Exercising Safely & Meaningfully with Rheumatoid Arthritis
Motion is Lotion!
What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a chronic disease that causes joint pain and inflammation. The disease is triggered by an autoimmune response where the body attacks healthy tissues. RA can affect multiple joints. Common sites include the hands, knees, wrists, ankles, and feet. It can also affect other parts of the body such as the eyes, heart, circulatory system, and or lungs. It is marked by periods of exacerbations, or “flares” and remissions. The disease is more prevalent in women and the onset tends to occur in middle age.
Hi, I’m Marlene!
There is SO much science to back up the benefits of thoughtful movement and activity helping people with RA live more active lives. I wrote this for you!
Exercise and RA
If you are a person who has RA and new to exercise, or it has been a while since you have exercised, it is important to start slowly and progress gradually. Individuals with RA tend to be more deconditioned with lower aerobic capacity. In part, this may be due to spending less time engaging in physical activity because of pain, joint stiffness, and difficulty walking that are experienced by some.
So what can help RA?
Journaling!
Journaling or keeping a daily log of symptoms is a good practice to develop. Journaling your symptoms can help you decide if you need to modify your exercise intensity, exercise selection, or take a rest day. Important items to document and observe include the time of day when you feel your best, pain levels on a scale of 0 to 10 (zero = no pain, 5 = moderate pain, and 10 = worse pain ever), pain sensations (e.g., achy, dull, sharp, etc.), mood, emotional state, fatigue level, and situation (e.g., I was stuck in traffic, I had a pleasant lunch with a friend).
Slow and steady is the key!
Simply starting with 5-10 minutes a day of activity may be enough for some individuals and gradually progressing the time each week can help you to ease into achieving a longer duration. Intermittent bouts (e.g., three 5-10-minute bouts in a day versus 30 minutes all at once) are beneficial and encourage movement throughout the day, which can help combat joint stiffness, and allow for gradually increasing endurance capacity.
These strategies are also beneficial for regular exercisers in terms of observing what may be contributing factors to occasional flare-ups, maximizing level of function, and having a record to serve as a reference for productive conversations with your physician during check-ups.
Balancing Activity and Rest
Pacing is Key!
It is important to balance activity with rest. Too much activity (e.g., cleaning the entire house and doing a full exercise session on the same day) can overstress the body and exacerbate symptoms, leading to a flare. This is where journaling (having a record of past activities, symptoms, and actions taken) can also be helpful in planning and pacing activities throughout the day or week. Some individuals subscribe to the adage that “more is better”, and that does not apply here.
Remember: There may be days where you feel capable of exercising, but need to dial back the intensity due to fatigue or a mild flare.
This could mean a shorter aerobic session, fewer repetitions or sets in your strength training routine, or avoiding exercises that may exacerbate a particular joint that is experiencing a mild flare.
So,What Is a Flare?
A flare is a period of increased disease activity or worsening of symptoms which are characterized by intense pain and stiffness of the joints.
It is important for individuals experiencing a flare to avoid strenuous exercise. Low-impact, low-intensity activity such as aquatic exercise in a warm pool can be helpful.
If aquatic exercise is not accessible, intermittent bouts of land-based activities such as mild stretching or gentle range of motion activities can be done as tolerated.
Here’s what I generally recommend for people living with RA, Lupus, Spondylitis and other autoimmune diseases.
The exercise program must be individualized! Each person’s experience with RA is different. Listed below are guidelines for aerobic, resistance, and strength training.
Aerobic Activities for RA
Frequency: 2-3 times per week
Intensity: low to moderate intensity
Time: 20-60 minutes per session
Type: Low-impact/low-loading activities such as cycling, NuStep cross trainer, and walking. Warm water aquatic exercise for those where land-based activity is cautioned.
Benefits: Increase endurance capacity, helps to relieve stiffness, improve mood, and better sleep.
Resistance Training for RA
Frequency: 2-3 days per week
Intensity: Light to moderate
Repetitions: 6-15 repetitions (avoiding a range that goes to failure to reduce joint stress). Repetitions can also be as low as 2-3 per exercise to reduce the potential for joint discomfort.
Sets: 1 set for beginners or deconditioned individuals slowly progressing to 2-3 sets per exercise.
Time: 15-45 (60) minutes
Type: Bands, isometric exercises, body weight, machines, and free weights are options. Pain level and severity of affected joints should determine the type of resistance used. Isometric exercises allow for contractions of the muscles without movement of the surrounding joints. This can help improve joint stabilization, posture, and endurance capacity.
Benefits: Improves muscular strength and endurance and strengthens the muscles around the joints which helps with joint stability. Improves mobility, physical functioning, performance for activities of daily living, preserve independence, decreases the risk for osteoporosis, slow down muscle wasting, and age-related muscle loss.
Stretching for RA
Frequency: At least 2 days per week
Intensity: Moderate intensity (5-6 on a 10-point scale)
Type: Slow static stretching
Hold time: 30 seconds in a pain-free range. If an area is particularly tight, start with a 15-second hold and gradually add 5 seconds each week until a hold time of 30 seconds is achieved.
Time: Individualized and determined by the person’s symptom severity.
Benefits: Improve or maintain range of motion.
Body Awareness
Tai chi, qui gong, and yoga are other types of exercise that can be beneficial due to slow controlled movements with minimal lower extremity impact. These modalities include exercises that improve posture, breathing, balance, joint position, coordination, and relaxation. Tai chi and qui gong (known as mindful martial arts) movements can be modified to reduce joint strain.
Meet the Author, Marlene DaCosta
Above all:
Check with your doctor before starting an exercise program. If you are a new exerciser or have not been active for a long time, it is important to start slowly and progress gradually.
Proper guidance from an exercise professional who has worked with individuals who have arthritis, understands the disease process and exercise guidelines, can help devise a program that is individualized, safe, and appropriate.
Work with an expert who “gets it”
REFERENCES
https://www.arthritis.org/diseases/rheumatoid-arthritis
Barnes JT, Pujol TJ, and Elder CL. Exercise Considerations for Patients with Rheumatoid Arthritis. Strength Cond J 24(3): 46-50, 2002.
Cheatham SW and Cain M. Rheumatoid Arthritis: Exercise Programming for the Strength and Conditioning Professional. Strength Cond J 37(1): 30-39, 2015.
Fragala MS, Cadore EL, Sandor D, Izquierdo M, Kraemer WJ, Peterson MD, and Ryan ED. Resistance Training for Older Adults: Position Statement from the National Strength and Conditioning Association.
J Strength Cond Res 33(8): 1-34, 2019.
Ronai P, Sorace P, and LaFontaine T. Resistance Training for Persons with Osteoarthritis and Rheumatoid Arthritis. Strength Cond J 30(2): 32-34, 2008.
Wing C and Peterson JA. Exercise and Arthritis: Guidelines for the Fitness Professional. ACSM’s HFJ,16(2): 8-12, 2012.