How to Exercise with Rheumatoid Arthritis - Getting Active Can Reduce Pain

For many rheumatoid-arthritis patients, burning joints can make exercise seem unbearable. But if you know what you’re doing, working out can actually help reduce pain and stiffness. Read on for expert advice on what you should – and shouldn’t – do when you exercise with rheumatoid arthritis…

If you have rheumatoid arthritis (RA), the painful condition in which joints become stiff and swollen, working out may be the last thing on your mind. But getting active isn’t only possible for people with RA, it’s recommended. Exercising safely can reduce pain and stiffness and improve your quality of life.

Unfortunately, only a third of those with arthritis do any exercise at all, according to a 2006 study by the Centers for Disease Control and Prevention (CDC).

That may be understandable, but it’s not advisable, because physical activity produces a variety of benefits.

Aerobic workouts, for example, aren’t only safe for people with RA, but they improve joint function and reduce pain, according to a 2010 review of 14 studies by the University of Grenoble Medical School in France.

But those aren’t the only benefits. Working out lowers blood pressure and increases cardiovascular endurance, says rheumatologist Nathan Wei, M.D., director of the Arthritis Treatment Center in Frederick, Md. It also increases muscle and ligament strength, which helps protect joints, he says.

What’s more, “the chronic inflammation of RA leads to a narrowing of the blood vessels in the heart and increases your risk for heart attack and stroke,” Wei says. “But if you exercise, you’re improving your cardiovascular health.”

Still, exercising with arthritis can pose special problems, especially if you haven’t been active recently. Here are the do’s and don’ts you need to know before starting:

The Do’s
DO let professionals guide you.
Talk with your rheumatologist to find out exactly what you can do. “It may be more than you think,” Wei says.

You can also ask for a referral to a physical therapist who can help you take your workout to a more rigorous level without sacrificing safety.

“Physical therapists are trained to work with people who have medical conditions like RA,” says Maura Daly Iversen, S.D., DPT, chair of the Department of Physical Therapy at Northeastern University in Boston.

Start by telling the physical therapist what medications you’re on and how active your RA is, suggests Iversen.

Some medications work very quickly, while others take longer, Iversen says. “Knowing that can help the physical therapist prescribe the right exercise for you.”

DO start slowly.
You need to increase time and intensity levels gradually, especially if you aren’t used to exercising with arthritis, Wei says.

People with RA who haven’t been working out regularly should begin with five minutes of aerobic (i.e., cardiovascular) exercise at least three days a week, according to recommendations by the American College of Sports Medicine. From there, build to sessions of 30 minutes or more.

The American College of Rheumatology recommends building to 150 minutes of moderate-intensity aerobic exercise per week, but says that individual sessions can be as short as 10 minutes.

DO watch out for pain.
“Pain during or after exercise is a warning signal to stop or slow down,” Wei says. “If you’re flaring, don’t push.”

Of course, some discomfort comes from using muscles you haven’t used in a while. But severe pain isn’t normal, Wei says. “That’s your body’s way of saying back off.”

Pushing through pain can lead to joint or muscle damage, adds Shari Whitley, CEO of Women’s Workout World in Chicago and a certified personal trainer who both has RA and works with clients with the condition.

“Exercise when you’re most rested,” she says. “If you’re tired and fatigued, you’re more likely to get injured.”
DO experiment with different ways of exercising.
You should try to find times and exercise methods that are most comfortable for you, the experts say.

In the morning, stretch gently before you get out of bed, then take a warm shower before you exercise so that the heat can relax your muscles, letting you move more easily, Iversen suggests.

If you suffer from morning stiffness, afternoon may be a better time for you to exercise, says Wei. But if your RA is well controlled, any time of day is fine.

Wei suggests stretching every day for at least 10 minutes, holding stretches 10-15 seconds each. “By stretching out the soft tissue structures around the joints, like the ligaments and muscles, you prevent the joint from freezing in place,” he says.

During a flare-up of chronic inflammation, you can do isometric exercises – those involving the contraction of muscles without moving the joints, Iversen says.

An example: Sit with your legs out in front of you on the floor. Contract the quadricep muscles – the ones on the front of your thighs – so the back of your knee pushes against the floor. Hold that contraction for 6-10 seconds and relax.

“This helps maintain leg strength,” Iversen says.

Also, “do simple things, like raising your arms over your head in smooth fluid movements,” Iversen says. “Do just a few repetitions on each joint.”

Tai chi, a Chinese form of slow, meditative exercise, has also shown beneficial results.

Doing sessions twice a week for 12 weeks reduced pain and improved mood among people with osteoarthritis, according to a 2008 study at the Tufts-New England Medical Center in Boston.

Pilates and yoga are also great choices for exercising with arthritis, because they build strength and increase flexibility through stretching without stressing joints, Wei says.


Wei suggests doing strengthening exercises three times a week, using machines, free weights or resistance bands (strips of latex rubber with handles on each end).

“Some people find resistance bands easier to use,” he says. “They work because you can only pull them so far.”

For example, stand on the center of the band, then take a handle in each hand, curl your forearms up and let them down, and you’re doing bicep curls.

Iversen stresses the importance of getting a physical therapist to show you how to do strengthening exercises properly.

“Some RA patients have joints that aren’t correctly aligned, so you have to be careful not to overstress them,” she says.

The Don’ts
DON’T skip the warm-up.
Start your exercise session by walking around the room at a brisk pace or getting on an exercise bike for 10 minutes, Whitley recommends. This increases blood flow to joints and muscles, reducing risk of injury and the stiffness caused by chronic inflammation.

A 2008 CDC study found that female soccer players who warmed up before games reduced their knee injuries by half.

And female golfers who warmed up were nine times less likely to be injured than those who didn’t, according to a 2007 study at Bloomsburg University in Pennsylvania.

But even if you’re not bending it like David Beckham (British soccer star), warm-ups are still essential to avoid pain.

DON’T do the same exercise every day.
Switch between different kinds of workouts, Wei recommends: Do strength-training three days a week, aerobic exercise on three alternating days, and some stretching every day.

“That way you’re giving your body a chance to recover, so you’re not leaving yourself open to repetitive stress or trauma to the joints,” he says. “But you’re still exercising six days a week.”

DON’T choose a high-impact routine.
“Exercise should be low- or non-impact so that there’s less jarring of the joints,” Wei says.

If you’re not in great shape, your joints are already vulnerable because of weak muscle and ligament support as well as the chronic inflammation from RA.

And joint cells are more sensitive to high-impact shocks if you have RA, according to a 2004 knee study at Indiana-Purdue University in Indianapolis.

Choose walking or swimming over jogging or basketball, Iversen says. “Swimming is wonderful because the [water’s] buoyancy alleviates stress on the joints.”

In swimming programs accredited by the Arthritis Foundation, the water is often warm so you’ll be more comfortable, Iversen notes.

(To see if there’s a program near you, contact your local chapter, or check with the closest YMCA.)

If you use cardio equipment in the gym, an elliptical trainer or stationary bike is easier on the joints than a treadmill, Iversen says.

DON’T buy bargain sneakers.
Those buy-one-get-one-free sneaker deals might tempt your wallet, but they could also do some damage. Good athletic shoes will support your feet and cushion your joints while you work out, Wei says.

“Get the best quality you can afford – quality shoes will absorb the stress on your feet, knees and hips.”

Flat, flexible shoes that allow natural movement – known as “mobility shoes” – are best for arthritic knees, according to a 2010 study at Rush University Medical Center in Chicago.

But while those aren’t yet available to the public, an athletic footwear store should be able to help you find a lightweight pair with plenty of support.

DON’T go it alone.
Expert advice can help you avoid injury as you begin to exercise with arthritis, Wei says.

“You start, hurt yourself, start again, injure yourself, and soon you stop exercising,” he warns.

By employing a certified personal trainer, “you get into shape more quickly and become functional more quickly,” he notes.

The caveat: Work with a physical therapist first, then move to a trainer, Iversen suggests. And look for a trainer who has experience with people who have RA.

“Ask how many people with RA they’ve worked with,” Wei suggests. “And ask for names so you can talk with them.”

To learn more, visit our Rheumatoid Arthritis Health Center.

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