It's hard enough for a room full of reasonable adults to get through a round of "Head and shoulders, hips and knees, hips and knees" without giggling, but throw in a replaced hip or two and a reconstructed shoulder and things get downright punchy.

Exercise instructor Cyndi Forbes can scarcely get through a short conversation without throwing in a one-liner. And during her 45-minute People with Arthritis Can Exercise class at the Rocky Mountain Development Council's Neighborhood Center, Forbes' humor makes the stretching and range of motion exercises fly by.

"I'm a rebuild," the 63-year-old tells her class, referring to her knee replacements and shoulder surgeries. Indeed, she has arthritis throughout her entire body.

"I have so many spurs," she says, "I said to myself, I might as well move out West and be a cowgirl."

Forbes has been teaching the PACE class ever since she moved to Helena from Milwaukee two and a half years ago. A former activity director and remotivator who specialized in therapeutic humor at one of the largest single-floor nursing homes in the U.S., Forbes has seen firsthand the impact that laughter can have on mental and physical health.

In her wallet, she keeps photos of Granny Giggles and Candi the Clown - two of the characters she's played to help bring laughter to the surface.

"People come in hungry for humor," she said. "I've got people who say, 'I didn't know I could move like this,' and they're laughing together."

PACE is a fitness program certified by the Arthritis Foundation. Participants go through a variety of exercises designed to increase flexibility, strength, endurance, coordination, balance, cardiopulmonary functioning and range of motion.

"I really get around better," said Eileen Darlow, an 82-year-old who has participated in the class for more than a year.

"I have better balance," added Phyllis Clouse, 90.

The two women are neighbors and ride the RMDC transportation bus together to class every Friday morning at 10.

"We have fun here, eat lunch, and then ride the bus home," Darlow said.

Forbes believes that the PACE class helps prevent a cycle of pain for arthritis sufferers. She says that when people become less active, their pain increases as their conditioning decreases. This can result in fatigue, depression and stress, and ultimately more pain.

"So many people become their illness," Forbes said. "I can't become my illness; I'd have multiple personalities."