Time for a Change: Lifestyle Changes for Arthritis

People with arthritis are often faced with the need to change their health habits. Whether it’s exercising more, eating less, or managing stress more effectively, there is almost always room for improvement. Making these changes for a day or two is easy, but keeping them up for the long haul is a whole different matter. If you try to make a change but fail to stick with it, you may feel as if there is something wrong with you and your determination. This article will explore tips regarding lifestyle changes to make with arthritis.

There isn’t. Almost everyone struggles this way. Otherwise, we would be a nation of calm, thin, salad eaters. Yet some people clearly do succeed at changing their lifestyles for the better. What may set them apart is their intuitive understanding of lifestyle change as an ongoing process, rather than a onetime event. Instead of going from Point A to Point B, changing the way you live often means going from Point A to Point E, with B, C, and D in between.

Stages of change

In 1979, psychology professor James Prochaska proposed what he called the Transtheoretical Model of Change. He and his colleagues used this model to study people who were trying to quit smoking. They found that intentional change tended to progress through five distinct stages: precontemplation, contemplation, preparation, action, and maintenance. Precontemplation is the stage at which you don’t intend to change a particular behavior in the foreseeable future. In the contemplation stage, you first start considering change, but you are still undecided about when to undertake it. That’s followed by the preparation stage, during which you make firm plans to change your behavior soon. Next is the action stage, when you actually begin exercising, dieting, or adopting some other healthy behavior. Finally, you reach the maintenance stage, by which time you have kept up the new behavior for several months. At this point, you are working to make your new habits permanent and trying not to backslide.

Recently, these stages have been applied to research on all kinds of healthful changes, from exercising and eating a low-fat diet, to applying sunscreen and using condoms. A few years ago a group of researchers that included Prochaska looked at how the stages relate to the use of arthritis self-management strategies, such as pacing oneself and using relaxation to help control pain. The study included 103 people with rheumatoid arthritis and 74 with osteoarthritis, all of whom responded to questionnaires about their behaviors and attitudes. Their responses did indeed cluster into five groups, ranging from those who believe that controlling arthritis symptoms is solely the doctor’s responsibility (precontemplation), to those thinking about and preparing for a more active role (contemplation and preparation), to those actively learning and using self-management skills (action and maintenance).

One advantage to thinking about lifestyle change as a series of stages is that it makes the whole process much less overwhelming. Instead of having to accomplish a big change in one giant leap, you break it down into five smaller steps. Gradually, stage by stage, you move closer to your goal. Just keep in mind that you may take a step backward now and then. Occasional slips are to be expected. The good news is that you probably won’t go all the way back to square one. Instead, you’ll just revisit the contemplation stage or the preparation stage — only this time, when you’re ready to try again, you will know more about what does and doesn’t work for you.

Ready, set, change!

Does your doctor keep urging you to lose weight? Have you been thinking vaguely about joining a gym? Did you take an arthritis self-management course but then fail to follow through on what you had learned? If so, you may be ready for a change. The rest of this article will help you identify where you are currently in the change process. Armed with this information, you will find it easier to figure out what to do next.

Precontemplation

In the arthritis self-management study mentioned above, 44% of those taking part were at the precontemplation stage. At this point, you are not even thinking about change yet. Your spouse, mother, and best friend may all be urging you to get more exercise, for example. But you still cling steadfastly to the belief that things are fine just the way they are. When you see a news story about the latest study on the benefits of walking for arthritis, you ignore it. In your mind, you are immune to the health problems that affect other sedentary people.

Unfortunately, by the time you realize your error, the damage has been done. If you are constantly dismissing the advice of others, it may be time to start listening to them. And if you have assiduously avoided learning more about your arthritis, there’s no time like the present to start educating yourself.

These strategies can help you move forward to the contemplation stage:

Weigh your options. During precontemplation, people tend to focus on the downside of adopting a healthy new behavior while ignoring the upside. Force yourself to give both sides equal thought. Draw a line down the middle of a piece of paper. On one side, write the top five pros of the healthy behavior, and on the other side, write the top five cons. Be as honest as you can. Now compare the two columns. Is there a stronger case for or against making a change?

Find an arthritis buddy. Advice is harder to tune out when it comes from someone with firsthand experience. If you have a friend, relative, coworker, or neighbor with arthritis, strike up a conversation about it. Or look for a buddy at an arthritis support group, either in person or online.

Contemplation

At this stage, you are starting to give some thought to changing your behavior. Yet while you might toy with the idea of signing up for a yoga class or swearing off sweets, your plans remain distant and indefinite. When you talk about the possibility of change, there’s always a “but” — “I want to start an exercise program, but I’m just too busy right now” or “I know I should cut back on junk food, but they always have doughnuts in the break room.”

Statements like these are signs of ambivalence. You vacillate between wanting to change and wanting things to stay the same. Some people get stuck at this point for years, unable to muster up enough mental traction to pull themselves out of their decision-
making rut. To escape this trap, shift your focus from acknowledging problems to identifying solutions.

These strategies can help you move forward to the preparation stage:

Give your mind a nudge. Every time you catch yourself making a “but” statement, push yourself to examine it more closely. In the example where you’re “too busy” to exercise, you might ask yourself: “If I don’t have a 30-minute block of time for exercise, do I have three 10-minute ones?” or “If I like to watch TV in the evening, could I do it while walking on a treadmill?”

Track your symptoms. Keep a daily journal in which you record how bad your pain is, how stiff your joints feel, and how much of your target behavior — say, physical activity — you did that day. Over time, you will probably see a pattern emerge. For instance, you may notice that you have more pain and stiffness after you have been inactive for several days in a row. Seeing this relationship recorded in black and white may be the impetus you need to stop thinking and start doing.

Preparation

By this point, you are committed to making a change within the month. Your plan is now firm and specific, and you may already be taking some preliminary steps to get ready. For example, let’s say you intend to start meditating every morning to help manage stress and pain. You may buy a video on meditation or sign up for a class, and you may try out different techniques to see which one you like best. This is an important stage, so take your time. Ultimately, you have a better chance of success if you first develop a detailed plan and learn any necessary skills.

In the study of arthritis self-management, pain and disability tended to be particularly pronounced at the preparation stage. That makes sense, because when you’re in pain, you are highly motivated to seek ways to relieve it. But of course, it’s better if you don’t wait for a prompt from pain.

These strategies can help you move forward to the action stage:

Mark your calendar. Pick a specific date to begin your new behavior. Schedule it just as you would any other important engagement. Then make sure you have everything ready for the appointed day. For example, if you plan to start eating five daily servings of fruits and vegetables, be sure to stock up on produce before your designated start date.

Go public with your plan. Tell family, friends, and coworkers about the change you intend to make. Ask for their support, and let them know how they can help. That way, you’ll have a support team already in place to cheer you on when things go well and cheer you up when they don’t.

Action

At last, you have set your plan in motion. You’re actively engaging in the new behavior, and you are making any necessary adjustments to fit it into your life. This stage requires more obvious effort than the others. No matter how well prepared you are, you’re still likely to encounter some unforeseen obstacles. For example, if your plan is to learn tai chi for exercise and relaxation, you may find that it requires more practice outside of class than you had anticipated. Rather than allowing this obstacle to derail your plan, look for ways around it. Perhaps you can get up half an hour earlier to practice in the morning, or maybe you can switch to a less demanding class.

The action stage encompasses the first six months after you initiate a new behavior. During this time, the change in your lifestyle is still fresh. On the plus side, this means your efforts are likely to receive more attention from others. On the minus side, it means you are apt to make some mistakes and occasionally slip back into your old, less healthy ways. If that happens, don’t overreact. It’s a normal part of the change process. Just make sure to get back on track right away.

These strategies can help you move forward to the maintenance stage:

Set yourself up for success. Start with easily attainable goals, and gradually work up to more challenging ones. For example, if you would eventually like to walk 45 minutes a day, you might start out walking for 15 minutes. Then build up slowly, 5 minutes at a time, over a period of weeks.

Pat yourself on the back. Research has found that successful changers tend to rely on rewards for positive behavior, rather than punishments for lapses. Give yourself a little treat for losing two pounds or going to the gym for two weeks. And don’t stint on the self-praise — you’ve earned it. Tell yourself what a smart, capable person you are to take charge of your health this way.

Maintenance

In some ways, this is the most crucial stage of all, since it’s when healthy behavior ceases to be an exception and starts to be the norm. By now, you have been keeping up the good work for at least six months, and your focus is on sticking with it indefinitely. While it can be tempting to take your progress for granted, it’s important to stay alert for lapses. As soon as you catch yourself sliding back into old habits, make a point of renewing your effort and commitment. Occasional setbacks are common, even months or years later. But the longer you let them continue, the more likely it is that little setbacks will grow into big ones.

As time passes, you’ll feel less tempted to backslide and more confident in your ability to change for good. By this point, you are well aware of all the benefits you have gained. You are focused on the positive and primed to succeed the next time your lifestyle needs some revamping.

Linda Wasmer Andrews is a health and psychology writer in Albuquerque, New Mexico.

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