How to Exercise With Rheumatoid Arthritis

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 a range of motion and improve symptoms such as joint pain, says James R. O'Dell, MD, of the University of Nebraska Medical Center in Omaha, where he is a professor, the chief of the rheumatology and immunology division, and vice chairman of the internal medicine department.

People with arthritis who exercise regularly sleep better and have more energy, improved daily function, and less pain, according to the American College of Rheumatology (ACR). While it’s common for people to limit their physical activity because of arthritis symptoms, inactivity is tied to a number of health issues, such as heart disease.

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Start With an RA Exercise Plan

“Patients with RA can and should exercise regularly, period,” says Elaine Husni, MD, MPH, the vice chair of rheumatology and the director of the arthritis and musculoskeletal center at Cleveland Clinic in Ohio and an assistant professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. “There may be modifications needed to try different modalities, depending on your level of fitness and ability." Think about water-based exercises to start, then move up to more traditional land-based exercises, or start with chair yoga instead of classic yoga classes.

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

To avoid pain and stay motivated, the Arthritis Foundation recommends starting slowly, depending on your physical activity level, and building from there.

The goal is to keep moving at your fitness level 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.”

Find a Physical Therapist

It’s important to incorporate exercise into your routine as soon as you’re diagnosed with RA. The best strategy is to consult a physical therapist specifically trained in inflammatory conditions; you’ll benefit from working with an expert who’s familiar with your RA needs.

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

What to Include in Your RA Exercise Plan

The Centers for Disease Control and Prevention (CDC) 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
• Strength training with weights or other resistance exercises at least two days a week
• Balance exercises, which are often forgotten, including mind-body activities, such as yoga and tai chi, and walking backward.

The benefits of exercise for people with RA are not only physical but also emotional. Exercise can boost your mood, lower your anxiety, and promote relaxation. And because depression can be linked to arthritis, exercise should be an important part of your treatment plan, according to the Johns Hopkins Arthritis Center.

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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, according to the American College of Sports Medicine.

Try making these simple adjustments:

1. Choose low-impact exercises that don’t stress the joints, such as walking, biking, or swimming.
2. Condition muscles properly before you challenge yourself in your workouts.
3. Don’t overdo it. Work out for a shorter time and at a lesser intensity when you’re having a flare-up or experiencing pain and swelling, says the Arthritis Foundation.
4. Create a routine that combines aerobic activity and resistance exercises that build muscle; rheumatoid arthritis accelerates the loss of muscle mass that happens as we age, notes the Mayo Clinic.
5. Warm up properly before you exercise.
6. Cool down afterward.
7. Add flexibility exercises to your routine to increase range of motion.
8. Wear good athletic shoes that offer shock absorption and support your feet, advises the Arthritis Foundation.
9. Try water exercise. Water helps support your weight, reducing stress on your joints, while also providing natural resistance, notes the Arthritis Foundation. If you’re having a flare or your RA is severe, consider walking in a pool.

Make It Fun and Engaging to Stay Motivated

Beyond finding the time and committing to exercise, it’s also important to find activities you enjoy, so you’ll be motivated to do them regularly. While your mobility may be more limited than before you had RA, you can still find fun ways to stay active. Consider walking in nature, trying a swim class, or taking a sturdy bike for a spin on a nice day.

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

Additional reporting by Erica Patino.