Exercising with Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a systemic autoimmune disease. It is characterized by inflammation of the membranes lining the joints. This causes pain, stiffness, warmth, swelling, and potential severe joint damage.
Symptoms vary from day to day. Sudden increases in symptoms are called flares. These are common and can last for days or months. During flares, the lining of the joint capsule thickens and the joint swells. The progression of RA breaks down the cartilage and bone of affected joints. In severe cases, bones fuse together, resulting in more pain and deformity. This leads to physical disability and reduced quality of life.
About 1 to 2 percent of Americans have RA. It affects women nearly three times as often as men. RA usually begins between ages 30 and 60 in women. It starts later in men.
RA sufferers have reduced muscle strength and joint function. This reduces mobility and increases pain. In the past, exercise was restricted. Physicians were concerned about worsening joint inflammation and speeding up joint damage. Fortunately, regular exercise does not appear to increase symptoms or damage. Research shows that aerobic exercise is safe. It also improves aerobic capacity for those with stable RA. Resistance exercise also is recommended. Stretching and warm-up are key. Exercise also is best done several times per day.
Since evidence suggests both aerobic and strength exercises help, try to do both. If you are just starting out, do more aerobic exercise. This will also help you lose weight. Over time, add resistance workouts. Doing both types will bring even more benefits for your pain and joint stiffness. It will also help your overall health and fitness. The key is to stay active and choose activities you enjoy.
- Talk with your doctor before you start an exercise program. Ask about any changes to your medications or concerns in becoming more active.
- Take all medicines prescribed by your doctor.
- Select low-impact and non-impact activities. Walking, swimming, water exercise and cycling are good choices.
- A long warm-up and gradual cool down may help you avoid additional joint pain.
- Divide your activity into many short sessions during the day. Try three 10-minute sessions to start. Set goals by time rather than distance.
- Start slowly. Over time, add to the intensity and length of your workouts. Take frequent breaks as needed. Adjust your workouts based on your symptoms.
- Start by exercising on your own. Begin walking or another form of activity that you can add to your daily routine.
- Invite others to join you. Exercising together is more fun and increases the chance you will continue. Dogs make great walking partners!
- Look for programs in your community. You could also contact an appropriately credentialed exercise professional* to help you. All you really need, though, is a good pair of shoes to get started walking.
- Select shoes and insoles for maximum shock absorption.
- Use a pedometer or other device to track your exercise. Slowly work toward a goal, like maybe 10,000 steps per day.
Aerobic Exercise Programs
The American College of Sports Medicine and the Centers for Disease Control and Prevention recommend at least 150 minutes per week of moderate-intensity aerobic activity, 75 minutes of vigorous aerobic activity, or an equivalent combination of both for adults. They also suggest muscle strengthening twice a week. Follow the FITT principle to design and implement a safe and effective program you will enjoy. F = frequency, I = intensity, T = time, and T = type. There are no established FITT guidelines for people with RA. Use the FITT guidelines for apparently healthy adults, but adjust for your own pain, stability, and functional limits.
- Frequency – Be active on most days of the week but at least three to four days.
- Intensity – Exercise at a moderate level. Use the “talk test” to help you monitor. For example, even though you may notice a slight rise in your heart rate and breathing, you should be able to carry on a conversation while walking at a moderate pace. As you walk faster, you will begin to breathe faster and have difficulty talking. At that point, you’ve achieved moderate intensity or “somewhat hard.” Vigorous exercise causes a large rise in heart rate and breathing. At this intensity it would become difficult to talk. Most people would rate this as “hard to very hard.”
- Time – Exercise 30 to 60 minutes per day. You can do it all at once or break it up into a few sessions of at least 10 minutes each. Multiple, shorter sessions may help reduce joint pain.
- Type – Exercise in the water to reduce joint stress. It also improves cardiovascular fitness. Do activities you enjoy and will do regularly in your new, more active lifestyle. Add variety depending on the day or the season to keep your program more enjoyable.
Aerobic Exercise Cautions
- Exercise is uncomfortable for about 85 percent of people with RA. This will affect how much exercise you can do.
- Schedule your exercise each day when your pain is lowest. Also, plan to exercise when your pain medication is most effective.
- During flare-ups, you may be unable to exercise or to exercise as much. Joint and muscle pain, joint stiffness, and muscular and psychological fatigue will make exercise more difficult.
- Avoid vigorous exercise during acute flare-ups or periods of inflammation. Instead, try gentle stretching exercises. These will help increase your range of motion.
- If you have been inactive for a long time, start with shorter sessions (10 to 15 minutes). Add five minutes to each session, increasing every two to four weeks. Over time, build up to being active at least 30 minutes a day on most days of the week.
- Expect some discomfort after your workouts. You should not be in pain, though. If pain is greater two hours after exercise than it was before, reduce the length and intensity of your next session.
- Total exercise time is more import than intensity. If you exercise at too high an intensity, you may not be able to exercise very long. This increases your risk of injury.
- Avoid vigorous, highly repetitive activities. This is especially true for people with unstable joints.
- Avoid overuse and repetitive stress injuries by alternating types of exercise over consecutive days.
- Drink plenty of fluids before, during, and after exercise.
Resistance Exercise Programs
Evidence suggests that light- to moderate-intensity resistance training is a good addition to your program. Muscle atrophy often accompanies RA. Resistance training helps reverse atrophy. It also strengthens the muscles surrounding the joint. This reduces the risk of injury and more joint damage. Resistance training helps in other ways, too. It increases or maintains the amount of muscle. It improves your ability to function and it also promotes overall good health.
- Frequency – At least two to three days per week. Plan a day of rest between sessions.
- Intensity – Light to moderate. Light intensity is weight you can lift 15 to 20 times. Moderate intensity is weight you can lift 10 to 15 times.
- Time – This depends on the number of exercises you do. In general, do one to three sets of 10 to 15 repetitions.
- Type –Exercise all major muscle groups but concentrate more on muscles surrounding the affected joints first. This will help strengthen and stabilize them. Exercise in the water with light resistance to reduce stress on the joints. Water exercise conditions muscles through a full, pain-free range of motion. Exercise with a machine or with free weights. There is little difference between them. Don’t belong to a gym or health club? No problem. You can do the same exercises at home with lighter weights, resistance bands, or your body as the resistance. Try push-ups or sit-ups.
Resistance Exercise Cautions
Avoid holding your breath when lifting. This can cause large changes in blood pressure. That change may increase the risk of passing out or developing abnormal heart rhythms. This is especially true if you also have high blood pressure. • Start with 10 to 15 repetitions. Build up to 15 to 20 repetitions before you add another set.
Other Types of Exercise
Stiffness and pain cause joints to be less flexible. Thus, exercise often is avoided. Maintain flexibility by using the joint. Also, do activities that stretch the muscles across the joint. Otherwise, unused muscles will shorten and limit range of motion. • Do flexibility exercises every day.
- Do dynamic flexibility exercises for all major muscle groups. This increases their range of motion.
- Avoid overstretching.
- Yoga, Pilates and tai-chi help improve strength and flexibility. They also help you relax and reduce pain.
People with RA often have a low exercise capacity. However, even just a little exercise over a short time can cause big improvements. Use those improvements to motivate you to continue. The key is to begin your more active lifestyle.
Design your exercise program for the most benefit and the fewest risks to your health or physical condition. Contact an appropriately credentialed exercise professional* to work with you and your doctor. They can help you establish realistic goals and together, you can design a safe, effective, and enjoyable program to meet your needs and goals.
Contact us for more information.
*A listing of exercise professionals can be found at www.usreps.org and EIM Credentialed professionals can be found through the ACSM ProFinder.