Rheumatoid Arthritis and Exercise: Staying Fit and Flexible

If you have rheumatoid arthritis, you may not feel like exercising — RA pain and fatigue can be powerful deterrents to physical activity. But exercise is a critical part of a comprehensive rheumatoid arthritis treatment plan, says Dr. Tina Chadha Bunch, a rheumatologist with Coordinated Health in Bethlehem, Penn. "Having RA does not preclude exercise, and in fact, we recommend that RA patients continue to exercise and lead active lifestyles for optimal cardiovascular and musculoskeletal health," she says.

Studies have shown that exercise helps people with RA maintain muscle tone, flexibility, and joint mobility. It also improves sleep and mood and lessens stress — all of which can help reduce painful RA symptoms. And physical activity can lead to weight loss, which is especially important because extra pounds increase pressure on joints, particularly in the hips, knees, and ankles.

The goal of exercise for someone with rheumatoid arthritis is to:

• Maintain a wide range of motion
• Increase strength, endurance, and mobility
• Improve general health
• Promote well-being

Before beginning an exercise program, talk with your doctor about any limitations. Easy range-of-motion exercises and other low-impact activities, such as swimming or cycling, are often recommended for RA patients. Yet, whatever activity you choose, experts suggest that you progress slowly and avoid movements that involve high impact to the joints.

The best types of exercise for rheumatoid arthritis include:

• Stretching or flexibility exercises to help maintain joint mobility and range of motion
• Strengthening exercises to develop and maintain muscle tone, endurance, and strength
• Aerobic exercise to improve cardiovascular fitness and help maintain a healthy body weight

Getting Started: Make Exercise a Part of Your Lifestyle
Especially if you're not already physically active, starting an exercise regimen can be daunting. "The idea that, 'Oh, I've got to get out here and go 30 minutes straight,' or, 'I have to put on my spandex and go to a gym,' becomes overwhelming," says Leigh Callahan, PhD, an arthritis researcher and associate professor at the University of North Carolina, Chapel Hill.

Start slowly and choose exercises or activities that are enjoyable and comfortable and can easily become part of your daily routine. "If you don't have a lot of disease activity in your feet, walking is a wonderful thing because all you need is a good, sturdy pair of walking shoes and socks, and out the door you can go," says Dr. Callahan, who recommends stretching before and after you walk.

It's also important to maintain a balance between rest (which will reduce inflammation) and exercise (which will relieve stiffness and weakness). If your joints become painful, red, or swollen, reduce your activity and work with your doctor or physical therapist to modify your program.

Here are some more tips for starting an exercise program for rheumatoid arthritis:

• Start with the easiest exercises, stretching and tensing of the joints without movement.
• Do some mild strength training. One study found that people with RA who exercised with machines that use compressed air for gentle resistance experienced less pain and increased muscle tone.
• Try aerobic exercises, such as walking, dancing, or swimming, particularly in heated pools. Avoid heavy impact exercises such as running, downhill skiing, and jumping.
• Take up tai chi. This is an excellent method for combining stretching and range-of-motion exercises with relaxation techniques. It is particularly value for elderly RA patients, who report significantly less pain after practicing this technique.
• Add intensity. While traditional guidelines have restricted RA patients to gentle exercise, recent research suggests that more intense exercise may not only be safe, but may actually produce greater muscle strength and overall functioning.
• Use common sense. If exercise is causing sharp pain, stop immediately. If lesser aches and pains continue for more than two hours after your exercise routine, try a lighter exercise program for a while.