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Exercise

Exercise—with or without RA—is critical to maintaining overall health. Exercise promotes cardiovascular, mental, and emotional health and helps us to maintain a healthy weight. It can improve sleep, prevent disease, and boost energy and stamina. Experts agree that maintaining a regular exercise program is one of the cornerstones of a healthy lifestyle—even for individuals living with RA.[1] However, anyone living with RA will tell you that exercise is no simple prescription to fill.

Exercise and RA

There is a lot of controversy surrounding RA and exercise. Many experts recommend daily exercise for people living with RA, but those who suffer from the condition often find that exercise is easier said than done. In fact, exercise and RA is the ultimate catch-22: exercise can alleviate joint pain and stiffness, but individuals suffering from pain and stiffness are hesitant to exercise for fear of exacerbating the pain.

Some evidence suggests that a significant amount of the disability related to RA occurs from a lack of fitness.[2] Pain and inflamed joints can lead to inactivity. Inactivity can weaken joints and cause a decrease in muscle strength and endurance—which can exacerbate the effects of the disease.[3] Furthermore, the lack of weight-bearing activity can have a negative impact on bone structure.[4],[5]

The Goals and Benefits of Exercise for RA

You don’t need to have any lofty fitness goals to benefit from a simple exercise program. In fact, the goal of exercising with RA is simple—maintain overall health and cope with pain and stiffness.

Experts have identified several goals of an exercise program for individuals living with RA:

  • Preserve or restore range of motion (ROM) and flexibility around affected joints
  • Increase muscle strength and endurance to build joint stability
  • Increase aerobic capacity to decrease the risk of cardiovascular disease and improve mood

Optimally, a regular exercise program will help to stabilize inflammation and slow the disabling process associated with RA.

If you’re living with RA, exercise can bring many benefits—it can help alleviate joint pain and stiffness, increase your flexibility, improve your sleep, and boost your endurance. Some research indicates that the endorphins released during exercise have an analgesic effect and can inhibit pain. Furthermore, stimulating the joint receptors with joint movement appears to inhibit the effects of pain signals coming from the same joint.

Exercise Recommendations for RA

There is no one-size-fits-all prescription for exercise when it comes to RA. In general, the American College of Sports Medicine (ACSM) recommends moderate, low-impact, large-muscle aerobic activity (walking, cycling, swimming) 3-5 days per week for 5-minute sessions building to 30-minute sessions over time. However, if you’re living with RA, the duration and intensity of exercise will vary depending on your current condition.

An ideal exercise regimen for RA will include:

  • Stretching
  • Aerobic exercise
  • Strengthening

Most experts recommend that all exercise sessions begin and end with stretching and ROM exercises.

When to Avoid Exercise

Although it is encouraged and recommended, the truth is that exercise is not always appropriate with RA, especially during a flare-up. The ACSM recommends against vigorous exercise in the presence of acute joint inflammation or uncontrolled systemic disease. Rest is extremely important during times of intense pain. During an acute flare-up, you may want to perform some gentle ROM exercises if you are able—but rest is key. Talk with your physician or physical therapist to determine whether you should exercise during general or local flares.

Knowing your Limits

Every individual is different and it’s up to you to set your own limits when it comes to exercise. It’s normal to experience some post-exercise discomfort; however, if you experience joint pain that lasts for longer than two hours after exercise, that is your cue that you were exercising too strenuously. In these cases, it may be necessary to find other more gentle activities.

In general, use caution. Depending on the current stage of your condition, exercising too rigorously could be counterproductive, landing you in bed for days.

Starting an Exercise Program

If exercise feels appropriate for you, it’s important to choose the right type and intensity level of exercise. There are a variety of guidelines for exercising with RA:

Choose Low-Impact Activities: The best forms of exercise for people with RA are low-impact activities such as walking, biking, swimming, rowing, and cross-country skiing. High-impact activities (such as running, basketball, tennis, or volleyball) carry the risk of injury and can aggravate RA. Avoid activities with sudden stops and changes of direction (soccer, basketball, tennis).

Keep Intensity Low: It’s important to avoid exercising too hard. Emphasize duration rather than intensity. Start small—with 5 minutes of activity—and aim to build the duration over time.

Add Weight-Bearing Exercise: Individuals with RA are at a higher risk of developing osteoporosis (bone loss) for a variety of reasons—the arthritis itself, medications used to treat the condition, or reduced physical activity. Weight-bearing activity helps build bone density and maintain bone health. Walking is an excellent form of weight-bearing exercise for individuals with RA.

Maintain Variety: Variety is important for many reasons aside from the obvious bonus of preventing boredom. By varying your activities among weight-bearing, partial weight-bearing, and non-weight-bearing exercises, you’ll help disperse joint loads to any individual joint. Furthermore, RA tends to ebb and flow and you’ll have good days and bad days—by having a variety of activities in place, you’ll ensure that you always have some type of activity you can enjoy depending on your condition.

Find a Balance: Maintaining a balance between activity and rest is critical to managing RA. Both excessive rest and excessive exercise can have adverse effects for individuals living with RA. Find the balance that works for you.

Recommended Activities

There are several types of exercise that are ideally suited to individuals living with RA. The most important thing is to find activities that you enjoy doing. As mentioned above, look for exercises that are low-impact, low-intensity, and weight bearing.

Stretching: Stretching is a critical component of any exercise program for RA. Stretching helps you to prevent stiffness and improve flexibility and range of motion. Many people with RA benefit from daily stretching—especially before and after more strenuous exercise.

Swimming and other Water Exercises: Swimming is an excellent choice for individuals with RA because the water supports the body, thereby limiting the amount of stress on the joints. In addition, some people enjoy water aerobics or simply walking in water—either in waist-deep water or in deep water with a flotation vest.

Tai Chi: Tai chi is an ancient Chinese practice that features soft, flowing movements. It is a system of slow, meditative, physical exercises designed for relaxation, balance, and health. It has been shown to relieve stiffness and improve strength and balance.

Walking: Walking is one of the simplest, most natural forms of exercise there is. Walking is a gentle, low-impact way to move your body, increase your heart rate, gain cardiovascular benefits, and ease your way into a higher level of fitness. The best part—you get to choose the distance and speed that is appropriate for you.

Cross-Country Skiing: If you live in a wintry place, cross-country skiing can be an excellent low-impact activity for building endurance and getting fresh air.

Biking: Bicycling is a simple and fun form of exercise. Cycling is a low-impact activity that does not have the excessive pounding associated with other activities, like running. It increases joint movement and can actually serve to strengthen joints because it builds cartilage rather than breaking it down.

Strength/Resistance Training: Strength training is important because RA can often lead to weakened muscles. You can choose from a variety of resistance tools, including elastic bands, free weights, medicine balls, machines—and even your own body weight. Weight machines are sometimes discouraged because they can force the joint into a specific predetermined movement pattern. Many people find that elastic bands are the optimal choice.

Exercise Tips

If you’re beginning an exercise program, take your time easing into increased physical activity. Listen to your body and be sure to back off if you notice joint pain that lasts longer than two hours after exercise. Here are a few tips for exercise success:

  • Use Heat: Sometimes it helps to apply heat to your joints prior to exercise. Heat helps relax the joints and muscles and can also help relieve any pain you may have. Heat should be warm, but not painfully hot. Apply heat—in the form of warm towels, hot packs, or a shower—for about 20 minutes.
  • Warm Up: It’s important to warm up by moving your joints gently with some range-of-motion or stretching exercises. Take five to ten minutes to warm up before moving on to strength or aerobic exercise.
  • Go Easy: Exercise should feel like effort, not struggle. Use slow, easy movements. If you notice pain, stop for a break. Pay attention—sharp pain that is stronger than usual might indicate a problem.
  • Cool Down: Take time to stretch after exercising to prevent stiffness.

Exercise is Good in Moderation

Living with RA does not have to mean a life sentence on the couch. A little exercise can be a good thing, but only you can know your limitations. In short—the best advice is to exercise when you are able and rest when you need to.

References:

[1] Metsios GS, Stavropoulos-Kalinoglou A, Veldhuijzen van Zanten JJCS, et al: Rheumatoid arthritis, cardiovascular disease and physical exercise: A systematic review. Rheumatology. 2008; 47: 239-248.

[2] Nieman DC: Exercise Soothes Arthritis Joint Effects. ACSM’s Health and Fitness Journal. 2000; 4: 20-27.

[3] Van den Ende CH, Hazes JM, le Cessie S, et al: Comparison of high and low intensity training in well controlled rheumatoid arthritis. Annals of the Rheumatic Diseases. 1996; 55(11): 798-805.

[4] Hakkinen A, Sokka T, Kotaniemi A, et al: Dynamic strength training in patients with early rheumatoid arthritis increases muscle strength but not bone density. The Journal of Rheumatology. 1999; 26: 1257-1263.

[5] De Jong Z, Munneke M, Lems WF, et al: Slowing of bone loss in patients with rheumatoid arthritis by long-term high-intensity exercise. Arthritis Rheum. 2004; 50(4):1066-1076.

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