News for Arthritis Foundation Program Instructors in the Arthritis Foundation, Great West Region
Articles This Issue
Instructors in Action
Gina VanVoorhis adds personal touches to her aquatic programs to inspire participants to work harder. Find out how.
Quarterly Reports Due
Submit your reports by April 15, 2014. Download the forms.
Programs for Better Living Undergo Policy and Procedure Revisions
Read about the IMPORTANT changes that have been made to the Programs for Better Living. Learn more.
Arthritis Foundation Online Tools Provide a Wealth of Information
Utilize these resources to get the most up to date information for your arthritis health. Get started.
Give someone the opportunity to take control of his or her arthritis in 2014. Recertify as an Arthritis Foundation instructor or invite a friend or co-worker to become certified. See the list of upcoming trainings.
Positive Results for Hip Implants in Young and Old
Two studies found that people younger than 50 and older than 90 fare well with new hips. Find out more.
Walk to Cure Arthritis
Every step counts and every dollar matters. Join the Walk to Cure Arthritis in your area.
The Many Forms of Arthritis
Learn more about the signs, symptoms and treatments for fibromyalgia. Read it here.
Gina VanVoorhis adds personal touches to her aquatic programs to inspire participants to work harder.
Certified Pool Operator / Aquatic Specialist
Arthritis Foundation Aquatic Program Instructor/Trainer
Kootenai Health Center, Couer d'Alene, Idaho
Gina VanVoorhis teaches the Arthritis Foundation Aquatic Program (AFAP) at the Kootenai Health Center in Coeur d’Alene, Idaho, where she is the pool operator and aquatic specialist. Gina has an extensive background in Aquatics Management and Exercise as well as a degree in Choreography and Dance from Dixie College.
Gina has been teaching aquatic classes for the Arthritis Foundation since 2003 and last year was certified as a trainer. This past October she held her first training at her home pool, certifying 15 instructors for the Arthritis Foundation Aquatic Program. “I was so impressed by her set up for this training," said one attendee. "I arrived and she had little goody bags for all the instructors with notes and tips about how to be a good instructor for the aquatic program. It was so creative!”
Gina loves to teach. “My passion for teaching makes me feel alive, happy, and inspired by those around me. It’s a beautiful thing watching people improve their health and their lives. I’ve heard participants say that we are part of their health care team. Those words show me that what we do as aquatic professionals is valued and important to our participants. The liquid gym is endless with opportunities to socialize, connect, strengthen, and soothe your body. It has the Awe factor – the universal language of the water is, Awe. Take the plunge!
Many successes have come from the ten-plus years that Gina has been teaching:
- 86-years-young Joyce says the class has helped improve her strength after having a new hip replacement.
- Cynthia says the hand/wrist movements have helped her recover from carpal tunnel surgery.
- Jane, who has been diagnosed with lupus and worries about falling on land, says the AFAP class has helped improve her balance.
- Vera, now 74-years-young, was diagnosed with rheumatoid arthritis in her early twenties. She attends class four times per week and credits the AFAP classes in Idaho and California for her quality of movement.
Along with her regular classes, Gina held a Jingle Bell “Run” for her aquatic participants who ran in the water to show their support for the Arthritis Foundation. This was a great alternative for those who were not comfortable participating in the land event.
Gina has been diagnosed with osteoarthritis with recent lab tests for rheumatoid arthritis. This May she will be having foot surgery for hallux rigidus. “This form of arthritis fuses and stiffens the metatarsal joint and big toe. Next year, when I am walking with ease, I want to bring the Walk with Ease program here to Kootenai Health.”
Read about the IMPORTANT changes that have been made to the Programs for Better Living.
As the Arthritis Foundation continues to revise our physical activity programs, changes have been made to the policies and procedures. These changes will remove some barriers without changing the program components. The new policies and procedures started January 1, 2014.
The changes are as follows:
Professional liability insurance can be provided by a facility/employer or by the instructor/leader.
- Instructors/Leaders do not have to find or rely on a facility to sign a co-sponsorship agreement if the instructors/leaders have their own professional liability insurance coverage with aggregate/single occurrence limit not less than one million dollars ($1,000,000.00) for personal injury or property damage.
- Instructors/Leaders can continue to use the liability insurance coverage provided by their employer or facility if a co-sponsorship agreement is signed.
- The instructor/leader is responsible for ensuring the location or facility meets any applicable requirements, for collecting and maintaining forms, and for submitting the participant release and program information forms. The instructor is also responsible for ensuring a safe atmosphere for his or her class.
Instructors are certified upon completion of a training workshop. Recertification is every two years.
- Instructors/Leaders are no longer required to teach a series of six classes prior to receiving their certification.
- Instructors/Leaders will now be considered certified upon attendance of an in-person instructor training. AF Exercise instructors who do the on-line training or AF Tai Chi instructors who attend non-AF trainings will still need to fill out a certification application.
- Recertification for AF Aquatic Program, AF Exercise Program and AF Tai Chi Program will now be every two years. The Arthritis Foundation will honor certifications given prior to these changes for three years.
Arthritis Foundation Participant Release Forms do not have to be used if a facility has its own release forms.
- Instructors/Leaders are still required to ensure that there is a completed release form on file for each participant and submit the forms for new participants to the Foundation each quarter. However, if a facility requires individuals to complete a release form upon enrollment those forms can be used in place of the AF’s Participant Release Form. If the facility does not have its own release form the AF Participant Release Form should be used.
Page two of the Participant Release Form has been revised to include standard language for participants in all Arthritis Foundation programs and special events.
There is a new online Arthritis Foundation Exercise Program training.
- We are excited to offer an online training through the Aerobics and Fitness Association of America (AFAA). The program fee is $129 and includes: an interactive online training workshop; downloadable PDF instructor manual (you can buy a manual for an additional cost); and a one-year AFAA membership – a $68 value.
- Online trainings are available in two versions. The “Live” version is like a webinar and will most likely be offered on a monthly basis. The National office is in the process of scheduling future trainings. The second version is an on-demand version that can be accessed 24/7/365. You can access both trainings at www.afaa.com/arthritisfoundation.
- The Foundation will continue to offer in-person Arthritis Foundation Exercise Program trainings.
If you have any questions about these changes, please ask your Arthritis Foundation staff contact for clarification.
Arthritis Foundation Online Tools Provide a Wealth of Information
Utilize these resources to get the most up to date information for your arthritis health.
The Arthritis Foundation has many resources to help you feel like your best self. Developed with you in mind, these online tools aim to help you better manage your arthritis.
Arthritis Weather Index
Studies show a variety of weather factors can impact your arthritis. Calculate your potential joint pain based on your local weather forecast and know what to expect with the Arthritis Weather Index.
Explore more resources in our Online Tools and Apps section.
Give someone the opportunity to take control of arthritis in 2014. Recertify as an Arthritis Foundation Instructor or invite a friend or co-worker to become certified. Search the event list for upcoming trainings.
Two studies found that people younger than 50 and older than 90 fare well with new hips.
Reprinted from ArthritisToday.org / By Marianne Wait
Two studies presented at the American Academy of Orthopaedic Surgeons (AAOS) annual conference this month offer new assurances to younger and older people who are considering a new hip. One study found that many hip replacements implanted in adults younger than 50 are still performing well 35 years later. Another found that undergoing hip replacement surgery at age 90 or older is relatively safe.
Arthritis is the most common cause of hip pain and disability, according to the AAOS, and a new hip can often relieve the problem. Most people who undergo hip replacement surgery are between ages 50 and 80.
Keeping Older Patients Mobile
Doctors are also seeing greater numbers of older patients who might benefit from the surgery. “The number of 90-year-olds has tripled over last 30 years,” says Alexander Miric, MD, assistant chief of orthopaedic surgery at Kaiser Permanente in Los Angeles and lead author of the study on hip implants in older patients. “We thought it would be interesting to see how well patients in their 90s do after hip replacement surgery.”
Past studies of this age group showed high infection and mortality rates, but they involved only a small number of patients, and some studies were decades old, says Dr. Miric. “These numbers didn’t look very encouraging, but in our own personal experience, we saw patients do very well.”
Using Kaiser’s registry of joint replacement patients, started in 2001, Dr. Miric and his colleagues identified 183 patients who were 90 or older at the time of hip replacement surgery. They found that compared to people younger than 80, these patients stayed in the hospital only about half a day longer and were not significantly more likely to develop an infection of the joint. They did have a higher mortality rate within 90 days of the surgery – 2.7 percent versus 0.2 percent – but, says Dr. Miric, “you would expect that in this age group.”
“If you make it into your 90s, you must have something going for you that helps you do well with surgery,” says Dr. Miric. “I think you have to stop looking at age as an indicator and look at how robust the person’s health is.”
The oldest patients did have an almost 10 percent greater risk of being readmitted to the hospital within 90 days, either due to surgery complications (such as urinary tract infections) or other reasons, compared to patients younger than 80. “It may just take longer for them to recover from this surgery, and we have to keep a close eye for a longer period before we can conclude that they’ve successfully recovered,” says Dr. Miric.
Why would a surgeon put a new hip in someone nearing the end of life? “They have pain and disability and it can have a severe impact on their quality of life and their ability to take care of themselves,” says Dr. Miric. “They may need it in some cases even more than someone who’s younger.”
Michael Parks, MD, associate attending orthopaedic surgeon at the Hospital for Special Surgery in New York, agrees. “We’re really seeing more patients over 90 years old that come in and they’re in pretty good health, but they have an aching knee or hip. It’s a quality-of-life issue. There are people that may be otherwise functional, able to do things, care for themselves, and they’re becoming progressively less able to do those things because of a painful hip.”
Dr. Parks called the mortality rate in the study small. “I would agree with the author’s conclusion, and that’s what we can take away from [the study]: These patients can safely undergo total hip replacement when compared to younger groups of patients.”
An Implant May Last a Lifetime
The second study involved a group of people who got their hip implants when they were between ages 18 and 49. Researchers have been checking on them periodically for 35 years to see how they and their implants were faring.
“We’ve been following them throughout the years,” says study co-author Lucian C. Warth, MD, a senior orthopaedic surgery resident in the department of orthopaedic surgery at University of Iowa Health in Iowa City. “It’s the longest study as far as follow-up goes of any total hip replacement yet.”
The original group consisted of 69 patients who received hip implants from the same surgeon in the 1970s. Today, among the patients still living, the researchers found that 46 percent of the original hip implants were still in place and functioning. In addition, many of the patients who died in the interim did so with their original implant in place. Overall, 63 percent of the original hip replacements were functioning at the latest follow-up or at the time of death.
Dr. Warth considers the results good news. “If I put a hip in someone who is 50 years old, based on this study I can say with almost two-thirds probability that the hip will outlast them,” says Warth. “That’s a real win for us because we just don’t want these folks to have to go through another big operation.”
The reality is probably even more positive, says Dr. Warth. He notes that the implant used in the study has long since been replaced by newer implants and techniques, so today’s hip replacements should, in theory, perform even better.
The durability of hip implants in younger people is important not just because the patients will presumably live for many years with the hip, but also because they’ll be relatively active for many of those years. “We know that hip replacement works well and has long-lasting good results in patients who are in their 60s and 70s,” says Dr. Parks. “The problem is that hip replacements fail at higher rates in younger patients because of increased level of activity.”
But with the results from this long-term study, says Dr. Parks, “We can look at these patients and give them an idea of the success of the procedure. At 35 years, over half of [the hips] are still going to be functioning. I think that’s pretty good. It’s better than what we tell patients.”
And, Dr. Parks agrees, the real outlook may be rosier. “We use cementless implants, which we think are going to last longer.”
Every step counts and every dollar matters.
Fourteen community members were trained to lead the Arthritis Foundation’s Walk with Ease program at a training held on March 15 in Bend, Oregon.
These instructors will now be leading Walk with Ease programs across Oregon – giving participants the tools and motivation to begin walking as a form of exercise to improve their health and alleviate arthritis pain.
Learn more about the signs, symptoms and treatments for fibromyalgia.
What It Is
Fibromyalgia is a chronic rheumatic condition that impairs the joints and/or soft tissues. It causes symptoms that vary from person to person, but the main ones are:
- Pain and tenderness. Musculoskeletal pain in all sections of the body is the most common symptom. The pain may begin in one region of the body, but eventually every section becomes affected. For some people, the pain comes and goes, and seems to travel throughout the body. The pain has been described as tender, aching, throbbing, sore, burning or gnawing, and sometimes is accompanied by sensations such as tingling, numbness, burning or prickling.
- Fatigue and sleep disturbance. Most people experience chronic fatigue and tire quickly after only mild exertion. For many people, the fatigue can be more debilitating than the pain.
Although fibromyalgia is difficult to diagnose and has no cure, it isn’t a progressive disease, meaning that it will not get worse over time and it’s not fatal.
The key to finding relief from pain and fatigue is usually a combination of treatments and therapies, and may take some trial and error to find what works for you. Here are several options worth trying.
Manage Your Medications
Currently, there are three FDA-approved drugs for use as treatments.
• Pregabalin (Lyrica) has shown benefits in relieving anxiety, some sleep problems and pain.
• Duloxetine (Cymbalta) and milnacipran (Savella) are dual-acting norepinephrine and serotonin reuptake inhibitors (anti-depressants), which raise concentrations of neurotransmitters known to inhibit pain transmission.
Other types of medications have also been shown to provide symptom relief, including analgesics such as tramadol (Ultracet, Ultram); muscle relaxants, such as cylobenzaprine (Cycloflex, Flexeril); and fatigue medications, such as modafinil (Provigil). Consult your physician for more information.
Use the Exercise Rx
Physical activity has been shown to be a valuable treatment and has many benefits for people with fibromyalgia, including reducing fatigue and boosting confidence.
Activities must be chosen carefully and started at a low level, however. “Deconditioned muscles are a potent pain generator,” says Kim Jones, PhD, a fibromyalgia researcher at Oregon Health & Science University in Portland. “It’s not fair to tell people, ‘just exercise and you’ll feel better,’ because many people have tried that and they end up in bed for two weeks recovering,” she says. The trick is to exercise slowly enough that you can condition muscle without generating pain. Jones also says a product called Spray and Stretch, a spray-on skin refrigerant that numbs pain, can be helpful when starting an exercise program.
For a list of all the arthritis exercise classes in your area, please visit www.arthritis.org.
Give Acupuncture a Shot
Acupuncture can help provide fibromyalgia pain relief, according to researchers at the Mayo Clinic in Rochester, Minnesota. The study showed that people who received acupuncture exhibited the greatest improvements in anxiety and fatigue.
Rub Away Pain
Research also suggests that massage can assist in chronic pain management by relieving some of the symptoms – namely pain, stiffness, fatigue and depression.
Listen To Your Body
Biofeedback can help re-direct physiological activity and teach you basic relaxation techniques, including visualization. For example, if you’ve having trouble falling asleep, you could try to picture a radio custom¬ized with multiple dials including symptoms such as pain, worry, anxi¬ety, and stress – then visualize turning the awake dial down and cranking the sleepy dial up.
Reduce Your Stress
When a person in pain experiences stress, they feel even more pain. Identifying and teaching yourself to better cope with stressors may reduce the impact of the symptoms you feel.
Learning, Understanding, Coping
You can live well with fibromyalgia. It’s all about understanding your condition, learning how to manage what’s going on, and rearranging your life a little bit. It’s helpful to make sure you do one or two things that are fun every day. When you’re having a lot of fun and are happy, you should feel your best – and be well on your way to live a happy, productive life.
Find out more:
Learn more about fibromyalgia in the disease center section of our website.
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