Exercise and Rheumatoid Arthritis

There is a lot of evidence now showing that physical activity is safe and has many benefits for people with RA. We know now that physical activity improves RA symptoms and lowers the risk for developing heart disease.

So, for people with RA physical activity is important in managing their condition and maintaining a healthy lifestyle. Engaging in physical activity (such as walking or swimming) and/or regular movement exercises that can improve your range of motion can enhance your ability to manage day-to-day life. There are many places where you can find information on how to be active. A good place to start is the NRAS website: www.nras.org.uk/exercise.

There are some main factors to take into account before you exercise:

1. Everyone is different: What may work for one person may not suit you. If in doubt, it is advisable to ask your GP or ask to be referred to a physical activity professional or a physiotherapist who will be able to guide you. Some gyms have instructors who have training on how to help people with RA and other long term conditions to create an effective exercise programme.

2. Low impact first: Low impact activities are best to start with as they help you engage with physical activity without strain on your joints, ligaments and muscles. Swimming, walking and cycling come into this category. Tai Chi (a Chinese martial art, characterized by methodically slow circular/ stretching movements and positions of body balance) is also a popular low impact exercise for people with RA. Starting with low impact activities for a few months can prepare your body to take up more intense exercise (such as brisk walking and cycling and resistance training), if you wish to do that.

3. Start low and build up: With any activity it is always advisable to start at a low intensity and gradually build up the amount you do. After all, you wouldn’t start training for a marathon by doing a 20 mile run! The same principle applies whether you are considering starting a walking programme or learning to play badminton.

4. Choose appropriate types of physical activity: Activities such as walking, cycling and swimming are important to reduce your fatigue, improve your overall fitness and the way your heart works. Resistance training is also safe for RA and can improve your ability to do daily tasks and your overall functional abilities. Always remember that all these activities need to start at low intensities and progressively build up.

5. Preparation is key: Make sure you warm up before starting your exercise session. This should be a gentle aerobic warm-up, such as walking on the spot OR walking OR light cycling for 3-5 minutes. The NHS have some good general information on warm-up exercises here. Well fitting, shock absorbing footwear, suitable for the activity, are also important. 

Types of Physical Activity

Swimming is an excellent form of physical activity as it causes very little strain on joints while allowing you to exercise to your full potential. It involves most muscles and joints and is a good all-round workout. Some people may prefer the warmer water in a hydrotherapy pool, although availability of these pools varies across the UK. 

If you are usually mobile and in otherwise good health then it may be that you will be able to cope with something more demanding. Activities such as a walking programme, aqua aerobics, badminton, cycling or whatever physical activity you did prior to your RA diagnosis may be suitable.

Don’t underestimate the importance of doing an activity you enjoy, as you are much more likely to continue doing it! Also, exercising with someone else (a family member or friend) can be more enjoyable and help with motivation.

If after starting a new activity you find that at first it seems to make you worse, there are changes to your exercises that you can try. It is probably worth reducing how often you do the activity and the amount you do to see if this helps, then gradually building up the time or intensity.

If you have excessive joint damage, supervision by either a physiotherapist or an exercise professional, with relevant experience, is required before starting a new exercise regime. Progression of the intensity should always be slower than normal and always based on your feedback to the person supervising.

Finally, if you are in a flare up (where a joint/joints are particularly swollen and tender) it is best to focus on letting the joints settle down and doing 'range of movement' exercises rather than other exercise activities. Don't forget that it may also be beneficial to use cold therapy to reduce pain and swelling in a flared joint. Once the flare subsides then you can gradually return to an increased level of exercise.

References available on request

Written: 17/03/2017