8 Steps to Staying Active With Rheumatoid Arthritis Don’t Let RA Symptoms Crush Your Competitive Spirit

You’ve always been an athlete with a yen to be outdoors, compete and play team sports. But now your rheumatoid arthritis (RA) symptoms have you riding the bench. Are your playing days over? Don’t pack up your favorite shorts and sneakers just yet, experts say. With your doctor’s help and these suggestions, you can continue to play... Living with rheumatoid arthritis (RA) doesn’t mean you have to sit on the sidelines. If your RA is well controlled, your inner athlete can stay active as long as you take some smart, safe steps in advance. “In general, patients with RA can engage in any reasonable activity,” says sports medicine and orthopedic expert Mark Galland, M.D., a managing partner of Orthopaedic Specialists of North Carolina in Raleigh, N.C., who frequently works with patients with rheumatoid arthritis. “Certain sports are more joint-preserving than others: Low-impact activities like swimming, walking, biking are best,” he says. “And any sport should only be undertaken after a good development of core strength, flexibility and strengthening.” In fact, sports may do your body good. “You’ll be moving your joints, so they’re less likely to stiffen and cause pain,” says Stephen Soloway, M.D., a rheumatologist at Arthritis and Rheumatology Associates in Vineland, N.J. Athletics are also mentally rewarding, especially if you join a team, says Galland. As you gain physical skills and work toward a goal, you improve your mental focus and outlook, and feel better about yourself. So don’t let RA slow you down. Follow these simple steps to unlock your inner jock: 1. Discuss goals with your doctor. Let your physician know what you hope to accomplish and how you plan to get there. Then the doctor can advise you on what’s realistic, given your joints’ condition and level of fitness. “Individuals vary greatly,” says Galland. So do their doctors’ opinions of what’s acceptable. For example, one physician may advise against running, but will allow it under special circumstances. That’s what happened to Esther Wei, an avid runner and 56-year-old nurse practitioner in New York, who was diagnosed with rheumatoid arthritis in her early 30s. “I have a stressful job,” she says. “I run, and it helps me deal with RA better.” So she and her doctor devised a plan so she wouldn’t have to give up her passion. 2. Choose your sports wisely. Running, volleyball, basketball, softball and soccer aren’t the best choices for people with rheumatoid arthritis, because they can diminish cartilage’s life span, says Galland. “Cartilage in RA patients will degrade and can be further exacerbated by weight-bearing.” “If you have any joint damage, it’s very important your sport be low-impact,” agrees rheumatologist Patience White, M.D., MA, a professor of Medicine and Pediatrics at George Washington School of Medicine and vice president of Public Health for the Arthritis Foundation. “Jumping and running marathons aren't good ideas,” she says. Tennis is tough as well because of the sport’s abrupt starts and stops. So what are wise workout choices? Walking, biking, swimming and yoga. “The key thing for all athletes is to be in tune with your body,” Soloway says. For example, if a triathlon is your dream, you can do the swimming and biking segments, and let a fellow teammate take on the running, suggests Galland. Or if tennis is your game, play doubles instead of singles, so there’s less movement throughout the court. Or play 9 holes of golf instead of 18. For more ideas, check out the Arthritis Foundation, which offers a personal movement tracker, calendar of local walking events, tips for staying active, and stories from other outdoorsy types with rheumatoid arthritis. 3. Gear up. Upgrade your footwear. Buy sneakers in a specialty store or from a podiatrist, so you can be fitted for supportive shoes or special supportive inserts called orthotics, suggests White. You can also ask your doctor about short-term use of braces, sleeves and tape to support joints. If you play a sport involving hands or feet, like golf, you can buy gel inserts that slip into gloves or shoes and warm the muscles, making it more comfortable to play, says Soloway. 4. Start slowly. Don’t try to do too much, too soon. “Some of my patients start by walking to the mailbox, and that’s a huge victory,” Galland says. “The challenge is to get your strength, range of motion, and aerobic capacity back to a level that will make it fun to play sports with others,” White says. For example, if your goal is to play golf, start by joining a walking team, and see how far you can go. “Then you can understand the gap you face before you play your sport,” White adds. 5. Consult a physical therapist. Your doctor may also recommend you work with a physical therapist to evaluate your fitness level and plan a safe and slowly escalating exercise program. “A physical therapist can teach a woman with rheumatoid arthritis how to incorporate strengthening and stretching exercises before, during and after the sport,” says Doreen Stiskal, Ph.D., a physical therapist at Seton Hall University’s School of Health and Medical Sciences in South Orange, N.J. They often recommend isometrics for someone with RA because the exercises, in which a person pushes against a fixed object, are a form of strength-training that’s easy on joints, she says. 6. Take up yoga. Strengthening your core, the band of muscles around your middle, is key to proper conditioning, says Galland. “Everything else in sports emanates from core flexibility and strengthening. And the best programs for that are yoga, Pilates, and tai chi.” Taking a yoga class twice a week is a great way to start conditioning for sports, although it’s safe enough to do every day. “You get more bang for your buck with yoga than going to a gym and lifting dumbbells with a personal trainer,” White adds. “It’s gentle on joints, and increases strength, balance and flexibility.” 7. Adapt to your RA. Women with rheumatoid arthritis can feel more sluggish than their teammates, says Stiskal, Ph.D., a physical therapist at Seton Hall University’s School of Health and Medical Sciences in South Orange, New Jersey. Fatigue is common with RA because it’s a systemic disease that can affect the cardiovascular system. “And the body has to use its resources to control inflammation,” Stiskal adds. A regular exercise program that builds muscle and endurance can address fatigue, Stiskal says. “But it shouldn’t be so strenuous that there’s little energy left for her sport.” Also, plan for adequate rest and sleep. Ask your doctor how rheumatoid arthritis medications might affect your new activities. For example, you might “need to use a sports sunscreen that won’t come off when you sweat,” Galland says. That’s because hydroxychloroquine (Plaquenil) and methotrexate, both drugs commonly used for RA treatments, can increase sun sensitivity. Also, rheumatoid arthritis medications such as methotrexate and steroids can thin bones, which is why sports that can lead to falls – such as ice skating, Rollerblading or soccer – aren’t recommended. If methotrexate makes you nauseous, avoid taking it the day before a game or rigorous practice, he advises. If you’re taking steroids and playing on a competitive team, you may need a note from your doctor, says White. Even though steroids for RA, such as prednisone, aren’t the same as the ones athletes take to bulk up muscles, you may need to explain why you take certain medications. 8. Don’t push through the pain. Pain and joint stiffness are common for people with rheumatoid arthritis, but learn to recognize pain that’s abnormal. “If you’re doing what you haven’t done for a while, it’s normal to be stiff,” says White. “But if the stiffness lasts longer or is more intense than you expect, you overdid it.” Don’t play through pain or exhaustion, Stiskal says. “Recognize the need for rest.” For more expert information and advice, visit our Rheumatoid Arthritis Health Center. What’s Your Inflammation IQ? Inflammation has become a hot topic over the last few years. The latest scientific research indicates that inflammation is behind more than 80% of the conditions we suffer from – everything from arthritis to heart disease. Dr. Mark Hyman, author of The UltraSimple Diet, agrees that inflammation leads to a host of health problems. Fighting it can get you on track to a healthier, happier life.