The importance of exercise

A discussion with Prof. George Metsios

Watch our very popular Rheum Zoom from May 2021 including Q&A session and short Exercise video with Ayesha Ahmad on resistance training.

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Why should I exercise? 

Physical activity and exercise are good for people with all forms of arthritis as it can help to ease some of the symptoms and improve general health. There is quite a lot of evidence now that exercise can improve muscle strength, function and the ability to do everyday things as well as reduce the risk of cardiovascular disease. 

Diagram produced on behalf of people with arthritis. Reproduced with permission; Sue Gurden, Aneurin Bevan Health Board 

New technologies in modern society have led to more sedentary occupations and lifestyles. Unfortunately, many people with inflammatory or rheumatoid arthritis, like the general population, aren’t active enough. People with rheumatoid arthritis might be worried that exercise will make RA and its symptoms, such as pain, worse. This is not the case, and studies evaluating exercise programmes have shown that exercise does not make your arthritis worse. Clinical guidelines recommend that people with rheumatoid arthritis “should [exercise to] improve general fitness and be encouraged to complete regular exercise including exercises for enhancing joint flexibility, muscle strength and managing other functional problems.”  

Who can help me to become and stay more active and to exercise? 

Healthcare professionals can support people to lead healthier lives. This includes becoming and staying physically active. It is important that you talk to your health professional about activity and exercise. This could be your General Practitioner (GP), specialist nurse practitioner, rheumatologist, physiotherapist or occupational therapist. It is advisable to speak to a healthcare professional before embarking upon specific exercise activities. If you are new to exercise, your practitioner might be able to refer you to a specially trained fitness professional (national exercise referral scheme) to help you gain confidence and establish a routine. 

How much and what types of exercise should I do? 

Guidelines from the Department of Health suggest that adults in the general population should aim to be active daily. Over a week, physical activity and exercise should add up to at least 150 minutes (2½ hours) of moderate-intensity activity in bouts of 10 minutes or more. 

Many people with Inflammatory arthritis also suffer from symptoms of fatigue. Bearing this in mind, it may be necessary to pace your exercise into shorter time frames repeated several times a day. Small amounts of exercise, even if insufficient, to meet the guidelines, have been shown to be beneficial to health. 

If you are new to exercise, it is important that you start slowly in order to train your system to cope. Try to get plenty of sleep in order to cope with daily activities. You should expect to experience some muscle soreness when you start new exercise regimes; this is quite normal and is a sign that your muscles are adapting to the new activity. This usually appears one or two days following activity and can last for a few days, it may disappear whilst you exercise and then return in the same way. The effect of this lessens over time as your muscles become used to the activity. You will soon learn the difference between muscle soreness and pain as a result of your arthritis. Remember, your condition can also fluctuate, and you may need to adapt your activity accordingly. Exercise to your maximum, whatever that may be, and you will soon find that you are capable of more.   

It is recommended that all adults should also undertake exercises to improve muscle strength on at least two days a week. Any adults who may be at risk of falling should also incorporate physical activities or exercises to improve balance and coordination on at least two days a week. All adults should minimise the amount of time spent being sedentary for extended periods. In addition, people with arthritis may need to do exercises to maintain and increase the movement in their joints. 

In addition, people with arthritis may need to do exercises to maintain and increase the movement in their joints. This may sound pretty daunting to someone with rheumatoid arthritis. This is why we have created this exercise section on the NRAS website so that we can give you the facts about RA and exercise, dispel myths and give you choices about how to become more active and build in exercises into your life that will suit your lifestyle. 

There are different types of exercises: 

• Stretching exercises aim to maintain or increase your joint movement by maintaining or lengthening the tissues around the joints. 

• Strengthening exercises aim to increase your strength, endurance and power. You may need to complete these exercises against some resistance, such as gravity or a weight. 
• Aerobic exercises aim to improve your overall physical fitness and endurance and include brisk walking, gym-based exercise programmes or exercising in water. 
• Balance exercises challenge postural stability and balance to reduce the risk of falling. 

Will I harm my joints by doing too much exercise? 

There is no evidence to suggest that regular, even intensive exercise will harm your joints. It is normal for anyone who is not used to exercising to experience some muscle soreness after doing a new exercise, but, over time, as you get used to exercising this will reduce. 

Activity levels

If you have previously been active, it is important to try to maintain your levels of activity. The type of activity may need to be modified; for example, contact sport may not be appropriate. Remember, “no pain, no gain” is a myth.  Learn to interpret your pain and act accordingly. 

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. 

Under review: March 2023