections to help ease the pain. He also suggested that the only truly effective way to get better was to ride my exercise bike.
My rheumatologist (the one who just retired) was kind enough to order physical therapy for me so that I could receive expert guidance on what types of activities I should be doing to delay possible knee surgery in the future. She also suggested that I consider weight loss surgery because being morbidly obese was not helpful.
Slowly, I began to ride the exercise bike at home more frequently and for longer periods of time. My physical therapist worked with me for two months to build strength and flexibility. She also determined that my knee cap was “frozen” in place which wasn’t helping matters either. Correcting that situation was enormously painful, but worth it in the long run.
Around the same time, I began to honestly assess what I was eating, document meals and snacks, and use my FitBit to monitor activity. I started slow but began to lose weight after a couple of months. I noticed that if I continued to exercise and document everything, I continued to lose weight. One month that I couldn’t ride the exercise bike the scale didn’t move as much, which strengthens the message that a combination of diet and exercise is most effective for weight loss/management.
Over the course of one year, I was able to drop 54 pounds (and still counting). The pain in my knees is almost a non-issue as long as I continue with the at-home plan my physical therapist created. I have achieved actual remission of my RA, which is different than low-disease activity or near remission. And, I feel pretty doggone good.
All of these positives seem to be interrelated.
- Physical therapy helped make exercising at home easier and safer.
- Exercise improves strength, mobility, and flexibility, and increases calorie burn.
- Reducing caloric intake and increasing calorie expenditure results in weight loss.
- Losing weight reduces adipose (deep body fat, especially in the abdomen) which is known to produce pro-inflammatory cytokines, notably tumor necrosis factor alpha (TNF-a) and interleukin 6 (IL-6), that contribute to RA-related disease activity.
- Muscle contractions produce a different type of cytokine, called a mytokine, which has anti-inflammatory properties. Interleukin-6 is also a mytokine that acts against TNF-a and IL-1 (the same target as the RA drug, Actemra).
- Being lighter and stronger makes moving around easier, and staying active helps me to be lighter and stronger.
- One last twist, losing weight has also indirectly increased my serum vitamin D levels such that I’ve reduced my daily supplement to bring my numbers back down into a safer range. Low serum vitamin D levels have been associated with RA disease activity; higher levels may be protective against RA pain.
Considering each of these factors, it is no surprise that I’m doing so well right now. The only downside (if you could call it that) is that I’ve needed to buy new clothes for the winter. But even with all of this success, I still need to be reminded the importance of exercising regularly and passing up on the sweets. My quality of life depends upon it!