According to Spainhour, studies show that exercise actually decreases the amount of pain for people with arthritis, but the effects aren't immediate. It can take four to six weeks – or even a couple of months – to experience pain relief, and many people find the delays discouraging. "The effect is dose related, she says. "The more you exercise, the more benefit you see. But you have to keep it up. There's a fine line between doing enough and doing too much."

You can avoid doing too much by working with professionals, such as exercise physiologists or personal trainers, and keeping in close contact with your physician. Spainhour advises starting any exercise regime slowly. While people without arthritis may be urged to exercise 30 minutes every day, people with arthritis should limit it to every other day. Exercise one day and rest the next she says. You need that day off in-between. "When someone has arthritis," she explains, "it takes more energy to do the same things as someone without arthritis." And even when you have a flare, Spainhour adds, it's crucial to keep moving, even if you just do simple range-of-motion exercises.

"I'm so out of shape. What if
people laugh or stare at me?"

The hardest thing about starting an exercise program, says former personal trainer Maeve McCaffrey, is walking through the door of a health club or hitting the street to start walking. "It gets easier from there on out," she says. Now a spokesperson for the International Health, Racquet and Sportsclub Association (IHRSA), McCaffrey suggests thinking about your health and longevity instead of your appearance (though she admits it's sometimes easier said than done). Plus, she adds, club staff will never laugh at you. They're glad to see you come in and excited about the opportunity to help you.

"Pick your group carefully," says Jackson Rainer, assistant professor of psychology at Gardner-Webb University in Boiling Springs, N.C. He suggests opting for an arthritis class at the YMCA over an aerobics class at the gym. "Most arthritis groups meet in the morning around 10, when all the pretty young things have gone to work," he says. "It's a much more congenial group."

Whether you decide to walk around the neighborhood with a group of friends or join a gym, exercising with other people who have arthritis is a tremendous help. Many health clubs and community centers offer classes specifically for seniors or people with arthritis. Local malls should be able to put you in touch with mall-walkers groups, and your local Arthritis Foundation office has information on PACE classes or the aquatics program. (Call 800/283-7800 to find the office nearest you.)

"I can't afford a gym
membership or personal trainer."

If money is tight, there are plenty of inexpensive options. If you can't afford a light pair of hand-weights from the local discount store (most cost around $10), try lifting bags of frozen vegetables (wrapped in hand towels) or, if you can hold onto them, cans from the pantry. And best of all, walking – whether it's around the living room or around the block – is always free. And, adds personal trainer Joe Sweeney, author of I Know I Should Exercise But…, there's no expensive equipment required.

If you're looking for a lower-priced gym, larger local churches or synagogues often have workout facilities – some of them quite impressive – that don't cost as much as a brand-name fitness club (you don't have to join the congregation, either). Many local hospitals offer similar facilities. And though she now works with a sports club, for years Nella Vizzari taught her aquatics class at a local high school pool. Check with community centers and local colleges for classes, such as yoga and tai chi, which run several weeks and cost in the vicinity of $100, depending on where you live.

There's also a new trend brewing among personal trainers, which can average $40 an hour, according to a 1998 IHRSA survey, again depending on where you live. Some trainers are offering group rates, and working with six or so people at one time. While there's some small controversy about whether this practice takes away the advantages offered by one-on-one interaction with a trainer, if it gets you exercising, it's far better than doing nothing. McCaffrey suggests looking for trainers who've taken the time to become specially certified to work with people who have conditions such as arthritis.

"I'll never be able to work all those
fancy machines at the gym."

Don't let fear of the unknown dissuade you from doing something to better your health. There are plenty of trained people in the gym who get paid to show you how to work the machines again, and again, and again, if necessary.

"There's a certain level of discomfort when you first join a club," says McCaffrey. "You don't know what to do and all the others do. The staff should help to make you feel comfortable and show you how to do things. They don't want to see you get hurt, so don't worry about asking them again and again if you have to. That's what they're there for."

"It's not ladylike to work out. I don't
want to get too much muscle."

Most young women these days are quite comfortable in a gym. They've grown up around the exercise and fitness craze and consider a good, sweaty workout as much a part of their day as a morning shower. Go up a generation and you'll find that women in their 60s and beyond just weren't brought up that way. To them, sweating isn't ladylike. But that's no reason not to work out.

"It may not be ladylike," says Jackson Rainer, "but it's very womanly. Women of that generation keep a great house and will tell you about it. I tell them ‘Your body is the house you live in; this is what you do to keep your physical house clean.' "

And unless you're planning on becoming a bodybuilder, says McCaffrey, don't worry about bulking up. Physiologically, women just aren't built to bulk up like men. "You're going to gain a little muscle," she says, "but you're not going to look like Arnold Schwarzenegger. If anything it will make you even more curvy."

"I'm impatient. If I don't see
results right away, I give up."

It happens all the time. You put in a great workout – or even a great week of workouts – and when you go to try on those tight pants, you find they're still tight. When workout time rolls back around, you're not so keen on making the effort. Well, you didn't get out of shape overnight, so don't be discouraged if you don't get back into shape in a matter of hours.

"Take your time," says Rainer. "This is a lifestyle change and you have to do it over time. It's hard when we live in such a fast-paced society, but there's truth in believing that if you keep at it you will succeed. Impatience is not helpful. If you expect immediate results, you're only shooting yourself in the foot."

"When I exercise,
I hurt the next day."

Starting out slow is especially important for people with arthritis, says McCaffrey. Keep in contact with your physician and get his recommendations before you start. Work with someone at the club and follow your physician's guidelines. "The worst part of beginning exercise is the soreness," she says. "You won't realize you had muscles there until they start to hurt. Lots of people get so excited they do too much and get hurt, so start slowly and build the intensity."

Spainhour agrees that taking it slowly is the best policy. "Start with one piece of equipment or one weight at a time," she advises. "I tell people you can add more, but you can't take it back." She also introduces Duke Center patients to the one-hour pain rule. "You shouldn't hurt more than one hour (above your regular arthritis pain) from working out. It should not be worse one to two hours afterward. If it is, you need to cut back the time or intensity of your workout."

Some pain, she adds, may be due to improper equipment. Walkers especially need to check and see if their shoes are up-to-par – be sure you have the proper footwear for the activity, and replace worn-out equipment regularly. As a rule of thumb, she says she replaces her running shoes every three months. The outside may look fine, but the inner cushions wear out quickly. Because the activity is less intense, walking shoes should last longer.

"There's never enough time."

The trick, experts say, is to carve the time out of your day – no matter how busy you are. Sweeney suggests several common sense tips: Make errands by foot whenever possible, park as far away from your destination as you can, take the stairs instead of the elevator, and walk to the bank or post office if possible.

And health club members who are strapped for seconds will be delighted to note that more and more, gyms are focusing on saving people time. According to McCaffrey, many clubs offer on-site dry cleaning, cafes and child-care – or better yet, child classes to get the young ones off to a healthy start. Another trend is a 30-minute lunchtime routine with machines set up in a circuit to ensure you get the proper workout in the time allowed.

"I can always start tomorrow."

This is the procrastinator's top response. There will always be a better time to get moving, when things are less hectic, when you've accomplished some of the other items on your list, or when you feel more up to it. The best answer to this excuse is one popularized by a major athletic shoe manufacturer: "Just Do It."

Sometimes, though, if you really feel the best thing to do is start later, then wait. "You won't do it 'til you're ready," says Rainer. "Sometimes you have to get good and sick of yourself. You have to say ‘I've had enough of this.' I don't think people are successful when they're hard on themselves. People need to find their own reason to do it. It has to be an internal decision."

Managing Editor Shannon Wilder recognizes several of the excuses on this list as part of her personal repertoire.