The way she teaches is sanctioned by the Arthritis Foundation, and involves about 35 minutes of slow, gentle stretching and agility moves with soft harp music playing in the background. Recently she put a group of women through the routine at the Mt. Olympus Senior Center in Holladay, but she also teaches elderly people in wheelchairs who live in a senior residence.
A former elite tennis player, Crowell tells her class to breathe deeply before exercising, then leads the class in modified yoga and tai chi moves designed to lengthen muscles and loosen stiff joints.
"If anything hurts," she tells the class, "please stop immediately."
Crowell was warning the class to be careful of overdoing it, not to stop moving. But pain is what deters people with arthritis from exercising, says Rebecca Castleton, arthritis program manager for the Utah Department of Health.
"Physical activity," Castleton says, "is the best prescription for managing the disease."
Not that long ago, doctors told their patients the opposite. People with arthritis were supposed to take it easy so as not to stress their joints. Many of them ended up crippled as the inflammatory disease deformed and calcified their hands, feet, hips, shoulders and knees.
Arthritis is still something of a mystery to researchers, especially the autoimmune forms such as rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosis, Still's disease and juvenile arthritis. The most common form is osteoarthritis, which appears when joints wear out. No cures exist for any of them.
Anecdotal evidence over the years has shown exercise even the most basic small moves helps. Not until the past couple of decades, however, has exercise been examined scientifically as a treatment for osteoarthritis, with most of the focus on hips and knees. It is now generally accepted that exercise regimens that focus on cardiovascular conditioning and lower extremity strength training help manage the painful and often disabling symptoms.
"Teasing apart the roles of injury versus exercise, especially participation in sports, it appears that the increased risk of knee [osteoarthritis] is not based on increased physical activity, but on increased risk of knee injury of particular sports, such as football," says Lissa Fahlman, lead epidemiologist of the Arthritis Research Institute of America. It has been gathering osteoarthritis data on thousands of people since 1988 in the Clearwater Osteoarthritis longitudinal study.
"Similar to how weight-bearing exercise builds stronger bones, weight-bearing exercise also builds stronger knee cartilage, decreasing the chances of injury," Fahlman says. "Other indirect effects include preventing being overweight, another important risk factor for knee [osteoarthritis] and preventing metabolic syndrome and diabetes," both which are thought to possibly play a metabolic role in osteoarthritis.
To help manage the arthritis in her back, Eleanor Greenland has attended the Arthritis Foundation Exercise Program at the Kearns Senior Center since 2005.
"I'd had trouble in my back for a long time, but I didn't realize what it was," she says.
Now 76, Greenland worked for a publishing company until 10 years ago, lifting heavy bundles as they came off the printing press. The hard physical activity caused her no pain, she says. Then she retired. She's had three strokes and a heart attack. When her doctor told her she'd end up in a wheelchair if she didn't keep moving, she started taking the senior center classes twice a week.
"The more I took them, the better I felt," she says. "I take no pain medication. But I can sure feel it if I don't go to class."
At the Kearns center, participants ages 60 to 80 do the exercises standing, with intermittent short rests sitting down. "Every joint gets used," Greenland says. "These classes are really informative."
Arthritis encompasses more than 100 diseases and conditions, including gout and fibromyalgia, which is arthritis in the muscles that doesn't cause deformity. All of the variations affect joints, the surrounding tissues and connective tissues. They can affect anyone at any age regardless of race or gender. However, according to the Arthritis Foundation, women are at particular risk of osteoarthritis, which they usually develop after age 40.
The American Academy of Orthopaedic Surgeons has found that arthritis is a more frequent cause of activity limitation than heart disease, cancer or diabetes. One in three people with arthritis in the United States has trouble functioning at work. And risk increases with age: A 2010 study found that approximately half of people age 65 or older reported an arthritis diagnosis.
Arthritis affects more than half of adults with diabetes or heart disease; obesity prevalence is more than 50 percent higher among adults with arthritis than those without.
This is why the Arthritis Foundation has stepped up its efforts to keep people moving. An article in Arthritis Today magazine points out that people often confuse muscle pain that follows exercise with joint pain from the disease. Sore muscles usually are the result of overuse or overstretching after a long period of inactivity; overuse of joints usually results in swelling, treatable with ice, elevation and rest.
But the best remedy for sore muscles is daily exercise, Greenland says. "Just 10, 15 minutes a day will really help you," she says. "You'd be surprised at what you can do when you do it slowly."
Arthritis: By the numbers
The second-most frequently reported chronic condition in the United States.
Affects 1 in 5 adults that's 50 million Americans and 300,000 children.
60 percent of people with arthritis are women.
Two-thirds of people with arthritis are under age 65. But the number of affected people over 65 is expected to double to more than 41 million by 2030.
By 2030, an estimated 67 million Americans will have some form of arthritis unless the trend is reversed.
Arthritis and other rheumatic conditions cost the U.S. economy $128 billion annually $80.8 billion in direct costs such as medical treatment and $47 billion in indirect costs, including lost earnings and missed work days.
The Utah Department of Health says that 57,000 of the more than 415,000 adults in the state diagnosed with arthritis report they don't do any vigorous or moderate exercise.
Arthritis: Several musculoskeletal disorders
Arthritis includes more than 100 diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues. It is not yet fully understood, and there is no cure.
Osteoarthritis • The most common, it is a degenerative joint disease that affects nearly 27 million Americans, especially as we age. It damages cartilage and bones but is not an autoimmune disease.
Rheumatoid arthritis • The most well-known of the autoimmune varieties. It is a chronic, systemic inflammatory illness that can affect the entire body, including the heart and other organs. Its prevalence in women is more than twice that of men.
Juvenile arthritis • Describes the many autoimmune and inflammatory conditions that affect children age 16 and younger.
The Utah Department of Health works with many groups to offer arthritis education and physical activity programs. To find one in your area, or to learn more, visit www.health.utah.gov/arthritis, or call 801-538-9458.
To contact the Arthritis Foundation: www.arthritis.org/chapters/utah/ or call 1-800-444-4993.