Rheumatoid arthritis exercise program

Narrator: One of the best things you can do to offset bone loss is weight bearing exercise. So we asked Master Trainer Dori Ricci to show us how to do 8 specific weight exercises without strain.
Dori Ricci, Master Trainer: You want to keep a neutral wrist position, which means you don’t want to flex or extend your wrist—you just want to keep it straight—so the back of your hand would be flat. You want to go through a full range of motion—if you feel discomfort in the elbow then what you would do is lower the weight. The leg extension strengthen the front of the thighs.The leg curl strengthens the back of the thigh. This muscle is called the quadriceps; this muscle is called the hamstring. In order to avoid straining the joints you would relax the feet, you would not flex or point, and if you feel strain in your knees, you would just lower the weight. This is called the tricep pushup: You elevate the elbows off the floor. You want to make sure your elbows are directly under your shoulders and you want to come up just a little bit, so that you make sure there’s not too much flexion in the wrist. This also strengthens your lower back. The seated row is a great exercise but you can also do it at home and on the road using resistance bands. You want to place the chair far enough away from the attachment so you have tension in the bands when you start. You’re working the upper back muscles. Now when these muscles are strong you have good posture. In order to avoid any stress or pain or tension in the wrists, you want to make sure you have a neutral wrist—you want the back of the wrist to be flat. In order to avoid straining the elbows you want to make sure you come down to a 90 degree angle when you pull down to the waist. The calf raise is an excellent exercise for the lower leg because you don’t need any equipment so you can pretty much do it anywhere. It works the muscles in the lower leg, the gastrocnemius and the soleus underneath. All you would do is stand with your feet shoulder width apart, go up on your toes and come down and bring your heels to the floor. If you feel discomfort in your ankles you can start out coming up a half an inch or an inch and then increase your range of motion as it feels better. The leg press is an excellent exercise for the lower body because it works the thighs and the glutes. You want to press out and come back to a 90 degree angle. That’s very important, you never want to put your feet low on the plates because there is too much flexion at the ankle and the knee. You always want to put your feet high so that you come back to a 90 degree angle and you press out to just before you lock your knees. Now we’re going to do the chest press exercise. This exercise works the pectoralis major and minor and we’re going to grab the handles here and what we want to remember here is to keep a flat wrist so we avoid straining the wrists. Come back to a 90 degree angle at the elbow to avoid putting extra stress on the elbow and we want to keep the elbows up at shoulder height.

11 Exercises for Rheumatoid Arthritis

  • 1

    Rheumatoid arthritis (RA) is an autoimmune disorder causing inflammation of the joints. Patients suffering from RA often complain of joint pain and swelling. This type of arthritis can lead to bone erosion, joint deformity, and relatively loose ligaments. Experts say conditions like osteoporosis can become an issue with RA due to steroid treatments and bone degeneration. When coping with RA, it’s important to develop muscle strength and flexibility to provide efficient shock absorption to the bones and to help the ligaments keep joints stabilized. Add these exercises to your wellness routine.

    11 Exercises for Rheumatoid Arthritis https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/crop/1494×999%2B0%2B0/resize/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2F02%2F06%2F5eaaa3764ce392eba882fd025ed1%2Fresizes%2F1500%2Fimage-gettyimages-548554325-senior-woman-stretching-on-beach.jpg

  • 2

    Gentle weight-bearing exercises can help build bone and address joint stability. Walking is one suggested activity. Other weight-bearing exercises like the All Fours Heel Slide” are a good way to help develop strength. To do the heel slide, get onto “all fours.” Draw your bellow button in towards your spine. Don’t hold your breath. Slide your right leg back, keeping your foot on the ground and keeping your hips level. Be careful not to arch your back. Alternate legs. Do 2-3 sets of 10 repetitions.

    Gentle Weight-Bearing Exercises https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/thumbnail/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2Fa0%2F87%2Ffd63fe3f495586822873eaab9f67%2Fresizes%2F1500%2Fimage-senior-woman-smiling-with-water-bottle.jpg

  • 3

    It’s important to maintain joint range of motion (ROM) when living with RA.

    Experts suggest to help counter joint stiffness, perform ROM exercises in a pain free range. As you gain more flexibility you will be able to go further, but don’t push too aggressively as this can irritate your joint. To address stiff shoulders try the wand exercise. Lie on your back holding a long wooden kitchen spoon in both hands. Bend your knees. Slowly move your arms overhead holding onto the spoon. Then move the spoon back down to your lap being careful to stay below your pain level. Do 2 sets of 10 repetitions.

    Range of Motion Exercises https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/thumbnail/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2F94%2F6b%2Fc901856b493381875f884bb675be%2Fimage-man-stretching.jpg

  • 4

    The stomach, low back, and chest muscles are part of a group called the core. Exercises focusing on the core that maintain a neutral (not too arched, not too flat) spine are typically recommended for RA patients. Marching is also an easy exercise to strengthen your core muscles. Lie on your back with your knees bent. Keep your back flat, your hips level. Keeping your knees bent, lift one knee up to hip level forming a 90 degree angle at the hips. Alternate legs. Do 2 sets of 10 repetitions.

    Core Muscle Strengthening https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/crop/5616×3757%2B0%2B0/resize/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2Fe4%2F49%2F876778a44914b32d21569ec9c046%2Fimage-getty-457490795.jpg

  • 5

    Isometric exercise is another way to address muscle weakness and joint instability. Isometrics involve contracting the muscle without the joint actually moving. To promote shoulder stability, try performing isometrics to the shoulders. Begin by bending your elbows at a 90 degree angle with your shoulder blades pushed back. Then stand in a doorway with the back of your hand/forearm against the doorframe. Push to turn your hands away from your body. Hold for 5 seconds and do 5 repetitions. Then perform the exercise in the opposite direction pushing to turn your hand/forearm in towards your body. Hold for 5 seconds and do 5 repetitions.

    Isometrics Exercises https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/thumbnail/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2Fcc%2Ff8%2Fb16e5f6f436b9f43b4d897252c09%2Fresizes%2F1500%2Fimage-door-frame.jpg

  • 6

    Stretching can improve joint motion and stiffness. Talk to your physical therapist about which specific muscles need to be stretched in order to avoid overstretching a joint or one that is at risk of slipping out of proper alignment. To help improve posture, try the Pectoral Stretch. Stand in a doorway arms just below shoulder height with one leg forward. Your hands are resting on doorframe LIGHTLY. While keeping your ribcage over your pelvis lean your trunk into the doorway lunging onto the front foot. You should feel stretch across your chest. Hold stretch for 30 seconds then switch the forward leg and repeat exercise.

    Gentle Stretches https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/crop/1493×999%2B0%2B0/resize/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2F3d%2F42%2F7d7931c24bf1b8530ae62b759882%2Fresizes%2F1500%2Fimage-gettyimages-180409598-senior-woman-stretching-arms-with-exercise-band.jpg

  • 7

    Painful feet due to rheumatoid arthritis can contribute to faulty compensations as you walk. This can then place strain on your knees and hips. Performing Arch Lifts can help strengthen the muscles that support the bones in your feet. Place your bare feet on top of a towel on the floor. Keep your toes facing forward and your heels on the floor. Lift the arch of your foot while trying to scrunch towel with your toes. Hold your toes in this scrunching position for 10 seconds. Do 10 repetitions.

    Arch Support https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/crop/722×483%2B3%2B0/resize/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2F26%2Fa8%2F3de604f346b48f101d5f13e08e3f%2Fimage-tired-and-aching-feet-468109757.jpg

  • 8

    Leg raises are a great way to strengthen your thigh muscles like your quadriceps. If you’re using ankle weights to strengthen your legs, consider placing them above your knee around your thigh. This provides resistance and avoids straining a knee which may be compromised due to RA symptoms. Try doing a series of Straight Leg Raises. Start by lying on your back with one knee bent and the other leg straight. Keep your back flat. Lift one leg up to the level of the other knee then SLOWLY lower it down to ground. Do 2-3 sets of 10 repetitions.

    Leg Raises https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/thumbnail/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2F5b%2Fa7%2F6d25c9174910bb607cfd8593c517%2Fresizes%2F1500%2Fimage-woman-stretching-leg.jpg

  • 9

    Rheumatoid arthritis frequently affects the smaller joints of the body like your fingers. When living with RA, it’s important to strengthen and maintain range of motion in your hands. One way to do this and help gain range in your fingers is to perform the Finger Claw exercise. Place each finger onto a coin on a table. While pressing slightly onto the coins bend your fingers SLOWLY. Now extend them fully feeling a stretch. Do 2 – 3 sets of 10 repetitions.

    Finger Strengthening https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/thumbnail/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2Fde%2F3a%2Fbe2f97fa4a8bb6e7fbdaa4493c9d%2Fresizes%2F1500%2Fimage-man-talking-with-senior-woman.jpg

  • 10

    Many patients with rheumatoid arthritis complain of tight sore forearm muscles. Strengthening these muscles can help perform daily chores like typing as well as help maintain motion of your elbow and wrists. Try Wrist Curls. Sit at your desk with your right forearm on the table. Position your right wrist hanging over the edge, palm facing down. Holding a light weight dumbbell (1-2 pounds), slowly lift your wrist up and down. Then turn your palm up and again lift your wrist up and down. Do 2-3 sets of 10 repetitions.

    Wrist Curls https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/crop/3339×2234%2B0%2B1/resize/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2F0b%2Fc7%2F151fffbb419da1c127f84f4d79f9%2Fimage-man-with-wrist-pain.jpg

  • 11

    When the buttock and hip muscles are weak, they can’t efficiently control the motion of your thigh bone. The knee may look out of alignment with the rest of your body as if it is “rolling in.” This can overload your hip and knee joints that may already be irritated in patients with RA. An exercise to strengthen one of the buttock muscles is the Side Lying Lift. Lie on your side with hips and legs stacked in line with shoulders. Lift your top leg up without letting it come forward then SLOWLY lower it down. Do 2-3 sets of 10 repetitions.

    Glute Strengthening https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/crop/5616×3757%2B0%2B0/resize/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2F84%2F56%2F0187031e4c59b7813e8ab7be87d1%2Fimage-senior-couple-stretching.jpg

  • 12

    Reports suggest taking classes that address balance, strength and flexibility such as yoga, Tai Chi and Qi Gong may be beneficial. These practices may also help reduce stress which can come with managing a chronic disease. Remember to always check with your physician before beginning any exercise program. And if you’re coping with rheumatoid arthritis, discuss with your doctor or physical therapist whether or not you need a brace to provide support while exercising.

    Yoga, Tai Chi and Qi Gong https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/thumbnail/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2F77%2F29%2Fa8b9b9d2458f99cf62cbba124d9e%2Fhumira-SS-exercise-8.jpg

Top 10 Exercises for People with Arthritis

People used to believe that exercise and arthritis were as compatible as oil and water. Yet research demonstrates that the opposite is true. Exercise can actually decrease joint pain and stiffness, and improve flexibility, mobility, mood and overall wellness for those with arthritis . Though it can be intimidating for those with osteoarthritis, rheumatoid arthritis, fibromyalgia or lupus to begin exercising, when coupled with weight loss, it may be one of the best means for managing the disease, explains Patience White, M.D., M.A., vice president of public health at the Arthritis Foundation. Especially since people with arthritis are more likely to be overweight than not.

“Exercise keeps the muscles strong around a joint so that the mechanics works,” explains White. “In the lower extremities, the knee is usually the first joint to experience pain for the 27 million people who suffer from osteoarthritis. If a person loses about 10 pounds and keeps exercising, they can cut the pain in their knees by about 50 percent and can even postpone a joint replacement.”

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But how does one begin? Before starting any exercise program, make sure it’s OK with your physician. Find forms of exercise that are both low-impact — such as biking, swimming and walking to help build strength — and combine it with stretching, which improves joint function. “The government recommends that you do 30 minutes of moderate physical exercise five times a week for joint health,” says White. “This can be in 10 minute increments, or you can do the recommended 10,000 steps daily.”

Either way, read on to learn more about low-impact exercises you can incorporate into your daily routine.

How to Exercise With Rheumatoid Arthritis

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When you have rheumatoid arthritis (RA), skipping out on regular exercise and stretching can cause your joints to become so tight and stiff that they can’t move or bend. With exercise, you can better maintain range of motion and improve symptoms like joint pain, says James R. O’Dell, MD, a professor, chief of therheumatology and immunology division, and vice chairman of the internal medicine departmentat the University of Nebraska Medical Center in Omaha.

However, 71 percent of people with RA don’t exercise regularly, even though it offers many benefits, researchers noted in a study published in the July 2015 issue of Sports Medicine. The barriers to exercise, such as fatigue and pain, are the same for people with RA who do exercise and those who don’t, but those who exercise are better able to overcome them, the researchers note.

Getting Started With an RA Exercise Plan

“Patients with RA can and should exercise regularly, period,” says Elaine Husni, MD, MPH, vice chair of rheumatology and director of the Arthritis and Musculoskeletal Center of Cleveland Clinic in Ohio and an assistant professor at the Lerner College of Medicine of Case Western Reserve University. “However, there may be modifications needed, depending on your level of fitness and ability.”

For starters, always warm up before exercising and cool down afterward, Dr. Husni suggests. Also, be sure to use pain as your guide to know when to modify or stop. “Exercise should not be painful, so the onset of pain tells you to slow down or modify your exercise,” she explains.

The goal is to keep moving and do so at your level of fitness to prevent injuries, Husni says. “If you are new to exercise, you may benefit from group classes or a trainer so someone with experience can watch and teach you how to exercise safely.”

It’s important to incorporate exercise into your routine as soon as you’re diagnosed with RA. The best strategy is to consult with a physical therapist specifically trained to work with people with inflammatory conditions — you’ll benefit by working with an expert that’s familiar with the needs of people with RA.

A physical therapist can map out a customized routine for you so that you know which exercises you can do and which you should avoid. Even just one session with a physical therapist can teach you how to get the most out of exercise, Dr. O’Dell explains.

What to Include in Your RA Exercise Plan

The American College of Rheumatology suggests creating an exercise regimen that combines:

  • Low-impact aerobic exercises such as walking or biking for a total of 150 minutes a week
  • Flexibility activities such as stretching for 5 to 10 minutes daily
  • Strengthening through lifting weights or other resistance exercises at least two days a week
  • Body awareness, a fourth but often forgotten exercise type, that includes mind-body activities such as yoga and Tai chi.

The benefits of exercise for people with RA are not only physical, but emotional as well. Exercise can “decrease the incidence of depression associated with debilitating disease,” says Gary Calabrese, PT, director of rehabilitation and sports therapy at Cleveland Clinic Sports Health in Ohio.

How to Protect Your Joints During Exercise

While exercise can help you function better on a daily basis and prevent muscles from atrophying, your exercise choices have to be specific to maintaining joint integrity and pain management, Calabrese explains.

Try making these simple adjustments:

  1. Choose low-impact exercises that don’t stress the joints, such as walking, biking, or swimming.
  2. Properly condition muscles before you challenge yourself in your workouts.
  3. Work out for a shorter time and at a lesser intensity when you’re having a flare-up or are experiencing pain and swelling.
  4. Try exercising in several short bursts throughout the day rather than one long workout session.
  5. Create a routine that combines aerobic activity and resistance exercises that build muscle to help you avoid an overuse injury.
  6. Always warm up properly before you exercise.
  7. Always cool down afterward.
  8. Add flexibility exercises to your routine to help increase range of motion.
  9. Wear good athletic shoes that offer shock absorption and support for your feet.
  10. Try other types of water therapy, like walking in a pool, when the condition is very active, if you’re having a flare, or if your RA is very severe.

Finding the Right Exercise for You

For Julie Tollinchi, of Bloomfield, New Jersey, the answer to getting active with RA was swimming. As a child, Tollinchi played softball and baseball and was generally active, but that changed when she was diagnosed with juvenile RA just after her 14th birthday. Her condition was so severe that she spent several years in a wheelchair. It was only after having both knees and one of her hips replaced that Tollinchi could finally walk again.

As an adult, she finds the greatest relief from joint pain in the water. “Swimming really helps me because I’m weightless in the water,” says Tollinchi, who works out in the indoor pool of a nearby gym. “It allows me to stretch a lot more than I can regularly without being in a lot of pain.”

If you’re looking to start an exercise regimen, be sure to talk to your doctor, Calabrese stresses. With the right guidance, exercise can be an invaluable part of an effective RA treatment plan.

Exercise

Every person with rheumatoid arthritis (RA) should have a regular exercise program specifically tailored to their abilities and needs. The goal of regular exercise is to achieve and maintain optimal health and physical functioning. Regular exercise, including exercises for strengthening muscles, stretching (range of motion), building endurance, and improving coordination and balance, can be useful in managing many of the symptoms that commonly affect people with RA, including fatigue, stiffness, pain, and weakness. Regular exercise is an important key for maintaining joint and bone health.

Exercise also provides general health benefits to people with RA who are at increased risk for cardiovascular disease and osteoporosis (loss of bone with increased risk for fracture). Exercise can help you maintain cardiovascular health, strengthen muscles, and maintain your bones. (This is especially important if you take glucocorticoids to control inflammation.)

In addition, regular exercise can help lift your mood and spirits, improve your outlook on life, improve your sleep (which can be disrupted by RA), and help reduce the effects of depression and other mental health conditions that commonly affect persons living with chronic autoimmune disease.

What do studies tell us about the benefits of exercise?

The benefits of exercise for patients with RA have been demonstrated in a variety of well-controlled studies.1-4

One study evaluated the benefits of a regular program of strength training combined with aerobic activity for patients with early RA.2 The study found that over a two-year period a regular strength training and aerobic exercise program resulted in significant improvements in muscle strength and physical functioning, without any negative effects on disease activity. Compared to a control group (which was also engaged in an exercise program combining range of motion exercises and regular aerobic activity), the group that combined strength training and aerobic activity had greater improvements in muscle strength, disease activity, and physical functioning, as well as significant improvements in bone mineral density measurements.

Benefits of regular exercise for patients with RA

  • Improved muscle strength and function
  • Improved joint stability
  • Increased endurance
  • Improved physical function and performance
  • Improved pain control
  • Increased quality of life
  • Improved bone health

Regular aerobic exercise (such as walking, swimming, supervised aerobic exercise classes, and cycling) has been shown to improve muscle function, the stability of joints, endurance, and physical functioning and performance. Additionally, aerobic exercise can result in improvements in pain control and overall quality of life for patients with RA.2-4 Weight training or resistance training may be particularly important because they have been shown to be useful in preventing bone loss (osteoporosis) which can result from the RA disease process as well as from long-term glucocorticoid (steroid) treatment.1

What are my exercise options?

A wide variety of exercise options are available to you, such as walking, swimming, yoga, weight training, or range of motion activities. But whatever exercise you choose to do, it must be appropriate for your physical abilities and may need to be customized to accommodate your symptoms and limitations. Members of your care team, including your doctor, nurse, physical therapist (PT), or occupational therapist (OT), can help you in designing an exercise program that suits you. They will have invaluable advice about what sorts of exercises will be most helpful to you and what to avoid. They will also instruct you in proper technique to prevent joint damage.

Three types of exercise you should incorporate into your workout

There are three basic types of exercise: exercises for strength, endurance (aerobic), and range of motion (flexibility). Ideally, you should combine all three to get the full benefit of a total workout.

Three basic types exercises you need

Type Examples Strength

  • Weight training
  • Yoga
  • Resistance training

Endurance (aerobic)

  • Running
  • Swimming
  • Cycling
  • Walking

Range of motion

  • Yoga
  • Stretching (passive and active)
  • Pilates

You’ll find that certain activities are sources for some or all of the three types of exercise you need. For instance, yoga and Tai Chi can be used to increase or maintain both strength and range of motion. Some water aerobics programs are designed to provide aerobic exercise and increase and maintain strength.

Isotonic versus isometric strength exercises

There are two forms of exercises for building strength, isotonic and isometric exercises. Isotonic exercises are those where your muscles are working against resistance, such as that supplied by gravity, water, weights, rubber bands, or your own body weight.

In isometric exercise, muscles are contracted and relaxed without movement of the joints. An example is when you place your palms together in front of you (in a prayer position) and push them together. Isometric exercises are very useful for RA patients who are limited by disability and pain.

Your PT will help you develop a program of isometric and/or isotonic strength exercises that are appropriate to your needs and abilities.

Exercise options abound

The list of activities that you can engage in to get the exercise you need is almost limitless. From swimming and jogging to yoga and walking, there is a form of exercise for most everyone. You can even get the exercise you need if you hate the idea of exercise. Try dancing or virtual sports with one of the many gaming sports or fitness programs. Different types of exercise can even be incorporated into your daily routine and be done while sitting at a table or desk, standing at the kitchen sink, sitting in a favorite chair, lying in bed, or taking a bath.

Whatever activity you choose to engage in, it is important to find the right balance for you. Always keep in mind your goals for exercise. You are trying to improve or maintain strength and endurance without causing damage to your joints. It is important to stretch ligaments and tendons and put your joints through their natural range of motion, but without causing pain.

Exercise options for patients with RA

Option Benefits Aerobic exercises

  • Aerobic exercise is any exercise that increases the heart rate and breathing above normal resting levels
  • Aerobic exercise options include brisk walking, swimming, running, dancing, bicycling (stationary, trail, or road), elliptical training, stair climbing, and instructor-led movement classes
  • Work with your doctor or physical therapist to make sure that you engage in these activities in a way that limits stress on your joints and is adapted to your limitations

Swimming or water exercise

  • Water provides buoyancy that makes movements easier and places less strain on joints, muscles, and tendons
  • Natural resistance provided by water provides benefits in terms of building strength and stamina
  • Individuals with significant disability and limited mobility can perform exercises they are not able to do out of the pool

Yoga

  • Provides benefits in terms of range of motion and strength training
  • Postures and breathing exercises developed over centuries to alternately stimulate, stretch, and tone the body and provide relaxation
  • Can be adapted for individuals with a range of disabilities

Martial arts

  • A variety of martial arts are available, including Tai Chi, Kung Fu, karate, and Qi Gong
  • Each of these disciplines are useful in building strength and maintain range of motion and flexibility

Pilates

  • Exercise system that provides many of the same benefits as yoga
  • Involves controlled movements (with emphasis on breathing and precise flow of movement) that promotes both flexibility (range of motion) and strength

Swiss ball

  • Your physical therapist can design a program of exercise using a Swiss ball (large inflatable ball) to improve coordination, balance, and strength

Weight training

  • Free weights, weight machines, or resistance machines provide a source of strength and endurance exercise
  • Workouts can be adapted to individual patient limitations in terms of disability
  • Weight and resistance training provides benefits for maintaining bone health

Team and individual sports

  • A variety of team and individual sports are available, including golf, volley ball, boating, hiking, tennis, and basketball
  • These activities provide both exercise and social interaction and support (team activities)

Dance

  • Dance is an activity that can be a great source of exercise
  • Can provide aerobic exercise, with added benefit of providing social interaction and enjoyment of music

You should consult with your doctor before starting an exercise program

Before you start exercising, it is important to talk to your doctor first. Ask your doctor whether it is safe to engage in certain activities when you are experiencing an RA flare. Ask what alterations you can make to activities to protect your joints from further damage.

How long and how often should I exercise?

The answer to this question will depend on your health, abilities, and limitations. Work with your doctor, nurse, PT, or OT to determine exactly how long and how often you should exercise.

Vigorous exercise is important for cardiovascular health. So, if you are able, you should select an endurance (aerobic) exercise that you can engage in for at least 10 minutes consecutively. If you find that your endurance is lacking, start at less than 10 minutes and work up to it slowly over time. A good sign that your endurance exercise is vigorous enough is if you feel an increase in your heart rate and breathing, but that you can still carry on a conversation. Determining your target heart rate is also a way to make sure that you are working hard enough, but not overdoing it.

Always warm up before you engage in endurance or strength training. As a rule of thumb, you should spend at least 10 minutes warming up with gentle stretches. Work slowly and gradually during your warm-up: don’t overdo it. If possible, you should engage in endurance exercises 3 days a week. You can do your endurance workout every other day for at least 10 minutes, with the goal of working up to 30 minutes. Remember to cool down at the end of each endurance session. For example, walk slowly until your heart rate and breathing have returned to the normal range.

Combine endurance with strength training and range of motion exercises, including stretching. Maintaining range of motion is especially important for patients with RA so incorporate stretching into every day. Be sure to stretch a little before your endurance exercise and as you cool down. Try doing your strength training every other day, on the days you don’t do endurance training. Make sure to leave one day a week free for recovery.

Are there exercise options for me if I have limited mobility or can’t get out to the gym?

There are a number of exercise options for individuals with RA who are not mobile, who have certain disabilities, or who just can’t get to the gym.

If you struggle with significant joint disability, water-based exercises are a good option, even better when you have access to a pool and organized classes led by an instructor who understands the needs of people with RA.

Other options include exercises that you can do in a chair, at your desk, in your bed, or while you are standing. We describe a small sample of these exercises below, but your PT or OT, or your doctor or nurse, will be able to show you many more of these kinds of exercises.

If you put aside a certain amount of time each day, even if you lack mobility, you can still engage in activities that will help you maintain muscle tone and range of motion.

Chair exercises

There are a variety of chair exercises that can be done in an office environment or at home in a rigid chair, including chair marching, chair running, chair dancing, and chair fencing.

For each of these exercises sit straight up in your chair with feet pointed straight ahead and planted firmly on the floor. For chair marching, life your entire foot off the floor, if possible, engaging your hip flexors. For chair running, just pick up the pace a bit. With running, you’ll find that you can’t place your whole foot on the floor with each step. Instead, try to touch the floor with your toes or the ball of your foot.

Now add a little music and your favorite dance step and you have chair dancing. Try the polka or, if you like a little Latin rhythm, salsa or merengue.

Finally, try chair fencing. You’ll extend your right leg forward as far as possible, keeping your foot flat on the floor with toes pointed straight forward. Extend your right arm, as if you are thrusting a sword, while keeping your left arm against your side with your fist drawn up next to your left shoulder. Now switch sides, thrusting with your left arm and extending your left leg and foot, while drawing your right arm and leg back. This activity will work your knees, ankles, shoulders, elbows, possibly wrists, as well as your core muscles.

These are just a few examples of chair-based exercises that can be performed in a seated position. There are others, using stretching bands and free weights. Your PT or OT will be able to suggest more and instruct you in the proper form.

Exercises at the table

A table is the perfect place to get exercise for hands and wrists, the joints of which are often affected by RA.

1. Finger curls. Start with your forearm resting on the surface of the table, palm facing up and fingers extended. Make your fingers curl up into a gentle fist, then gradually uncurl. Repeat this movement slowly and gently 10 times for each hand. (You can do finger curls with both hands at the same time or with each hand separately.)

2. Finger walking. Start with your hands on the surface of the table, palms facing down with fingers stretched out. Keeping your thumbs in place and in contact with the table, walk the fingers of each hand (horizontally) on the surface of the table toward the thumb, then back again where they started. Repeat this 10 times. This activity will help to protect against ulnar shift.

3. Fingertip touches. Start by holding both your hands out in front of you, palms up and fingers outstretched (you can keep your elbows at your sides or lean them comfortably on the surface of the table). Bring the tip of your thumb in contact with each fingertip. Then reach with your thumb to touch the base of each finger. Repeat this pattern 5 times.

4. Wrist circles and lifts. Start by holding both your hands out in front of you, palms down with your fingers formed in a loose fist (you can keep your elbows at your sides or lean them comfortably on the surface of the table). Starting at the wrist, make a slow clockwise circle movement with your hand. Repeat this movement 10 times. Then do the same circle movement, but this time counter-clockwise. Repeat this 10 times. Follow this by gently lifting your wrist toward you, then dropping it back away from you. Repeat this 10 times. You can repeat this exercise, but starting with your palms held upward.

5. Thumb and finger lifts. Start by laying your forearms and hands (fingers extended) on the surface of the table. Press your fingers into the table. Then, lift your thumbs off the surface of the table, hold briefly, and relax. Then lift both index fingers, hold briefly, relax. Continue lifting with each finger while trying to keep the other fingers/thumb pressed into the table. Repeat this exercise 2 times.

6. Tug of war. Start by gripping an envelope or card between your thumb and index finger. With the other hand try to pull the envelope or card free for a count of 3 and resist the pull with your thumb and index finger. Repeat this tug of war using the thumb and each of the other fingers on your hand to resist the pull of your other hand. Then repeat this tug of war, this time reversing the role of your hands.

Elbow exercise

1. Start with the fingertips of each hand touching its corresponding shoulder, elbows facing forward. Gently extend your arms in front of your body at about shoulder height with palms facing upward. Reverse the motion to return your fingertips to each shoulder.

2. Start with the fingertips of each hand touching its corresponding shoulder, elbows to each side. Gently extend your arms to each side of your body at about shoulder height with palms facing upward. Reverse the motion to return your fingertips to each shoulder.

3. As with the exercise above, start with fingertips touching its corresponding shoulder, elbows to each side. Gently extend your arms above your head and reach to the ceiling. Reverse the motion to return your fingertips to each shoulder.

Shoulder stretches

1. Start with your arms hanging loosely by your sides. Slowly raise each shoulder, one at a time or together, toward each corresponding ear. Allow your shoulders to fall gently back to the starting position. Repeat this motion 5 times.

2. Start by placing your hands, palms facing out, at the base of your back near your hips. Gently slide your hands up your back as comfortably as you can go, either both hands together or each hand separately. Then, slide your hand(s) down your back again. Repeat this motion 5 times.

3. Start with your hands above your head, arms extended and palms pressed together. Lower both arms gradually until your elbows touch your torso and palms face upward. Reverse the motion until your palms are once again pressed together about your head.

Exercises for the bed

1. Start by lying flat on your back in the center of the bed with your arms down by your sides, palms facing down. Slowly extend and lift your arms up and over your torso to rest above your head while you breathe in. Slowly reverse the motion as your exhale to your starting position. Repeat this pattern 5 times.

2. Substitute a different exercise for this one which doesn’t put strain on the neck. Patients with RA in their cervical spine must be extra cautious not to injure themselves. The exercise below should be good.

2. Start by laying flat on your back in the center of the bed. Gently lift your right leg and reach behind your thigh, or around your knee. Gently bring your thigh to your chest and lift your head towards your knee while you exhale. Lower your head back to the bed and straighten your leg to the beginning position. Repeat series with the left leg. Continue this set of motions for 3 rounds.

Are there any special concerns that I should have as I start to exercise?

Living with RA, you may have specific concerns regarding exercise, such as whether to engage in activities when joints are swollen, inflamed, or painful. If the cervical spine is affected, you need to be extra cautious when engaging in activities that put strain on the neck. Remember to always practice good joint preservation techniques. Your physical therapist, occupational therapist, and rheumatologist will be able to guide you in safe ways to exercise which are still challenging without causing injury to joints, muscles, tendons, or ligaments. Don’t forget to go slow, warm up before activity, and take time to stretch and cool down afterwards.

Things to keep in mind as you start your exercise program

Start slowly, stay within your ability

  • With any type of exercise or activity, it is important not to overdo it, especially at the start
  • If you feel faint, dizzy, nauseous, or have tightness in your chest, stop and call your doctor immediately

Get some supervision

  • You should start your exercise program under the supervision of a trained health professional, such as a physical therapist
  • By working with an experienced professional, you’ll be able to develop the right kind of program and get valuable advice about how to get the most out of exercise without causing damage to your joints
  • A physical therapist or trainer can help you set goals, such as targets for heart rate and breathing, and monitor you so you don’t overdo it

Warm up before exercise

  • You should warm up for at least 10 minutes before you start your endurance or strength exercise
  • Be careful during your warm up not to over stretch: work carefully and gradually

Make sure to cool down after exercise

  • Make sure to cool down gradually
  • For instance, after running or cycling or brisk walking, you might walk slowly until your heart rate has returned to the normal range

Check with your doctor before attempting any exercises.

Exercise can ease rheumatoid arthritis pain

Rheumatoid arthritis (RA) can cause pain and stiffness that makes moving the last thing you want to do.

But staying active is important. Not only is it beneficial for your general health — it’s also a way to strengthen your joints, improve your range of motion, and give you the opportunity to take part in the activities you enjoy.

For people with RA, it’s best to take a cautious and strategic approach when starting an exercise program. An individualized program — ideally developed with the help of a physical therapist — can help you protect vulnerable joints while strengthening surrounding muscles. A well-rounded exercise program should include each of these elements:

Aerobic conditioning. Exercise that increases your heart rate and breathing rate has many benefits, including lowering your chances of developing conditions such as diabetes, stroke, and heart disease. It’s especially important for people with rheumatoid arthritis because they are more prone to developing heart disease than people without RA. When choosing aerobic activities, people with rheumatoid arthritis should consider low-impact exercises such as swimming, bicycle riding, and walking.

Resistance training. Weak muscles, whether due to inactivity or to the side effects of medications like steroids, can diminish your stamina and leave joints less stable. Isometric exercises — exercises that involve muscle contractions with no movement, such as clasping your hands and pressing your arms together — can be a great way to start resistance training. When pain is under control, free weights or weight machines are good options for building muscle and increasing strength.

Stretching and flexibility exercises. Joints damaged by rheumatoid arthritis don’t move with the same ease or to the same degree (also called range of motion) as healthy joints. That makes activities that lengthen and strengthen the muscles surrounding your joints, such as stretching exercises, tai chi, and yoga, especially important for people with RA.

Balance exercises. Having rheumatoid arthritis can cause problems with gait and balance, leaving you more vulnerable to stumbles and falls. A physical therapist can recommend individualized balance-training exercises. These may include practicing standing on one leg or exercises to strengthen core muscles.

To learn more about exercises to help rheumatoid arthritis and how to take control by protecting your joints, reducing pain, and improving mobility, buy Rheumatoid Arthritis, a Special Health Report from Harvard Medical School.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Exercise and RA

What types of exercise could I try?

There are many activities that are safe and effective for people with RA. Any activity that works your muscles a bit harder or causes you to ‘puff’ a little, without increasing your pain or other symptoms, will be beneficial. Choose activities that you enjoy and are convenient.

Activities that are particularly useful include:

  • Water exercise: Many people with RA prefer exercising in water. The buoyancy of the water takes pressure off painful joints and you may find you can move more freely than you can on land. Warm water can also be soothing for sore muscles and stiff joints. There may be suitable classes at local pools or at hydrotherapy pools (heated to around 34 degrees), usually found at hospitals, community health or rehabilitation centres or physiotherapy clinics. For more information see the Water exercise information sheet. If you are new to exercise or your RA is limiting your ability to exercise, you may find it useful to have one-on-one hydrotherapy sessions with a physiotherapist. Talk to your doctor or contact local hospitals and health centres to find a physiotherapist who offers hydrotherapy sessions. You can also search for an aquatic physiotherapist in your area on the Australian Physiotherapy Association website www.physiotherapy.asn.au.
  • Strength training: Muscle weakness is very common in RA. A combination of pain, fatigue (tiredness) and the disease itself often leads to weakening and wasting of the muscles. This can make it even more tiring to do your normal daily activities. Research has shown that muscle weakness in RA can be prevented and even reversed by strength training. Strength training involves working your muscles a little harder than you do in normal life. You do this by working with hand weights, leg weights, gym machines, resistance bands or even just your own body weight (eg. doing pushups). The key to successful strength training is to:
    • start with supervision from a qualified health or exercise professional who understands RA
    • learn the right way to do the exercises and how much resistance to add to prevent injury
    • keep challenging your muscles by doing different exercises and using more resistance.

Strength training may also improve the strength of your bones and help prevent a condition called osteoporosis. Ask about strength training at your local community health centre, physiotherapy clinic or gym.

What about during a ‘flare’?

During a ‘flare’ it is usually recommended to rest the affected joint(s). You should still gently move the affected joint(s) as far as is comfortable several times a day as this may help prevent stiffness. However you should not apply any force or resistance to the affected area. For example, if your wrist is affected, do not use any weights or resistance bands with that arm. If you are feeling otherwise well, you can still do some gentle exercise for the rest of your body. Talk to your rheumatologist or physiotherapist for more information.

Safety tips

  • Check with your doctor or rheumatologist before starting an exercise program.
  • If possible, see a physiotherapist or exercise physiologist for advice about specific exercises. They can suggest safe exercises tailored to your condition and make sure you are doing your exercises correctly so you don’t cause an injury.
  • Always build up slowly. When you first start, do less than you think you will be able to manage. If you cope well, do a little bit more next time and keep building up gradually.
  • Always start your exercise by doing some gentle movements to prepare your muscles and joints for the activity. This will help prevent pain and injury. You may find it useful to use heat packs or warm showers before activity to loosen up stiff joints and muscles.
  • Never place your joints under excessive pressure or in unsafe positions that can increase your risk of injury. Wherever possible, learn exercises from a qualified health professional and exercise under supervision.

CONTACT YOUR LOCAL ARTHRITIS OFFICE FOR MORE INFORMATION AND SUPPORT SERVICESWebsites: Australian Physiotherapy Association, Exercise and Sports Science Australia

RA and Exercise: Does Exercise Help with Pain and Inflammation?

Jennifer Freeman, MD

Doctor of Medicine (M.D.) in 2008 from UT Health San Antonio, Surgeon at TRACC Dallas

Oct 27, 2018 5 min read

As part of a well-rounded treatment strategy, it is important to include exercise for rheumatoid arthritis (RA). Though it may seem difficult or challenging to exercise, especially when dealing with chronic pain, physical activity is necessary to increase joint function, strengthen muscles, and improve overall health and energy levels.

While exercise is very important in RA treatment regimens, there are a few risks. Be sure to practice safe exercises and combine them with stretching and strength building activities for better physical health.

How Does Exercise Help RA?

RA causes several clinical manifestations which result in decreased or poor mobility, chronic pain, depression and overall lack of energy. Physical exercise is strongly recommended for RA patients to reduce joint pain and prevent these symptoms from impacting their quality of life.

Moderate and regular physical activity helps to keep joints and muscles in motion and build muscle strength. This is important for RA patients who may begin to notice severe decreases in mobility and increases in painful joint stiffness. Physical activity and controlled stretching can also help to increase flexibility which is necessary for those who suffer from RA to be able to continue to perform day-to-day activities.

Additionally, by performing consistent physical activity, cardiovascular strength improves which helps prevent heart disease and other medical complications that relate to RA.

RA patients also tend to suffer from chronic fatigue, depression, and immune system complications that make them more susceptible to infections and illness. Exercise can counter these negative outcomes by improving emotional well-being, increasing energy levels, and boosting immune system function.

Benefits of Exercise for RA

There are some important benefits of developing a consistent and balanced exercise plan for RA. Here are some of the top benefits of exercise for RA:

  • — Fight against fatigue
  • — Improve sleep patterns
  • — Improve energy levels
  • — Increase joint range of motion
  • — Improve joint flexibility
  • — Reduce joint pain
  • — Increase bone and muscle strength
  • — Prevent heart disease and other medical complications
  • — Boost immune system function
  • — Improve emotional and mental well-being
  • — Decrease levels of depression

Just as patients take specialized medications regularly, so too should they exercise regularly to improve health and fight against disease symptoms. They should think of their exercise program as just another medication in their treatment arsenal!

When to Exercise With RA

Forms of physical activity or stretching should be performed daily even if only for 10 minutes. Every little bit helps! The key is to exercise consistently even if it needs to be done at a slower pace, as opposed to exercising vigorously but infrequently (or not at all).

Though you may exercise, go for a walk or stretch daily, it may become difficult to continue during a flare-up. If you have concerns about exercising during a flare-up, speak to your doctor or physical therapist about activity options that are less stressful on joints. It’s important to reduce discomfort during a flare-up, and there may be simpler exercise options that are more suitable for you.

Types of Exercise for RA

Those with RA can still perform regular physical activities and even play certain sports. Depending on the disease stage, many RA patients continue to stick to their regular exercise routines or modify them to protect joints from stress and further damage.

Some common and recommended exercises for RA include (but are not excluded to):

Walking

Walking is good for the body and the mind. It helps increase mobility in muscles and joints without a lot of stressful impact. Walking also helps to improve the cardiovascular system and maintain overall levels of physical health.

There are countless places to walk, and it can be combined with social activity as well. Start out walking slowly and for small amounts of time like 30 minutes. Gradually build your way up to longer and more adventurous walks. Walking for just half an hour each day can make a big difference in relieving joint stiffness and improving mood levels.

Bicycling

Bicycling is an excellent cardiovascular exercise which is critical for RA patients in preventing heart disease. Biking either stationary or on flat roads and pathways is a low-impact activity and easy on the joints.

By performing regular bike exercise, patients can improve their leg muscle strength and decrease morning stiffness. Over time, patients will notice an improvement in joint mobility and overall levels of health.

Swimming

Swimming is a great way to improve joint function. Research has shown that exercising in water, also known as hydrotherapy, is the most effective form of physical activity for RA patients. The buoyancy of the water allows RA patients to do more exercise without causing stress and strain on their joints.

Many patients who do water exercises such as swimming or water aerobics see tremendous improvements in joint pain and stiffness. It is also associated with better emotional happiness and overall wellbeing.

Movement

Movement exercises, like yoga and tai chi, are effective and low-impact forms of stimulating body activity, improving flexibility through stretching and strengthening muscles. RA patients who perform movement exercises benefit from reduced joint pain and stiffness.

Both forms of movement activities are also linked to lower depression and reduced stress levels. These activities include meditation, mindfulness, and deep breathing in addition to physical exercise.

Strength Building

Patients working with a physical therapist may build muscle strength through the use of free weights, resistance bands, and weight machines. By strengthening muscles, it reduces the amount of stress placed on weakened joints as the muscles around them grow stronger and more supportive.

With stronger muscles, daily activities that were once difficult to perform with RA can become easier again. Patients often find their ability to grip and lift items improves because of their increased muscle strength.

Stretches for RA

In addition to building muscle and cardiovascular strength, RA patients should also incorporate stretching into their daily routines. Stretching is necessary for everyone to improve flexibility and range of motion. It is especially important for those who suffer from RA and experience daily morning stiffness.

Here are some of the stretches to perform in the morning and before any physical activity:

  • — Leg and hamstring stretches by reaching to touch your toes with bent knees
  • — Finger and wrist stretches by bending and lifting wrists and curling and flexing fingers
  • — Cross-body arm stretches and reaching overhead to stretch out arms and shoulders
  • — Neck and shoulder stretches through gentle and slow head rotations

By holding stretching positions for 10 to 20 seconds and doing a variety of stretches daily, it will improve flexibility and mobility. Perform a variety of stretches within the first hour of the day as well as before any planned physical activity.

Making Your Exercise Plan

Exercise for RA is critical in the overall treatment plan. However, appropriate types and levels of exercise depend on the disease stage and each patient’s unique case. Talk to your rheumatologist about the recommend types of exercise that will work best for you.

You may also consider working directly with a physical therapist for additional support. Always be sure to protect your health and not push your body too hard. Light, consistent exercise can go a long way towards improving RA symptoms and enhancing mental and emotional well-being.

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