Exercise is one of the very best remedies for the pain of rheumatoid arthritis (RA). RA patients who exercise are usually more pain-free than those who don't exercise. That's why experts now say that regular exercise is an essential treatment for RA. There are at least four ways exercise positively impacts the health of people with RA.

Muscle strength increases with exercise. Exercise improves muscle weakness by increasing the flow of blood to the muscles and surrounding tissues. As the muscles surrounding the joints get stronger, they can support the joints better. This reduces strain upon the joints and helps protect them.

Joint mobility is preserved by exercise. Too much rest can cause stiffness and reduce joint mobility. Even during flares simple range of motion exercises can be done to preserve joint mobility.

Depression is reduced by regular exercise. As physical pain is relieved by exercise, patients feel less depressed about their health. Exercise helps people feel empowered against RA and find it easier to comply with their treatments. Weight control is enhanced by exercise. Maintaining a normal body weight protects the hip, knee and foot joints from excessive pressure.

Talk with your doctor before you begin any exercise program.

Maintain a balance between exercise and rest. Exercise alleviates pain and provides the benefits named above. Rest fights fatigue and reduces inflammation.

Exercise more when RA is under control and rest more during a flare.

Don't completely stop exercising during a flare. Stiffness may set in. Instead, reduce the number of repetitions and switch to passive exercises that avoid joint motion.

Prior to exercise, heat treatments can loosen joints and alleviate stiffness. A warm bath or shower, or a hot pack may helpful before exercising.

Avoid exercises that jar the joints, such as jogging, jumping rope and downhill skiing.

People who exercise are usually healthier and happier than those who don't exercise. They are also more likely to live longer and to have a more positive outlook. For these reasons, exercise has now become an important part of the treatment plan.

The benefits of exercise

Regular exercise, designed around a patient's physical abilities and limitations, yields many benefits: Cardiovascular health is improved. Regular exercise helps lower blood pressure. It also increases "good" cholesterol, improves circulation and helps reduce the risk of heart disease.

Muscles around the joints get stronger. This reduces strain on the joints and helps protect them. Flexibility is better and stiffness is reduced.

Bones get stronger. Weight bearing exercise applies tension to muscle and bone. Weight bearing exercise can increase bone density by as much as 2 - 8% a year, helping to prevent osteoporosis.

Weight control is enhanced by exercise. Keeping a normal weight helps to prevent health problems like heart disease and high blood pressure.

Stress is reduced by exercise. Exercise promotes relaxation and reduces tension. Over time, exercise increases the body's ability to deal with stress.

Mental functions may be improved. Math skills, creativity, reaction time, imagination and other mental skills have been linked to aerobic exercise.

Depression and anxiety are decreased. Exercise prompts the release of endorphins, the body's natural "feel good" chemicals. Studies show that as fitness improves, endorphins are released faster during exercise.

The digestive tract benefits from exercise. Those who exercise often are less likely to have constipation, indigestion or ulcers.

Other benefits include sleeping better at night, less fatigue and more energy.

Exercise can be therapeutic or just for fun. A therapeutic exercise program is one designed to achieve specific health benefits for the patient. A physical therapist, occupational therapist or physician can help patients design exercise programs that are right for them. A balanced program may include three kinds of exercise: Stretching exercises preserve joint function and flexibility. They also help prevent muscle stiffness and cramps. Yoga and Tai Chi are stretching exercise regimens that focus on flexibility and balance. Range of motion exercises move joints as far as they can comfortably go, and then stretch just a little further. Some types of stretching exercises can be very good for the back.

Strength training exercises build muscle power. There are two kinds of strength building exercises: isotonic and isometric. Isotonic exercises involve moving the joints. They may use resistance, such as weights or moving against water. Isometric exercises contract the muscles without moving the joints. Both kinds of strength building exercise help reduce body fat. They also help lower "bad" cholesterol and aid digestion. Strength building exercises become more important as we grow older and lose muscle tissue.

Aerobic exercises build the stamina of the entire body and strengthen the heart and lungs. Dancing, bicycling and walking are examples of aerobic exercises. Swimming does not raise the heart rate as high as other aerobic exercises, but it is ideal during pregnancy. Aerobic exercise is also called endurance exercise.

1. Half of those who begin a workout routine abandon it within a year. For this reason, it is important to choose activities that you really enjoy. Walking has the lowest drop out rate. Alternating among a variety of activities can help prevent boredom.

2. If you have a chronic illness, consult your doctor before beginning any exercise program. For healthy people, the American Heart Association recommends at least 30 minutes of exercise three or more times a week. Ask your doctor if this is appropriate for you.

3. Before any endurance exercise, always warm up with stretching or range of motion exercises. To end the workout, transition into a cool down phase that lasts several minutes before completely stopping. This will help prevent stiffness and pain.

4. Stop exercising if you don't feel well. Sharp pain, shortness of breath, dizziness, a tightening in the chest or nausea are "stop" signs. If muscles cramp, rub them and try a new position or technique. Get advice from a physical therapist or fitness expert if you need to re-evaluate your program.

a member of the Accordant Health Services Medical Advisory Team.

References

First published April 27, 2001
Last updated December 16, 2002
Copyright © 2001 Accordant Health Services, Inc. All Rights Reserved.

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