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Exercise for rheumatoid arthritis

Exercise is important because it helps reduce the risk of further joint damage. It also helps by reducing pain and the risk of heart disease and by improving muscle strength and mental wellbeing. There are exercises for people at all stages of their RA journey.  

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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. Many of these exercises can be done without the need for exercise equipment or gym membership.

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/ workout routine. 

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 exercises 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 high intensity 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, is also important.  

Types of 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 aerobic exercise, 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, such as strength training, which put greater strain on the joints. Don’t forget that it may also be beneficial to use cold therapy to reduce joint pain and swelling during a flare. Once the flare subsides, then you can gradually return to an increased level of exercise. 

Updated: 17/03/2017

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