Innovation in exercise - a programme for you?

By Claire Jeffries, Physiotherapy Manager and Clinical Specialist in Hydrotherapy and Rheumatology, Solent NHS Trust

Taken from NRAS magazine, Autumn 2011

For many years it has been well recognised that exercise plays an important role in the lives of people with Rheumatoid Arthritis (RA). Understanding the reasons why to exercise and what types of exercise you can do when you have RA can prove to be an important milestone for those with the condition. Traditionally in most cases prescription of exercise has been based on simple gentle range of motion movements to keep sufferers joints moving with the addition on occasion of some low grade specific strengthening exercises. In some cases this prescription of exercise is still highly appropriate depending on the state of a person’s disease. Similarly though we also now know that people with RA can tolerate higher levels of exercise without making the progression of their disease worse.

Exercise can improve any persons sense of well being and mood, decrease stress levels and provide the body with it's own natural painkillers - all of these are effects that can also be felt by people with RA despite their disease. The use of exercise is essential in many physical ways specifically for RA sufferers including improving and maintaining range of movement of the joints, muscle power and balance amongst a few. All of these elements enable a person with RA to remain independent and continue with normal activities of daily living - to dress, to work, to cook, to drive, to continue family activities and have fun.

Cardiovascular fitness (ie: maintaining healthy and good functioning heart and lungs) is essential for everybody. Cardiovascular fitness helps to reduce our chances of suffering from a stroke or a heart attack. Recent research has shown us that it is even more important for specific groups of people including those with RA to maintain good cardiovascular fitness.

Some benefits of exercise

General RA specific 

Reduce blood pressure

Reduce cholesterol

Reduce diabetes     

Improve cardiovascular fitness

Reduce stress

Increase well being

Release of body's natural painkillers

Improve / maintain joint range of movement

Improve / maintain muscle power

Improve balance

Improve / maintain walking ability

Maintain independent function

Maintain / improve flexibility


To gain and maintain the benefits of exercise, continued and sustained exercise long term is key. Unfortunately however it is often seen that people stop exercising for many reasons, and this is seen similarly in people with RA. On that basis it is important that exercise prescription is varied, achievable and fun for all.

The 10 out of 10 programme - a good place to start

Working in partnership, Portsmouth Hospitals Trust Rheumatology Department and Solent NHS Trust Rheumatology Physiotherapy services have developed a new way of introducing exercise to RA sufferers. Aiming to address RA patients'need to improve cardiovascular fitness, improve muscle power, improve function and balance, the programme caters for those who are new to exercise and also those who already exercise but want to try something new. The main drive behind the programme is to give RA patients the confidence to try exercise classes and subsequently the confidence to continue exercising in the community long term.

Running over 10 weeks, the 10 out of 10 programme allows patients to experience a different form of exercise each week. All of the exercise forms are purposely structured around "mainstream / normal" classes that you can find at local activity centers and gyms. Each class is led by a fully qualified instructor for the specific exercise form and the rheumatology and physiotherapy team attend the classes to support the participants.

In week one of the programme participants are given a brief educational session addressing the need for exercise, its benefits and safety. A practical session working on postural control and positioning is combined with instruction on how to get on and off of the floor safely in preparation for some of the classes. Participants then complete their first exercise form of relaxation and meditation. Subsequent weekly exercise forms include chair based exercise, Pilates, tai chi, yoga, water exercise, modified circuits, healthy walking, body balance, and wii fit. To accompany the exercise tuition all participants are given an exercise booklet containing information on the basic principles of the exercise and also it benefits specifically for RA sufferers.

The first 10 out of 10 programme ran in Portsmouth in early 2011 with 13 participants successfully completing the programme. Formal evaluation of the participants attitudes towards exercise following the programme are still to be made but participant feedback on the programme has been extremely positive. One attendee feedback “I find it hard to believe that I would ever be in a position to want to thank somebody for putting me through what I thought at the start would increase my pain and fatigue, however the programme has been exceptional”. Similar thoughts were echoed by another participant who stated “I never thought I would have been able to do a circuit based exercise or work in a normal pool”.

The next phase of the programme is currently underway with a second pilot programme being run in Portsmouth. This program has allowed for minor changes to be made to the assessment process and one of the exercise forms. The long term plan for the project is the production of a master “set up pack” that can be accessed and utilized by rheumatology departments across the country, thus making the 10 out of 10 programme available to all sufferers of RA.