Where do I begin?

Safety Message 

If you are worried about starting a new exercise, then your doctor can give you a check-up to make sure you’ll benefit from more activity and reassure you it is safe to do so. If necessary, your GP can also refer you to see a physiotherapist or other healthcare professional who can advise you about specific exercises. Of course, there may be reasons why exercise needs to be performed in a certain way, closely monitored by a professional. 

• The exercises on this website have been created specifically with people with rheumatoid arthritis in mind allowing for a broad spectrum of abilities. The amount of exercise you can do will depend on your disease activity, severity and duration 
• If you have had joint replacements, it may mean that you need to be gentle in your start to exercises and it is best to seek advice on whether there are specific activities you should avoid 
• For those people where the disease has caused damage to the joints, high-intensity exercise may need to be avoided 
• Some complications such as Cardio-vascular disease may mean that you need to monitor the exercise 
• It is always advisable to start at a low intensity and gradually build up the amount you do. It is good practice to warm up before starting your activity and cool down afterwards with slow range of movement exercise. Suitable footwear, ideally well-fitting trainers with a cushioned sole, which have some flexibility, should be used for any of the exercises involved in weight-bearing 

How do I begin exercising? 

• Talk to a member of your rheumatology team or your GP about what exercise(s) you are considering. Think about a goal that exercise may help you to realistically achieve and reward yourself when you achieve your goal. 
• Pick an activity you can realistically practise regularly, and you enjoy. 
• Plan where, when and how you are going to do your exercise 
• Pace yourself – build up slowly and be realistic about how much you can do. 

• It may help to involve friends and family to encourage you to change your exercise behaviours – they will be able to praise you when you do well and may be able to help if you need support. 
• You may not feel like exercising sometimes, but if you have a friend waiting to exercise with you, this will keep you going. 
• Consider where, when and how you have successfully exercised in the past. Reflecting on this may increase your confidence and help you to plan successful exercise. 

How do I know when I should increase my level of activity? 

After a while, you will become used to the exercises, and it is important that you keep making exercise a bit more difficult in order to continue to improve. 

How do I keep motivated? It’s SMART to set yourself some goals. 

Goal setting 

Specific - Rather than setting yourself the goal to do everyday activities more easily, you need to be specific. Write down particular activities, such as climbing stairs, walking the dog around the block or walking to work. 

Measurable - Will you know when you have achieved your goal? How? 

Achievable - Be careful not to set targets that are too difficult, and that you will not be able to achieve. 

Relevant - Set goals that are applicable to your everyday life. That way, when you achieve them, you will really notice the difference! 

Timed - When you identify a goal, write down a date when you would like to achieve it. 

Continuing with an exercise programme can be difficult whether you have rheumatoid arthritis or not. RA being a fluctuating disease, can make maintaining an exercise routine trick so…. 

• Try not to feel too disappointed or guilty if you are unable to do your exercises as you had planned 
• If you have stopped exercising – just restart your exercise routine as soon as you are able, but remember to build up the exercise intensity gradually again. It’s important to stick to your exercise program as much as you can. You may find it initially difficult to get going, but if you stick with it, you will feel good as you start to succeed at making exercise a regular part of your life. 

• Remember and reflect on your goals – are these still appropriate? 
• Make sure you check your progress – if you achieve a goal this will give you confidence to keep exercising and manage your RA generally, which can be beneficial in itself. 
• Be sure to celebrate achieving a goal. 
• Sometimes it is helpful to record your exercise participation and progress in a diary. 
• It is also helpful to remember how your past successes made you feel. 

• Good health and a sense of well-being are excellent motivators. 

Should I stop exercising when I get a flare-up of my RA? 

The symptoms of rheumatoid arthritis fluctuate, and there will be times when your pain is worse, and it is important that you are able to cope with these situations so that you can continue to exercise. The list below will give you guidance on what to do when this happens. 

1. REST 

This does not mean bed rest, but relative rest (doing less than usual). This may include avoiding lifting heavy shopping or carrying heavy cooking pans. 

2. ICE or HEAT 

If the joint is inflamed, you may find it helpful to use an ice pack for 15 to 20 minutes, several times each day (for example, a packet of frozen peas wrapped in a damp tea towel placed on the inflamed joint). If the joint is stiff and aching, you might prefer to place a hot water bottle on the area for 15 to 20 minutes at a time. Your response to these treatments is very individual so find what works for you. 

3. KEEP THE JOINTS MOVING 

It is important to move your joints to avoid stiffness. Try to do some simple movement exercises, as shown below 

4. RETURN GENTLY BACK TO YOUR EXERCISE PROGRAMME 

Once the symptoms have settled, try to gently begin your exercise programme again. For a few days, make the exercises easier, for example, by doing only a few repetitions for each exercise. 

5. GRADUALLY WORK BACK TO YOUR PREVIOUS EXERCISE LEVEL 

Each day try to do a little more until you are exercising at the same level as you were before the flare. 

Types of Activity 

This will again depend on your present levels of activity 

Try to be as active as you can in your daily life, walk part of the way to the shops, bus stop etc 

Tai Chi, Pilates, Yoga are all gentle aerobic exercises which help with strength, mobility and balance. 

Walking, Jogging, Cycling are good outdoor activities which allow the body to absorb vitamin D, which is essential for Calcium production good for bone health and cardiovascular health.          

Swimming or exercise in water is very popular for people with rheumatoid arthritis, especially if experiencing a flare or pain increase. The buoyancy of the water eases movement and extends soft tissue. Water can act as a resistance, increasing muscle strength. Hydrotherapy pools utilise the feel-good factor of warm water, which has great psychological benefits. However, swollen joints often respond well to a cooler pool. 

If you enjoy exercising in a gym, this can be useful for aerobic fitness, range of movement, strengthening and balance. Many leisure facilities offer classes.  If part of a referral scheme, you may be able to try taster sessions and stick with those you enjoy.  

You can exercise at home, fitting this in at times to suit yourself. 

You can exercise in a sitting position if you find standing difficult or painful some examples of which can be found below. 

Useful resources 

Reducing obesity and improving diet 

www.dh.gov.uk/health/category/policy-areas/public-health/physical-activity-2/ 

UK physical activity guidelines 

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_127931 

Exercise and arthritis 

NRAS Guide to Exercise

References available on request 

Lindsay M. Bearne PhD MSc MCSP Senior Lecturer, Health and Social Care Research Division, King’s College London. 

Sue Gurden MCSP Clinical Specialist Rheumatology Physiotherapist, Aneurin Bevan Health Board 

Victoria Manning PhD, MSc BA Hons, Postdoctoral Research Associate, Imperial College London. 

Original Article: 27/06/2006 

Reviewed: 13/08/14 

Next Review due: 12/08/17