fbpx
-The Power of Strength Training for Rheumatoid Arthritis, with Kinesiologist Dr. Jasmin Ma - picture of two women with brown hair smiling
General Education, Podcast, Provider Interviews

The Power of Strength Training for Rheumatoid Arthritis, with Kinesiologist Dr. Jasmin Ma

3 weeks ago
52 min read
Add comment
FacebookXRedditPinterestEmail

Listen now:

Summary:

You might have heard that strength training is important for rheumatoid arthritis, but wondered: where to start?  On episode 138 of the Arthritis Life Podcast, Cheryl chats with Dr. Jasmin Ma, a Kinesiologist and professor at University of British Columbia (UBC), about how to make physical activity doable and FUN through community support. 

Dr. Ma advises people with rheumatoid arthritis to start small, listen to their body, and use her “START” guide to gradually build an active routine that feels right for you. She also explains how the START guide is a useful tool for clinicians like physiotherapists and occupational therapists to support patients in developing sustainable strength training routines.

Dr. Ma  also shares her favorite mantra, “control the controllables and enjoy the enjoyables,” which is a great reminder to focus on what you can manage and find joy in the little things. Plus, Cheryl and Dr. Ma dive into how having a supportive community—whether it’s big or just a few people—can make a huge difference in thriving with RA! 

Episode at a glance:

  • Physical Activity with RA: Dr. Ma shares how you should listen to your body’s needs and pace yourself to avoid overexertion. Physical activity is more than exercise; it’s about reducing sedentary time and increasing daily activity.
  • Kinesiologist’s Approach to Movement: Using the 24-Hour Movement Guidelines, Dr. Ma talks about the balance of physical activity, sleep, and reducing sedentary behavior, all while accounting for the challenges posed by RA.
  • The Importance of Community: Cheryl and Dr. Ma discuss how community is key for thriving with RA, but it looks different for everyone. Whether it’s a large group, one-on-one support, or reaching out to a healthcare professional, connection makes a difference.
  • Inspirational Mantra: Dr. Ma shares her favorite saying: “Control the controllables and enjoy the enjoyables.” Focus on what you can manage and find joy in the present moment.
  • Empowering Mindset: Cheryl and Dr. Ma discuss how RA management is about becoming your own scientist and finding what works best for you.
  • Mental Shift on Exercise: Cheryl and Dr. Ma explore the idea of reframing exercise as something empowering, rather than just a necessity, and how staying active can contribute to feeling more in control of your health.

Medical disclaimer: 

All content found on Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Episode Sponsors

Rheum to THRIVE, an online course and support program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. See all the details and join the program or waitlist now! 

Speaker Bios:

Dr. Jasmin Ma is an assistant professor of teaching in the School of Kinesiology at the University of British Columbia, a Clinician Investigator with Arthritis Research Canada, and an Investigator with the International Collaboration on Repair Discoveries. She was named a UBC Knowledge Mobilization Scholar for her work in bridging her role as a kinesiologist and researcher, working with clinicians and community members to provide physical activity participation opportunities for people with diverse physical abilities. She leads the Movement 4 All (M4A) lab which focuses on the co-creation of trainings, tools, interventions, and experiential learning opportunities for students, practitioners, and peers to support people with chronic disease and disability to be physically active.

Cheryl Crow

Cheryl is an occupational therapist who has lived with rheumatoid arthritis for nineteen years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources.

Full Episode Transcript:

Cheryl:  00:00

All right, I’m so excited to have a kinesiologist on the Arthritis Life Podcast for the first time. So, I’m so happy to welcome Jasmin Ma. Hi!

Jasmin:  00:11

Hi, Cheryl. Thank you so much for having me.

Cheryl:  00:13

I’m so excited to have you, and if you don’t mind just sharing, you know, a little bit about yourself, where you live, and what is your relationship to arthritis?  

Jasmin:  00:21

Yeah, so I always think that’s a funny question to ask, to share about yourself. You can identify so many different things. But I’d say first and foremost is, I’m a physical activity enthusiast. I live in Vancouver, in BC, so very fortunate to live on these beautiful lands. And yeah, a little bit about myself. I am a kinesiologist by trade, but my primary job is a faculty member in the School of Kinesiology, and I mostly teach in the areas of exercise and disability. Essentially, how do we help people to start and stick to physical activity. 

In terms of my relationship to arthritis, I’d say it kind of centers around both community and research. So, some very important people in my life have arthritis. My dad has gout, and my mom has knee osteoarthritis. And over the years, I’ve developed really close and really important relationships to me through Arthritis Research Canada’s Arthritis Patient Advisory Board. These are folks that live with arthritis and people that I continue to learn from. So, that’s kind of a bit of how I sort of see my relationship with arthritis, like from the community have stemmed a lot of questions that I try to address through my research and teaching.

Cheryl:  01:52

That’s so phenomenal. And the only, the reason I heard about you in the first place was actually through Eileen Davidson. A very active, you know, patient advocate, and she’s been on the podcast more than once. So, the people who’ve been listening for a while might know her. And I will, for sure, link to one of Eileen’s past episodes where she’s talked about, you know, physical activity and the importance of that. And I’ll also link in the show notes to Arthritis Research Canada and the Advisory Board, because that’s such a great resource for patients to know about. Oftentimes, I’m in the United States, and oftentimes we default to thinking about our own Arthritis Foundation and forget there’s amazing resources in Canada and across the world as well. So, before we go more into your story, I want to actually take a second to define what is a kinesiologist, and what is kinesiology, for people listening. 

Jasmin:  02:49

That is a great question. I’m so glad you asked, Cheryl. And I’d say that this definition, like most health professions, you know, our scope is constantly evolving, but ours, in particular, because we are a newer profession, does continue to evolve. So, if you were to ask me, kinesiology is a study of human movement. And a kinesiologist, it sort of helps to distinguish between, say, for example, your physical therapist and a personal trainer. So, one of the key differences between physical therapists and the kinesiologist is the movement that we work with is on the broader spectrum of physical activity, and we take a bit more of a focus on, for example, fitness, and more of, say, for example, some of those long-term goals in movement. 

Whereas your physical therapist, you might be working on more of a rehabilitation specific goal. That’s not to say that we can’t work together with physiotherapists or on a rehabilitation goal, but I do like to make a little bit of that distinction, in that we are focused on, you know, sort of that fitness performance and sort of your integration into everyday movement as well. So, everyone practices their kinesiology practice a little bit differently. But for me, it’s about getting people to start and stick to physical activity and find ways that we love physical activity

Cheryl:  04:12

Absolutely yes. And I, you know, I honestly didn’t know what kinesiology was until I had already started my Master’s in occupational therapy. And all the students, and they’re introducing themselves, said, I majored in kinesiology. I went to a very liberal arts undergraduate program. So, I was like, what? There was nothing like practical in the program, in my school, you know what I mean? Nothing, it was all like, you know. Anyway, I went to an amazing college, but it just wasn’t about preparing you for, like, a specific career. So, I was like, oh, what is kinesiology? Is it a science of movement, or the study of movement? It’s so fascinating. Yeah, because, like you said, you can apply it in so many different ways. And when you have arthritis, you know, it’s a deterrent fundamentally to movement initially, because I think most people at a base, at your gut level, think if I’m in pain, I shouldn’t move. But as we know from science, which I will let you talk about, that’s not actually the way to go. So, you know, I’m actually, in your story, I’m interested in what made you want to become a kinesiologist and then specialize in arthritis?

Jasmin:  05:28

Oh, geez, yeah. Dating back a bit, I’d say, I mean, like I said, like, kinesiology, we’re really interested in movement, and, you know, we come about it from a really interdisciplinary perspective. So, I love that you picked up that, you know, there are different aspects of kinesiology. And what I think is really cool, you know, especially here at UBC, the university that I’m at, you know, we look at human movement right from self to society, we’ll say. So, we look at the psychosocial aspects of it, as well as the physiological, biomechanical, neuromechanical, etc. So, lots of different ways you can look at it. One, I think it was the diversity, like, I could never choose. I loved school. 

Cheryl:  06:04

That was me, too. That’s why occupational therapy was, like, choosing without choosing, because it’s like they’re in everything, like everyday activities and helping people function in life. I’m like, that’s yeah, it’s broad. 

Jasmin:  06:16

Yes, exactly. 

Cheryl:  06:17

Yeah.

Jasmin:  06:17

Yeah. So, it’s the variety, you know, like the interdisciplinary approach to human movement. But, you know, looking way back, I was really fortunate, you know, like I grew up playing sports as a kid. It’s the classic, but I had really active parents. And then, when I was going through my schooling, when I first started kinesiology, what had me continue all of my training in kinesiology was, I worked as a kinesiologist and a personal trainer for an exercise clinic that was specialized for people with disabilities, and many of which, you know, many of which of our clients also had arthritis. And yeah, it was just like, I just got involved in this community, like, I’ll keep coming back to it, but it’s just how important that is, like the people that you meet and the relationships that you hold, that was a really big part of why I started kin was, yep, I loved movement and exercise, but it’s the people that have you keep coming back is really sort of, yeah, why that kind of got me to start my career as a kinesiologist and later to study it. 

Cheryl:  07:24

That makes a lot of sense. I mean, I’m very I’m very extroverted, so community is a huge draw, a huge draw for me. And I just love the branding of this. You have a lab that you work in or work for. I don’t know what the right word is there, but Movement for All, Movement for All. And you know, what does that, what does Movement for All mean, and how did this lab start? Just tell me more about it.

Jasmin:  07:52

Yeah. So, yeah, the Movement for All lab is, I guess, my lab that, you know, I always had this dream of, so when I started my kin degree back in the day, I had this dream of, you know, like, wouldn’t it be really cool if I could run an exercise center where it kind of worked as a living lab, and, you know, it was inclusive, and it felt like a place that was fun, and everyone felt welcome, but we could also, you know, study what’s working and what’s not working and advance how we do physical activity. So, that was kind of like the impetus for it. 

So, when I was hired with faculty at UBC and the School of Kin, I had this opportunity to create my lab. And so, a lot of the research that I do and the work that I do is with community partners that, you know, offer programming, whether that’s for people with disabilities or the general population, and are interested in finding ways to make their spaces and their programming more inclusive. So, yeah, that’s like, where the Movement for All lab kind of came from was, you know, like, I always had that sort of tagline of, like, we put the ‘All in Physically Active’, and it makes more sense when you see it written, but any case —

Cheryl:  09:05

Oh, I like that. Physically, yeah, I love that. Yeah.

Jasmin:  09:11

Yeah. And then, the M for A lab, the initials M-A is conveniently spelled my last name.

Cheryl:  09:17

Oh, no, we are so birds of a feather, because I’m so obsessed with acronyms and play on words and like, even like Rheum to THRIVE is like an acronym for my program. That’s like, I totally, I love it. I love it. This is so —

Jasmin:  09:32

Well —

Cheryl:  09:33

I mean — Oh, sorry, continue. 

Jasmin:  09:36

Sorry, yeah, yeah, no, I was just gonna say, like, to kind of segue from that, we’ll come back to that. But, you know, I think just an opportunity to give a bit of a shout out to some of my mentors and colleagues that got me into arthritis because my former postdoc supervisor, Dr Linda Lee, who’s a scientist at — yes, you know Linda, she also loves acronyms. And then, you know, I also just have to give a shout out to Alison Coombs as well, who’s a knowledge worker. She wears many hats, and if you haven’t had her on your podcast, I highly recommend that you do. But both of them have just, you know, been really integral in getting me involved in the arthritis community and the research world. And, yeah, we’re also all cut from the same cloth. But we love our acronyms.

Cheryl:  10:22

Yeah, it really seems to be something that ties us all together in the arthritis world. And I just, I love the way that you talked about wanting to develop a space that is, the word that stood out to me there is ‘fun’, actually, in addition to all the other things. Because I think oftentimes when things are developed for people with disabilities, people are almost seem to be afraid of fun, because they’re like, well, we don’t want to make light of the fact that you have a disability. But like, everyone wants to have fun, right? And have joy, and not have things be — I think most people don’t appreciate things being super dry or, you know, so, what are some of the ways that you’ve embedded fun into the experience?

Jasmin:  11:06

Yeah, absolutely. So, I think part of it is, I mean, I work a lot with students, so, you know, a big part of my role is in teaching. And, you know, I remember, like, it was kind of funny. I would think of this as sort of like my TSN turning point of my professional career. 

Cheryl:  11:24

Yeah, I love it. 

Jasmin:  11:25

Before I started my PhD, I had an offer to go off to physiotherapy school, and I kind of sat there thinking like, oh, like, which way do I go? I don’t know. And, you know, I think a big thing for me was, you know, being in academia and teaching and doing research, like you can have so much impact, you know, beyond you yourself as a, you know, at least for myself, as what I can do as a singular practitioner. And I’m not saying that those who work in practice aren’t making impacts, you know, beyond their own practice. But for me and my skill set, you know, teaching and, you know, sort of going public with addressing some of these questions was a big thing for me. 

So, that’s all to say is that I guess one of the ways that I try to make this fun is when I teach students how to do physical activity counseling, how to prescribe exercise. Like, we come at it from the lens of, hey, yeah, you know what at the end of the day, like, we want people to move more, but if we want people to move, we have to do it in a way that taps into intrinsic motivations. Like, you’re doing it for yourself, because it’s something that you enjoy, right? So, that’s one thing. 

And then, on the other side of things, you know, I still here and there, lead group exercise classes online and, you know, we try to do, you know, fun things of getting people involved in the class and being silly and, you know, incorporating dance, dance battles into what we do. Like, that’s just kind of my style, a little bit of like wear the scrunchie and put your hair up and have a good time.

Cheryl:  12:56

No, I love that. I think that that’s beautiful, and that’s, you know, in my experience, it really, it resonates, too, that when people, when physical activity is fun, people are more like — or just intrinsically enjoyable for whatever reason, whether it’s from the music, whether it’s the community, whether it’s the physical feeling you get, like the endorphin rush — people are obviously going to be more likely to stick with it. And so, I think this is, yeah, and I love your explanation of, you know, being able to have a broader impact. I mean, people ask me sometimes why, do you have, like, a clinic where you see people with arthritis? And I don’t at this time, for the exact same reason that you said, like, if I can only see, like, you know, eight patients a day as an occupational therapist, versus being able to help larger groups and more people using like the various platforms I’m on.

But, you know, I would love to delve a little bit more into rheumatoid arthritis, because there’s so many and I, you know — so for those listening, if I didn’t already say this, I have rheumatoid arthritis, if this is your first episode. I’ve been talking about this for like 130 something times. But yeah, so I’ve, I’m 42 and I’ve had rheumatoid arthritis since 2003, so for 21 years, so. And just a quick background for just really, really quick that I was very, very physically fit, very physically active. And I experienced what I didn’t even know until 10 years later, because no one explained it to me, was severe rheumatoid cachexia before being diagnosed. So, I lost like 20 pounds of muscle from like and 135- or 130-pound frame right before my diagnosis, my body was just so off, and I felt awful. 

But anyway, you know, and then so rheumatoid arthritis activity uncontrolled can directly lead to muscle wasting. That’s one of the reasons strength training is important. What are some of the other reasons? That’s just from my personal experience, like watching my body dwin — I was like, do I have muscle cancer? Like, what is happening? Because I didn’t have an RA diagnosis yet, and I only had one joint that hurt. That was the part that delayed my diagnosis. Anyway, I had an atypical presentation initially, and I only perceived — I wish I could go back in time and see because I had such a high pain tolerance, but I only perceived one joint that was hurting, my sprained finger. So, I was going down different routes. But what — so, in general, that was my atypical experience, for the typical person with rheumatoid arthritis, why is strength training specifically important?

Jasmin:  15:27

Yeah. Well, yeah. First off, Cheryl, thanks for sharing your experiences as well. And for you know, asking this question, too, because it’s an important question. So, why is strength training specifically important for people with RA? You already hit a really important point is to help decrease the risk or help slow the decline associated with rheumatoid cachexia. 

Another thing that’s kind of similarly related with slightly different is sarcopenia, another kind of similar fancy term to say that we oftentimes see a decline in muscle mass, especially as we age. And that’s not atypical. But where it does become atypical is when we see a more rapid decline, and it gets to the point where that decline in how much muscle you have and how well it works, gets you to the point that you’re not able to maintain independence. And that’s the really scary part. 

So, to put some numbers to it, you know, people with RA actually have the, are most, of the chronic conditions, most likely to develop sarcopenia. In fact, 16 times more likely to develop sarcopenia than those without RA. So, that’s, you know, scary. 

Cheryl:  16:40

I didn’t know. 

Jasmin:  16:41

No, I know.

Cheryl:  16:42

I knew it was more likely, I didn’t know was that much more likely. Wow, okay. Definitely noting that. 

Jasmin:  16:49

Yeah, I know. I hate to bring the doom and gloom of like, oh, that’s scary. But you know, it just, I mentioned it just to highlight the importance of strength training, because one of the best things that we can do to combat sarcopenia is to do strength training, right. Or, you know, muscle strengthening activities. So, there’s the sarcopenia bit, there’s the rheumatoid cachexia, there’s making sure that you’re able to maintain your independence, right. Like, wanting to play with your kids or your grandkids, or, you know, get on or off the toilet independently. Like, these are all important things that we want to be able to do. 

And the other thing that I’ll highlight, so these are some of the stuff that’s relevant to rheumatoid arthritis, but it also extends to, you know, for those that don’t have arthritis is for the longest time — you might have, I don’t know if you’ve heard, Cheryl, like, if someone said, you know, there’s the physical activity guidelines where you’re meant to get 150-minutes of moderate intensity physical activity a week. So, that’s great. Like, people talk about the 150 all the time. And a lot of the promotional stuff is for what’s called, like, your aerobic activity. So, that would be sort of those, continuing move, continuous movements that get your heart rate up. You might, you know, start to breathe heavier, get into a bit of a huff and puff and what people typically associate with improving your what’s called your cardiorespiratory fitness, but your ability to keep going for a long period of time without stopping. 

I’m not saying that that’s not important, but it’s not the stuff that keeps you strong. So, the strength training stuff is the other side of the guidelines that we don’t often talk about, and it’s equally important and in disease prevention, like much of the aerobic activity is like walking, running, cycling, wheeling, etc, but strength training is uniquely important for helping to prevent things like sarcopenia, you know, making sure that you stay strong, help to reduce the risk of falls, like these are all really things that are quite unique to strength training.

Cheryl:  18:46

Yeah, I think we should, I think we should delve deeper if that’s okay, because I think this is something that is so, so crucial. And I think when we hear exercise or physical activity, I mean, I’m sure you’ve heard of all these different attempts to say, instead of saying ‘exercise’, we should say ‘physical activity’. But we really are, it’s really apples or oranges when we’re talking about, like, getting your heart rate up for cardiovascular fitness, like you said, versus muscle training. Obviously, you are, if you’re cycling or swimming, your heart rate is going to be up and you are using your muscles, but you’re not, like, your muscles are involved. It’s not that they’re — it completely, it’s like apples and oranges that are like a Venn diagram that open up a little bit strength training versus — so, how do you explain that, I mean, you just explained it really well here, but I’m just, like, trying to figure out how to, like, put a giant exclamation point on this. Like, one of the things I remember my training, maybe this is not, maybe this is, this is like a half memory. So, please tell me if I’m incorrect. About, like slow twitch versus fast twitch, like different kinds of fibers, like endurance fibers versus, is that part of this or no?

Jasmin:  20:00

Yeah, yeah. Like, I think, I think we can get into some of that stuff about different fiber typing, but I think, like, from a pragmatic, like, just from a useful perspective, you’re getting into something that’s really important, Cheryl, is that, like, this Venn diagram concept. I think, well, when you look at physical activity guidelines, we separate them as these two very different things, like, you’re either doing aerobic activity or you’re doing strength training. But the reality is, there’s a bit of a mix between the two, depending on what you do. 

So, the way I like to see aerobic activity and strength training activity is sort of on a continuum, and I think like the continuum middle ground is where we have a lot of exciting questions and a lot to learn more about. Because if, you know, I talked a bit about aerobic activity, like strength training is where you are moving against resistance. It could be using body weight. It could be using free weights. It could be using machines, bands, whatever that is. But the point is that you’re moving against resistance. 

Now, there’s kind of some in between here where, well, we haven’t studied it quite as well. You could pick something like hiking. Like, where do you classify hiking? Because, like many people will put it in this aerobic category, but you’re also moving your body weight up. Like, it’s kind of like doing a bunch of lunges.

Cheryl:  21:23

I’d say you’re like loading, you know, your quads, certainly my quads feel it when I’m hiking or doing stairs. Stair workouts are like my favorite, whatever, I’m a glutton for punishment.

Jasmin:  21:36

Yeah. So, you know, I know we’re going to get into some myth busting later, and we can talk about that later. But you know, how we build muscle, like, I think there’s a lot more flexibility to how we build muscle than what we had traditionally perceived. And I think the more we get to understand about some of these, like, hybrid activities, like hiking, or certain sports like maybe things like kayaking, you know, boxing, like, I think we can build strength and endurance through these activities all in one. But if we are looking at, you know, kind of the traditional sense, it’s oftentimes what people perceive as, you know, what you do in the gym with weights.

Cheryl:  22:16

That makes sense, and some of it you can do with your own body weight too, like, I like a good old-fashioned wall, sit, you know? 

Jasmin:  22:25

Oh, yeah. 

Cheryl:  22:25

But, and yeah. So, you know, what are some of the best resources — this is like a leading question, because you have some amazing resources for people. What I hear a lot, because my specialty, or my heart really goes out to people either newly diagnosed or who just feel like they have literally no understanding because they’ve been left alone to try to figure out how to live with this condition, which is sadly, too many people, but people who want to get started. Like, okay, everyone tells me I need to exercise. Like, where do I go? There’s a jillion websites out there. 

Jasmin:  23:01

There are, yeah, absolutely, and there are, there are a lot of really great things. And I’m just going to put a quick plug for Eileen again, because, you know, like I said, I’ve learned so much from Eileen Davidson and her work. You can follow her on Chronic Eileen, I think you mentioned that you’ll link to that, but you know, she’s been a big source of inspiration and has helped us so much in developing a lot of the resources that we have. So, there’s certainly linking in through the lived experience perspective, that is like step one, I think, part of the process. But thank you also for giving us the plug to talk a little bit about what our lab does as well. 

So, we’ve put together what’s called the I START Toolkit, which, coming back to the acronyms, we love them all. It’s short for Improving Strength Training and Tailoring among People with Rheumatoid Arthritis. So, this toolkit we’ve been working on for, oh, gosh, the past six years. And what it really is, it’s a compilation of the evidence-based guidelines for how to do strength training with rheumatoid arthritis, especially as you’re starting out. So, what it sort of looks like is as a starting place, it’s a suite of different resources, but one of the key resources is this complimentary practitioner and patient guide. So, it could be that maybe, you know, you’ve got your rheumatologist or physiotherapist or kinesiologist, and they want to learn more about how to work with a client or a patient with rheumatoid arthritis and how to get them started with strength training. So, it’s got some key resources on how to do that. 

But likewise, you know, it’s a two-way street in these conversations. You know, they really need to be co-developed, and how we come to developing a training program, right. Because it’s not the practitioner that has to do the program. It’s, you know, it’s you yourself as the individual like you have to do the hard work and the heavy lifting. Pun intended. So, you know, there’s also a patient guide that helps to guide you through some of those key questions that would help your practitioner get to know you better and the best work with you to prescribe a program of strength training. 

Because I don’t know about you, like, you know, I have this experience all the time where you go to the doctor and you’re like, I have all these important questions. I have all these things that I want to say. You get there and you panic and you tell them none of the things that you wanted to tell them, or you downplay all the things that you wanted to share, what have you, right? 

Cheryl:  25:32

It’s the second one for me, I downplay it.

Jasmin:  25:35

Right? Yeah. 

Cheryl:  25:38

It’s hard. 

Jasmin:  25:39

It is, right? And so, that’s kind of the purpose of this toolkit is, you know, to give you a sense of the types of questions that you want to ask your practitioner, allows you the opportunity to maybe write down some of those ideas before you come in and have a conversation with them. And that can either be shared in advance with your practitioner, that they have you know, they can come better prepared to your session, or it’s that accountability checklist that you’re like, I’m going to share all the things I intended to share, and I’m not going to downplay things, you know, I’m going to make sure that I that, you know, I have this checklist, essentially. So, that’s kind of the first thing of the I START Toolkit. 

And then, there are a bunch of supporting resources for it. So, in addition to having the conversation, we’ve got, you know, a webinar to teach you about some of the basic principles of how to strength train with rheumatoid arthritis. So, what do you do when you’re in pain, when you’re experiencing a flare, fatigue, all the common symptoms that you experience with rheumatoid arthritis. And then, beyond that, we’ve got sample exercise prescription forms. So, you know, if you’re having a good day or a bad day, it shows you how to maybe make the exercise more appropriate for a bad day or make it a little bit harder if you’re feeling great. And then, we’ve also got what I love, actually, one of my favorite things is we’ve got a series of exercise videos, and they feature both individuals living with and without rheumatoid arthritis. So, we can see, like, you know, movements look a little bit different for everyone, and that’s okay, that sometimes, I think, is something to be celebrated. So, yeah, that does, you know, give us a little bit of an overview of what those resources are. 

Cheryl:  27:16

Well, and I’m seeing a common thread with, I just interviewed or published an episode with Dr. Liana Frankel, who’s a rheumatologist, who’s the head of the, currently head of the Rheumatology Research Foundation. But she did a lot of research on shared decision making, which I’m sure you’ve heard about, which is like, you know, the best practice of rheumatology, where you actually, it’s like, yeah, for me as occupational therapist, it was so weird to think that this was, like, why do we have to even say this? Like, shouldn’t this be what everyone’s doing? But I guess we have to make it very explicit that you actually talk to your patient about what’s important to them, ask them what is actually doable, meaningful, valuable in their life. 

And I think this is such a beautiful example of that, right? You have these conversations, this guideline, and it’s like a PDF just if you’re trying to visualize what we’re talking about. There’s a PDF guideline for getting started. And then, there’s this really rich his — rich history, weird that my brain just auto-filled that phrase, rich resource of videos. And the second thing that this reminded me of from the Dr. Liana episode is that it’s about, there’s a lot of videos online. You could see videos from patients doing exercises if you just Google on YouTube. But what’s lacking in like the Wild West sometimes of Google and the Internet is the curation by an expert voice just to help you contextualize what you’re seeing. So, the fact that these are all curated videos by, you know, you and your team, other academia, people and other, you know, that that really helps you give, gives you that trust in that resource. So. 

Jasmin:  28:46

Totally. 

Cheryl:  28:47

Little plug.

Jasmin:  28:48

Yeah, and I appreciate you putting that out, Cheryl, and just to give credit, like we have, you know, while I get to be the, you know, the talking head here, like we have a whole team that helps to develop these resources, you know, folks that are coming in as practitioners, people with lived experience, as well as researchers. And yeah, like it takes a village to make these things and to do it right, and we’re constantly iterating. 

Cheryl:  29:12

Mm-hmm, absolutely. I mean, and I wanted to — you mentioned, you mentioned the myths about exercise and RA. I would love to hear, yeah, what are some of the biggest myths that you’ve seen with the patients that have come in and or even just, yeah, any conversations you’ve had, and this is your chance to bust the myths.

Jasmin:  29:33

Totally, yeah. I love myth busting. And, you know, I’ll say to you with the caveat that evidence is always evolving, and so what our truth is today, like, keep checking in, because our truth in, you know, 5, 10, years from now, hopefully and probably will be different, I think, for the better. So, you know, I want to start by saying with a little bit of an anecdote. So, Cheryl Koehn, who you might know, she’s the founder and president of the Arthritis Consumer Experts. Yes.

Cheryl:  30:02

She’s been on the podcast. 

Jasmin:  30:03

She’s a big deal, right? Wow.

Cheryl:  30:05

It was the meeting of the Cheryl’s, yeah.

Jasmin:  30:08

Yeah, so, you know, she’s a former National Team volleyball player. I don’t know if she told you about that, yeah.

Cheryl:  30:18

Yeah, she did. But I forgot. Yeah.

Jasmin:  30:20

Yeah. So, she was telling me about, you know, when she was first diagnosed with rheumatoid arthritis that her practitioner told her not to exercise. So, you can imagine, for a national level athlete, being told not to exercise, like, whoa. And, you know, Cheryl, like, she was like, nah, I’m doing it anyways. And, you know, she says to this day, it was one of the best things that she did for herself. So, you know, the first myth is, and I think we’ve moved past this, but sometimes we do still have some old guard here and there is that, yes, movement is for everyone. It’s just about finding the right ways to move. So, you know, I’ll give you one example there. You know, when you’re experiencing a flare, like that can be, that’s tough, right? And there’s other factors there, like the fatigue, the pain, that can make it really hard to move, but movement is still really important. Like, motion is lotion. 

So, we oftentimes, when you have a — sometimes, I know it’s multiple joints. It can be your whole body, but if you can, right, move the affected joint through available tolerable range of motion and/or focus on the areas that are less affected and decrease your intensity. So, it could just mean, you know, maybe it means, you know, getting up to go for a little bit of a walk or a wheel, just something is better than nothing, I think is, like, my first sort of myth is that, like, we don’t have to do everything at a high intensity, and it doesn’t have to be in these big chunks of 10-minutes or more. Like, something is always better than nothing. That’s the first thing. Yeah. 

The second one is that, you already hit on it. You don’t need fancy gym equipment. And so, we don’t need a fancy gym membership. You don’t need, you know, your special clothes in a special place to do strength training, per se. Like I said, as a starting place, like I mentioned, I live in Vancouver, and it was really cute. My parents came to visit from Ontario. It’s much flatter in Ontario, and my dad’s like, “I have this revelation. I know why people in Vancouver are so fit. You walk to the grocery store and you will encounter a hill.” 

Cheryl:  32:36

So, true. Yeah, Seattle’s very same. We’re over two hours south of you. So, yeah.

Jasmin:  32:42

So, yeah, you know, sometimes, if the lifting weights isn’t where you want to be, like, maybe it starts by, you know, walking in areas where you’ve got sort of some gradual changes in elevation as a place to start. And then, as you get stronger, then maybe it’s then working towards, you know, some of the stuff that’s a little bit harder that you know, might incorporate, whether that’s your body weight, whether it’s, you know, you could use exercise bands. When some people didn’t have exercise bands, I said great, use a pantyhose, right? Or household equipment, like anything you buy from Costco, that’s heavy.

Cheryl:  33:18

Seriously, yeah. 

Jasmin:  33:19

Right? And the last thing that I’ll say is a myth that I think is a really important one, is that you don’t have to lift heavy. So, for the longest time, there was this perception that to improve your strength, you have to lift the heavy things. And we know that’s not the case anymore. If you want to paint how big your muscles are as well as how much they can lift, you can even use light weights. So, yeah, but that’s.

Cheryl:  33:50

That is really out there. That is something I’ve definitely encountered, that idea that you have to really challenge the muscles in order to build muscle.

Jasmin:  34:02

And so, that is the secret, though, right? So, it’s like, it’s not about the weight that you lift quite as much until you get to, like, the sort of elite level. When you’re looking at the elite bit there around, like, optimal strength. Then yes, you do still have to lift heavy. Absolutely. But if the purpose is to improve your strength for general function. You want to get stronger. Maybe you want to compete, you know, in sport, what have you, but, you know, you’re not at that 1% to 2% of final optimization, you can totally get by with lifting light weights. The caveat is that you should feel like your muscles are worked by the end. 

So, we still have to have that intensity equivalent where, you know, we are thinking like, okay, I couldn’t keep going forever at the end of this set, you know, that is like, say, for example, you have 10 repetitions, that’s one set; and then you take a break, and then you do that again, that’s another set. But the end of the set, you think, okay, you know, I might have, you know, three repetitions left in the tank, or, you know, but you’re not thinking, well, I could just keep doing this all day, because then that’s a little bit trickier to get that same adaptation from those light weights. Like, you still have to go to the point of, like, oh, my gosh. Like, I’m getting to the point where, like, I’m about to have to stop or just before that. 

Cheryl:  35:23

Yeah, and I think, can I add one myth that will introduce a new topic of fatigue? So, I think this is something that just an ‘Aha!’ moment that occurred to me after I started, I started working with a personal trainer twice a week just about one year ago. And I have, I really, my main thing was to help with functional daily activities and feel a little bit stronger when I’m doing stuff like lifting. And also, just like, theoretically, like, yeah, my 40s, I have rheumatoid arthritis. I should strength train. I’ve been putting this off long enough. Okay. I did not expect it outright to help with my fatigue. And my personal experience has been it is noticeable, like noticeably, I feel more energy since. But it wasn’t right away. It took a couple weeks, kind of.

And I think that this, The Spoon Theory, which many patients resonate with, and I understand it’s become part of a community. We’re spoonies. We love each other. It’s a theory that you use spoons as metaphors for energy units, and you go throughout, you only have so many to go through your day. And you know, you take a shower, you use a spoon. The problem with the myth about that, right, is that you can only do things that use spoons, and you can’t do things that gain you a spoon. For me, it feels like when I strength train, particularly, in addition to doing cardio, I actually gain energy. Have you seen that with any other patients?

Jasmin:  36:50

Absolutely, yeah. We hear that, certainly, yeah, from a lot of stories that we hear from our clients and the patient partners that we work with is that movement adds to your day, like it gives you some of that fuel. And I think part of it, you know, there’s a physical aspect of movement that I think, you know, adds to your spoons. But I think there’s also, for some people, there’s a social component to it, right? A lot of people will organize their movement or their physical activity with other people, and for some of us, that really fills their cup. So, yeah, I think it’s like, it’s very multifactorial, and yeah, as to why it can add, you know, a spoon or spoons to your day.

Cheryl:  37:36

Yeah, and I was just surprised, because I’ve always been good about cardio, because I like that little, you know, endorphin high, like I have an exercise bike and, you know, or just walk and, you know, I used to run. But long story short, you know, I didn’t, I always thought that, yeah, maybe I would feel, yeah, overall, like I’m feeling more robust, but, and maybe a little bit less fatigued after those workouts. But it was noticeable when with strength training. It’s just really been a surprise, like a happy surprise for me. And I just, yeah, encourage others to — obviously, hopefully you’ve this has come up in many of the episodes, just to, like, the fact that, you know, physical activity doesn’t have to be scary, it can be fun, and it can, and everyone diagnosed with RA, often, when they think about lifestyle, wants to jump to like diet. But my, if I can only have to put my bet on one, I mean, the evidence is a lot stronger for just at least, it’s more uniform, I would say, for physical activity, than it is for nutrition. Not to say that any one individual might be better served by a nutrition intervention versus exercise intervention. But like, you know, at the population level with like large groups of people, physical activity is, like, just over and over again, is what helps people with RA, with pain and fatigue, right. 

Jasmin:  38:56

Yeah, absolutely. 

Cheryl:  38:57

I’ll link—

Jasmin:  38:58

Exercise is medicine. 

Cheryl:  38:59

Yeah, it is, yeah, motion is lotion, and movement is medicine. I will put the 2022, American College of Rheumatology Integrative Health guidelines, because they show in a chart, you know, all the different lifestyle interventions, and that physical, consistent engagement in physical activity, was the only one that was strongly recommended. Yeah, which — and I’m saying this as an occupational therapist, and, you know, occupational therapy and physical therapy were not even as strongly recommended, you know? So, it’s kind of like, my dedication is always to the truth, not to what actually serves me, you know, I want to, I want to know what works for myself and for other patients. 

So, do your patients ever struggle with identifying joint pain versus muscle pain? Because I never did, because, I think my theory was that, because I was just an athlete prior. But because, I think in your guidelines, I looked at the I START, and I think that was one thing. I was like, you write, you say in there, yeah, it’s okay for your muscles to hurt afterwards, but you don’t want your joints to hurt afterwards, right. Is that ever difficult for people to distinguish?

Jasmin:  40:09

Yeah, I think so. Like, I think you know people, you know, even when we coach exercise, like some people do well with cueing that has you think about like what you’re feeling in your body, whereas other people will do better with, like, making, you know, relationships to, like, your outside environment. So, for example, like, if you’re teaching a squat, you know, you might say, okay, you know, pretend like you’ve got a chair down there and you’re going to try and touch your bum to the chair. Like, that’s kind of like that external cue. Where, like, an intrinsic would be, like, okay, like, can you feel it in your butt? Can you feel it in, you know, the backs of your legs and the fronts of your legs, right. Like, all those, even just in how we coach and how people resonate with a cue, it’s different from person to person. So, likewise, being able to pick up on where they’re feeling pain or where they’re feeling their body being work is different from person to person. 

So, part of the challenge with that, and why we address that question in our guidelines, is we have what’s called DOMS, or delayed on that muscle soreness, which, you know, if you haven’t worked a muscle in a while, and you put in work with it, and you’re like, you know, maybe it’s the next day or two days later, and you’re like, oh, my gosh, everything hurts, you know, this particular, you know? So, it can be scary, right? Because sometimes pain, pain is both a good like, like, in some ways, pain is there for a reason, because it tells us sometimes, like, when we’ve done too much. So, when — so, that’s why we try to make that distinction. You know, if you’ve done an exercise that’s new for you, and you feel this kind of like soreness in your muscles the next day, or maybe a couple days later, sometimes that’s okay, right. That’s just the muscles adapting to this new stimulus. 

However, it is a little bit different if you’ve noticed that the pain is in the joint and it’s also, you know, progressing and so that monitoring is really important about knowing what is your baseline level of pain, how does it feel, you know, before, during, and after a workout, in the follow up. So, yeah, it’s tricky for a lot of people. And, you know, so much of that is does come into some of the trial and error of just getting to know your body and your pain.

Cheryl:  42:19

Yeah, and I think putting that expectation up from the front is so helpful, because I think if patients expect that, it’s going to be this linear process, and I should just — I start feeling bad, and I just start exercising, and I feel better and better and better and better in this, like, linear way they’re going to be discouraged if they don’t feel good. So, if you say, oh yeah, no, it’s going to — there are going to be days. And sometimes, I like to tell people, sometimes it’s like a butterfly flaps its swings in Africa, and you don’t feel good that day. And that’s not out of your natural, you know. You might be listening to your body and you don’t think you’re pushing it too far. And then, you wake up the next day and you’re like, I’m in pain. What have I done? So, that’s, and I think, I mean, I could tell just from your affect that, like, you know that you’re like a great, you know, coach, in that sense, for the clients. And it’s just so, it’s so nice to have someone there to validate you when you’re going through those ups and downs, and not have to go through it all on your own, you know. Yeah. So, this is just, this is so great. I mean, I feel like we could just talk forever. Is there anything you wanted to say before I go to the rapid-fire questions?

Jasmin:  43:24

No, let’s go to the rapid-fire questions. 

Cheryl:  43:25

Okay, perfect. What are some of your best words of wisdom for newly diagnosed patients with rheumatoid arthritis?

Jasmin:  43:34

Yeah, I think first thing first is to be kind to yourself. You led me into it perfectly, Cheryl, like, sometimes there are good days and there are bad days. So, just, you know, sometimes when it’s a bad day, we have to adjust our expectations, and that’s okay. So, yeah, not to, not to get down on yourself. If you had set up these plans to do your workout and today’s just not the day, that’s okay, there will be other days and more appropriate days for that. So, yeah, first thing behind yourself, I’d say, connect with community and become your own scientists. Like, and this comes from a lot of the clients that I’ve worked with over the years, is that I hear about this pattern of trial and error and that, you know, we can give these guidelines, but everyone is so unique, like, we’re all little flowers, little snowflakes. So, to be open to trialing out what works for your body and to listen to it. So, yeah, be kind to yourself. Connect with community. And become your own scientist. 

Cheryl:  44:38

Those are beautiful. And do you have a favorite arthritis gadget or tool in the toolbox that maybe you recommend for patients or your dad uses? 

Jasmin:  44:48

Yeah, yeah, I have. This is something that I oftentimes will share with my clients, my family, and I use it myself all the time. But I mean, resistance bands, they’re very affordable, but particularly like the loop resistance bands, because they, like, you can get, like, they’re just, you don’t have to hold on to them, per se. Like, you can kind of like, you know, tension at the wrist, like, if it’s, you know, if you have any challenge with that, with gripping, you can wrap it around your legs and do clam shells, like hips, they’re oftentimes a tricky joint with arthritis. There’s just so many things that you can do with a loop resistance band, and you can buy one for probably $5 so, yeah, that one’s definitely my gadget of choice.

Cheryl:  45:36

I love it. Do you have a favorite book or movie or show you’ve consumed recently?

Jasmin:  45:42

99! I love Brooklyn 99. 

Cheryl:  45:45

Oh, my gosh.

Jasmin:  45:46

I’m sad. I’m sad that it’s done and over with, but it’s the only TV show that I’ve ever rewatched.

Cheryl:  45:53

Oh, wow, wow. I love it. I, yeah, he is, he is so good. Um, why am I forgetting his name? What’s 

Jasmin:  46:01

Andy Sandberg? 

Cheryl:  46:01

Andy Sandberg. I was like, yeah, I think my brain was like, Adam Sandler, who is, yeah, I know what he looks like. I just, my brain did not want to remember. Yeah, I love him. That’s so great. Do you have a favorite mantra or inspirational saying?

Jasmin:  46:17

Yeah. So, my dad, he would always say, you know, if it’s meant to be, it’s meant to be. But then, you know, I found this, this quote. It was actually on a calendar in a bathroom. Which makes it sound way less cool, but it, I live by it. It’s control the controllables and enjoy the enjoyables. Like, we have so much in our life that, you know that things happen, and there’s some things that we can have an impact on, and some we just have to enjoy it for what it is.

Cheryl:  46:49

That is, that is so beautiful. That’s something I’m constantly working on, just controlling the controllable, not trying to waste my energy controlling the uncontrollable. So, that’s perfect, perfect timing for that reminder for me. And then, what does it mean to you — this is, again, one of those very like broad questions — to live a good life and thrive with rheumatic disease?

Jasmin:  47:12

Yeah. I mean, if I’m going to come at it from the Kinesiologist perspective, like I do oftentimes refer to the 24-Hour Movement Guidelines, where it’s about not only getting your exercise, but your everyday active, making sure you’re getting appropriate sleep, and decreasing the amount of time that we spend sedentary. But I think, you know, to really tie that together in how we thrive, like community is so important. So, there’s like behaviors that you do as an individual, but it’s also the people around us that really make us whole.

Cheryl:  47:41

That’s like, mic drop. Mic drop, right. You think we’re going to talk about exercise, we’re going to talk about community. 

Jasmin:  47:49

That’s right. We love people.

Cheryl:  47:51

Come for the exercise, stay for the community. 

Jasmin:  47:54

That’s right, exactly.

Cheryl:  47:57

Title of episode. I’m always thinking, I’m grabbing, like, quotes from the episode, or thinking of my head with them. That’s so, so true. I mean, again, we’re all different. Like you said, it’s, it’s really like that, you know, self-evidence or becoming your own scientist. Some people like I’m thinking, you know, like, my husband is more introverted. He enjoys, you know, some sedentary — he enjoys some alone time, physical activity, taking a walk by himself, jogging by himself, you know, going on a hike by himself. And I’m like, these are like, like, what’s it like to want to be by yourself? Because I’m like, such an extrovert. I’m like, no, but we’re all different, right? Like, I had to remember myself the other day talking about my support group. I’m like, some people aren’t like, excited about the idea of a support group, because they are not, like, I’m just gonna go process my feelings with a bunch of people I have never met before. Like, that is scary to most people. To me, I’m like, new friends, you know?

Jasmin:  48:49

Yes, yeah, and yeah. And I think how you, like, engage with, you know, that concept of community is different for each person. Like, community doesn’t have to be a massive community. Like, maybe it’s that one person for you. And maybe it doesn’t mean that you’re exercising with people, but maybe if you came across something where you’re like, I don’t know if I handle this. I’m unsure about this. Like, maybe you’re reaching out to your community, whether that’s you know, other people with lived experience, or your practitioner community to help guide you through it and answer those questions. It’s all to say is that, like, you know, community has to be in the way that’s right for you, but to remember that you’re not alone. 

Cheryl:  49:23

Yeah, that’s beautiful. And where can people find you online?

Jasmin:  49:29

Yes, well, probably the best place is to, you know, for my contact information is on our lab website. That’s m4a.kin.ubc.ca. But I do also have Twitter. That’s @JasminMa, Jasmin with no E, my parents made it complicated for me. Or my Instagram is @DrJasminMa.

Cheryl:  49:49

Well, no, that’s the new thing is everyone wants to like name their children names that are unique spelling. But no, I mean, I think it’s a beautiful name. It’s not that hard to remember. Yeah, thank you. Thank you so much. You really helped distill this, like, I feel like, if I was a newbie to rheumatoid arthritis and to physical activity, I’d feel like, you’ve helped make it really, like, doable, you know, like, okay, this is achievable. Other people do this. It’s an evolution. It’s trial and error, and it’s good for me. So, I’m gonna do it. I’m gonna get started using my START guide, I START guide. So, thank you so much. I hope people —

Jasmin:  50:25

Thank you, Cheryl, I really enjoyed this.

Cheryl:  50:26

Oh, my gosh, no. Thank you. And I will put all the links to the things we talked about in the show notes. Oh, and I just wanted to define, because I can’t remember if we defined it. You, the university, it’s UBC, right? University of British Columbia? 

Jasmin:  50:42

That’s correct.

Cheryl:  50:43

Yeah, I always, like, that’s one of my pet peeves when I listen to a podcast and they don’t always distinguish an acronym. And I think I often, I will say, guilty, I often forget to just define RA as rheumatoid arthritis, because I’ve just in my head it’s like, obvious, because my world is arthritis, but arthritis is my life. So, that’s what we meant earlier when we said that. But thank you so much. I will put links to all these things in the show notes, and we will talk to you later. Thanks again.

Jasmin:  51:16

Thanks, Cheryl. Bye!

Add comment

Your email address will not be published. Required fields are marked *