By Erin Buenger, PT, DPT
What is Rheumatoid Arthritis?
Rheumatoid Arthritis (RA) is a chronic, autoimmune disorder in which your body attacks its own soft tissue structures, primarily the synovium or tissue lining of the joints. About 40% of those affected with RA experience symptoms beyond the joints including skin, eyes, lungs, heart, kidneys, salivary glands, nerve tissue, blood vessels and bone marrow. This inflammatory condition causes a painful swelling at the affected sites. Over time, chronic inflammation can cause eventual bone breakdown and visible deformities.
Osteoarthritis (OA), on the other hand, causes a breakdown of cartilage located at the joint interfaces only. It does not affect the organs of the body directly.
Isn’t it best to stop exercising when in pain?
RA symptoms are highly variable with periods of flare-up and remission. When it comes to RA, one of the worst things you can do is to become sedentary. There is a common misconception particularly that during a flare up, cessation of all physical activity is the appropriate prescription.
Exercises for RA should be aimed at decreasing the development of deformities and in hope of preventing joint fusion or joint replacement down the line. Physical activity must be consistent in order to achieve and maintain gains/adaptations. Varying the intensity, time, and type of exercise according to symptoms is the key — not discontinuing physical activity for an extended period. Appropriate exercise levels vary from person to person. Asking for guidance and listening to your body are important. If an exercise causes direct pain, it will have to be modified.
You may want to start first with a physical or occupational therapist consultation prior to a more regular exercise routine, particularly if you are sedentary or have been sedentary for a length of time. He or she can give you modifications for painful activities of daily living, stretches to help keep the joints mobile and start to progress you into regular exercise, as well as offer modalities and manual interventions to help manage the pain.
What are the current recommendations?
According to American College of Sports Medicine, exercise guidelines for RA include:
Regular exercise to improve strength and flexibility. Strengthening the muscles surrounding the joints can help reduce the disability of RA. It can additionally help combat fatigue and depression often associated with RA. Walking, bicycling, swimming are great exercises to start with and easier on your body during a flare period. Classes to consider include Pilates, yoga, tai chi, and gentle strength training.
Does research support physical activity in RA?
According to Mayo Clinic, those affected by RA are more prone to developing heart disease, diabetes and osteopenia/osteoporosis due to decreased physical activity, as well as some medication side effects. According to the British Society for Rheumatology, “sedentary behavior may exacerbate already heightened inflammation in RA and hold relevance for disease related outcomes.”
A review article in 2011 of the “Benefits of Exercise in Rheumatoid Arthritis” found that:
Exercise in general seems to improve overall function in RA without any proven detrimental effects to disease activity. Thus, all RA patients should be encouraged to include some form of aerobic and resistance exercise training as part of their routine care. More research is still required on the optimal dose and types of exercise, especially when combining types, as well as how best to incorporate exercise into the lives of RA patients across the variable course of the disease. (Fenton, et al.)
Always get the green light from your doctor and keep them apprised of any lifestyle changes or change in symptom status. Work with you doctor to determine the best plan for managing your RA over time and get back in the driver’s seat to improve your physical activity status!
Feeling like you can’t implement an exercise program safely, have other injury considerations, or just can’t find the motivation to make a change? Consider a physical therapy evaluation, one of our group fitness classes or one-on-one personal training and/or Pilates at PhysioPartners!
Dr. Erin Buenger is a physical therapist at PhysioPartners. Visit our website to schedule an appointment with Erin.
Benefits of Exercise in Rheumatoid Arthritis – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Summary-of-general-exercise-guidelines-for-RA-This-information-is-derived-from-ACSM_tbl1_50395976 [accessed 9 Mar, 2019]
https://academic.oup.com/rheumatology/article/57/2/213/3192222. (Fenton, et. al)