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Rheumatoid Arthritis and Exercise

By Dr Ananya Mandal, MD

Rheumatoid Arthritis (RA) involves more than one joint and is a systemic illness affecting the immune system. Studies have shown that regular exercise and physical activity can prolong and make lives healthier and happier among persons with RA.

RA, however, is one of the most important conditions that limits movement and causes debility over time. It has been seen that those who are inactive and have low levels of physical activity tend to worsen faster, develop decreased pain tolerance, weak muscles, stiff joints and poor balance than those who are physically active. Exercise thus forms an important part of management of RA.

Key points

  • Physical activity in RA refers to daily tasks that include occupational as well as recreational tasks that are usually affected by the RA.
  • Persons with RA who exercise regularly have better pain tolerance, optimal joint flexibility and movement for longer periods, more energy, improved sleep, better perception of the disease, stronger muscles, less stiffness, better balance and better day-to-day functioning
  • Exercises recommended for RA patients need to be begun slowly and performed at low intensity to ensure a safe, long term and successful exercise program

Safe exercises for RA

Exercises are usually undertaken on three levels:-

  • Therapeutic or rehabilitative
  • Leisure or recreational
  • Competitive

Ideally there needs to be a balance between these levels. The prescribed or therapeutic exercises are usually targeted towards mobility and functioning of specific joints or body parts that are affected by RA or by a surgery performed to correct joint stiffness or pain. This is the first step for inactive and less physically active sufferers, those with restricted joint motion, decreased muscle power and those recovering from surgery for RA.

After the initial phase recreational activities like walking, running, skiing and swimming may be undertaken. These may be performed in a controlled and safe manner to minimize the risk of injuries.

The third level is competitive exercises that require greater skill and training and are performed for longer durations. These are suitable for early RA patients but are unsuited for advanced cases.

Four major types of exercises

The four major types of exercises include:-

Flexibility exercises

These, as their name suggests, help in improving movement and range of motion of a joint. These allow for better posture and balance as well. These may be prescribed 5-10 times on a daily basis. These exercises help reduce joint stiffness on the next morning. It is recommended that stretching exercises be done at least 3 days a week with each stretch being held for about 30 seconds.

Strengthening exercises

These are more intense exercises. These come in after the muscles are strengthened with flexibility exercises. Stronger muscles improve movement and prevent bone loss. These are usually a set of 8-10 exercises for the major muscle groups of the body 2-3 times a week. There should be 8-12 repetitions of each exercise. The resistance or weight has to be of enough intensity to work the muscles without increasing joint pain.

Aerobic exercises

These are mainly cardiorespiratory workouts that use the large muscles of the body in a repetitive and rhythmic manner. These muscles increase heart and lung reserves. These can reduce weight; improve sleep and mood as well as general health. Recommended safe forms include walking, aerobic dance, aquatic exercise, bicycling or stationary bikes, treadmills or elliptical trainers. Current recommendations for aerobic activity are to do 150 minutes of moderate intensity exercise a week spread out over the week.

Body awareness exercises

These include exercises like Tai chi and yoga. They form an important part of management of RA these days with mental as well as physical benefits.

Reviewed by , BA Hons (Cantab)

Further Reading

Last Updated: Mar 13, 2013

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