Rheumatoid Arthritis (RA) is the second most common type of arthritis, right after osteoarthritis. About 370 thousand Canadians live with it. That’s a lot of people.
And while medication has come a long way and can really help with managing symptoms and with slowing down progression of the disease, exercise is often less talked about as a therapeutic option.
Let’s change that.
Exercise is a vital tool in helping reduce and manage symptoms, improve physical function, and leads to a better quality of life.
Even the 2022 American College of Rheumatology (ACR) Guidelines support incorporating exercise into treatment plans, stating the importance of tailored exercise plans in addition to medication to alleviate symptoms and improve overall patient outcomes.1
So What is Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic autoimmune condition that affects the joints, causing pain, swelling, and decreased mobility. With time, this can often lead to excessive inflammation causing joint damage and deformities which can really affect one’s quality of life. It often affects the hands, wrists, feet, and ankles - the smaller joints in the body - but it can also affect the bigger ones too such as the knees, hips, and shoulders.
Benefits of Exercise for Rheumatoid Arthritis
While RA affects both men and women, approximately 70% of cases occur in women.2 As a result, exercise can be a very powerful tool when addressing gender-specific concerns in women with RA.
Here are just some benefits that exercise can provide for people with rheumatoid arthritis, especially women.
Reduced Inflammation
Regular exercise has been shown to decrease systemic inflammation in those with RA. Inflammatory markers like C-Reactive Protein (CRP) have been shown to decrease with physical activity, which not only helps lower joint inflammation and any associated pain, but has also been shown to have protective effects on joints over time.3 On top of that, there’s some evidence to suggest regular activity can also impact immune function which further helps with symptom management.4 This can be particularly helpful for those who experience chronic inflammation from RA.
Improved Joint Mobility
RA can stiffen joints, which can make everyday activities that much more challenging. There are studies that show that exercise - both aerobic and resistance-based - can maintain and improve range of motion in affected joints, reducing stiffness and making movement easier.5,6 Even those with severe functional limitations had drastic improvements in movement quality, which just goes to show how much of a game changer exercise can be in managing RA.5
Increased Muscle Mass & Strength
Two thirds of people with RA develop something called “rheumatoid cachexia,” which is
an accelerated loss of muscle mass and is believed to be caused by a few factors,
such as cytokine-driven hypermetabolism, protein degradation, diet, and physical inactivity.7 The swelling and pain from RA can often lead to people not using the affected joint as much as well. This often results in weakened muscles in the area of affected joints, which then can lead to joint instability and can exacerbate symptoms. Resistance training can help build muscle mass and strength, which has been shown to increase joint stability as well as the overall resilience of those with RA, allowing for better support and reducing the strain on inflamed joints.7,8
Enhanced Cardiovascular Health
Given that the main reason for a reduced life expectancy in people with RA is cardiovascular disease (CVD) related, it is imperative to mention that regular exercise can help mitigate some of these CVD risks. It’s worth noting that people with RA are usually less active and 20-30% less aerobically fit than age-matched people without RA.7 So, adding regular physical activity to your routine, specifically aerobic activities like biking, swimming, or walking, can help lower cardiovascular risk factors specific to those with RA and help improve overall health.9
Improved Mental Health
Living with a chronic illness like RA can be emotionally taxing. It’s well known that exercise has positive effects on mental health, and recent studies confirm that for those with rheumatoid arthritis. One paper found that people who went through an exercise intervention reported feeling a greater sense of self-efficacy, mood improvements, and less stress.10 Another also found that regular physical activity significantly lessens depressive symptoms in those with RA.11 So beyond the physical benefits it provides, exercise can provide a considerable emotional and psychological boost to those with rheumatoid arthritis.
Better Bone Health
Hormonal changes in women, especially after menopause, increases the risk of osteoporosis. For women with RA, this concern is amplified due to both the disease itself and the use of certain medications used to manage it, such as corticosteroids. Weight bearing exercises such as resistance training and walking help maintain and strengthen bones, which can help reduce the risk of osteoporosis in people with RA.12 This is especially important for women who need to mitigate bone density loss while managing RA symptoms.
Managing Weight
It’s common to see weight gain as one ages, but this can exacerbate RA symptoms by putting extra stress on affected joints. Exercise not only helps control one’s weight, but it can also help decrease visceral fat, which is the fat stored in and around our organs. Not only is this type of fat worse for overall health and can affect organ function, it’s also linked to higher systemic inflammation in the body. Regular exercise can help manage weight, which can help ease joint pain and improve RA symptoms.13,14
Safe, and Less Pain
One worry many people have is that exercise can exacerbate symptoms or cause more damage to the affected joints. There’s some evidence that shows that that’s not really the case.
One study found that resistance training did not exacerbate joint inflammation (swelling, tenderness, range of motion, synovitis), and not only that, but that sometimes those with moderate disease activity saw a reduced number of clinically affected joints after vigorous exercise.15,16
When it comes to damaging the joint through exercise, we can look at the RAPIT exercise program study, which found that after 2 years of following a high intensity program, participants did not see an increased rate of damage to either the large or small joints of the hands and feet.17,18 Also, after 3 months of exercising, the same program found that cartilage damage did not significantly change from when the participants started.19
Best Exercises for Rheumatoid Arthritis
So how do you start exercising with rheumatoid arthritis?
Well, it turns out that there isn’t really a general consensus on what specifically you should be doing or how challenging it should be. There are some guidelines and suggestions that experts have collected, but the appropriate activity will depend on you.
Regardless of what type of activity you do, one thing experts agree on is that the intensity of the exercise should really be tailored to each person based on their symptoms and stage of disease progression.
One thing is for sure though, is that some exercise is still better than no exercise.
Here are some activities that are good options for those with RA.
Strength Training: Resistance bands, free weights, machines, and bodyweight exercises
Strength training can be one of the best things you do for yourself, whether you have arthritis or not.
Included should be exercises that work the large muscle groups of the upper and lower halves of the body, as well as hand strengthening exercises. This can help significantly improve muscle strength, and help reduce inflammation, pain, morning stiffness, and disease activity.7
One should also aim to work any affected joints - within reason of course. You want to find the balance of working the tissues around the affected joint so you can strengthen it, but not aggravate it.
Anything that makes your muscles work against resistance is considered strength training. Whether this be against dumbbells, barbells, machines, bands, or even against your own body weight. You want to use a method that you have access to and that you enjoy. The chances of you sticking with it if it’s available and you actually enjoy it skyrocket!
One thing to note is that machines may provide some extra stability compared to free weights or bodyweight exercises. Since the machine kind of holds you in place and directs you, some people may find this option a bit nicer on the body, especially when first starting out.
The ACR Guidelines strongly recommend supervision and prescription by an exercise professional to help ensure safety and effectiveness.1 This can be especially a good idea if you don’t have any background in strength training to begin with. See our next section to see what we have to say about supervised exercise.
Aerobic Exercise: Walking, cycling, elliptical machine, swimming, water aerobics, dancing, etc.
Aerobic exercise includes anything that gets the heart rate elevated from resting levels, and often involves movement that’s “cyclical,” meaning repetitive for a longer time period.
In cases where a joint is more severely affected, especially in the lower body (hip, knee, ankle, toes), non-weight bearing aerobic activities may be preferred as this will eliminate extra strain on the joints. Examples would be swimming or cycling.
Some people can tolerate, and some would actually benefit from weight bearing activities as the extra impact doesn’t aggravate their joints and it can provide greater protection against bone mineral density loss.
Cycling is low-impact, works the large muscles of the lower body, and improves various health markers in those with RA such as aerobic capacity, muscle strength, and joint mobility, without exacerbating symptoms.7
Swimming and water-based exercises like water aerobics is another low-impact option that has been shown to be effective for people with Ra in lowering joint tenderness, improving joint range of motion, as well as improving mental well-being.7
Who doesn’t like dancing? Believe it or not, it can provide a good heart pumping stimulus and has been shown to improve aerobic power and mental health without affecting disease activity in those with RA!7
Walking is another option for people that involves a bit more impact. The faster you go, the more impact it has on the joints. Jogging can even be tolerable for some people. So while walking or jogging can be a great aerobic workout for some, for others it may be aggravating. So, take caution and keep a watchful eye on how intense you go and how the body reacts.
Flexibility & Mobility Exercises: Stretching, range-of-motion exercises, yoga, pilates, tai chi
Since stiffness and a reduced range of motion can occur with RA, adding in some flexibility and mobility work can help provide some relief and help loosen things up.
Yoga and pilates in particular may be good options as they combine stretching alongside working the muscles, working both mobility and strength.
Since these kinds of activities tend to be less strenuous on the body, you usually can do them more frequently. Another bonus is that you don’t need to do them for long in order to feel the benefits, even just 10-20 minutes a day is enough to feel a bit more loosened up.
People with RA, whether recently diagnosed or those with a long history of it, should aim to incorporate regular exercise into their lives.
The exercise in question, though, should be adapted to each person’s specific needs, taking into account their disease activity and symptoms.
The specifics of what intervention to choose, as well as the reps, sets, time, intensity, volume could not be determined as it’s specific to each individual. A lot of these factors, again, should be determined based on symptoms.
Since many people with RA start off with below average physical fitness, any exercise training should start off at a lower intensity. It’s a good idea to ease into things so the body isn’t stressed too much, and so that the body has time to adapt. Too much too soon could cause not only a flare up, but also excessive soreness preventing any additional exercise or movement, as well as overloading the tissues that could lead to injury.
Starting slow allows you to focus on form and the movements themselves, while allowing you to see how your body reacts to it. It can provide a good baseline for what you’re capable of at the moment and allows you to adjust the next workout accordingly.
Try to find variations or modifications that work best for you. If it’s difficult to reach overhead, instead of doing a dumbbell shoulder press, opt for a landmine press as you don’t need to go directly overhead with that variation. If your neck is affected, then swimming may be difficult, but water exercises may be a better option.
Remember, for seeing continuous improvements in training - essentially, getting “fitter” - your training should get progressively more challenging. That could look like a change in the dosage (duration or intensity), or in the variation of exercise (e.g. going from a double legged exercise to a single legged exercise variation). Of course, this progression should be in line with one’s goals and should be appropriate for the person.
It’s common to progress one workout, and then go back and regress the next workout. That’s ok! As long as the overall trendline is seeing an improvement, you’ll know you’re on the right track.
One thing to note is that there isn’t much evidence for exercise prescription for those with more severe disability due to RA (classes III and IV). Some form of strengthening exercises are still recommended regardless of stage of RA.7
The question of whether to continue exercise, especially strength training, through “flare ups” is still up in the air. Another area of question is the effects of exercise on joints with severe damage. More research needs to be done on these topics in order to provide proper suggestions.
In the case of joint surgery (whether replacement or otherwise) it’s important to strengthen the joint, ideally through a supervised program tailored to the abilities and capabilities of the person in question.
A great rule of thumb not only for those with RA, but in general, is listen to your body.
If something is nagging at you, probably best to lay low for the time being. If you feel great during the activity, but then can’t move for 3 days after, then you know for next time to make adjustments and do less total work or go less intense.
Personalised Training & Group Classes
It’s highly recommended for physical activity to be supervised at first. This will allow the individual to receive tailored programming appropriate for them. Not only should this result in less pain and flare ups, but it should lead them to their goals sooner.
Working one on one with a professional will allow appropriate exercise selection, programming, and form supervision. Not only that, but having a professional by one’s side can provide more support and confidence while exercising, especially when trying out new things!
Having a tailored program can also alleviate uncertainty, confusion, and negative beliefs about exercise in people with RA, while providing education, adherence, and coping strategies to help overcome any barriers, RA-related or otherwise.10
Some people might even prefer group exercise catered to those with RA. Group based programs can still offer expert guidance and support, while offering more of a community environment with others dealing with the same or similar issues.6
Conclusion
Exercise should be seen as an essential piece to the puzzle when it comes to managing rheumatoid arthritis.
Ranging from physical improvements in joint function and pain management to psychological mood-boosters, the benefits of adding regular physical activity to one’s routine is tremendous. For women especially, who are disproportionately affected by RA, exercise can help address gender-specific concerns like bone health as well.
It’s important for individuals with RA to consult their healthcare provider regarding their overall health and status of their condition, but it is just as equally important to get in touch with an experienced and knowledgeable exercise provider (like a registered kinesiologist) who can help guide you through a tailored exercise program suited to you and your specific needs.
If you’re someone who’s looking for that sort of guidance, get in touch today! We’d love to get to know you and help you reach your goals so you can live the life you want for years to come.
Final Thoughts
Our goal at Delta Kinesiology is to help women reach their health and fitness goals
regardless of age, ability, or experience level.
We tailor each session using evidence-based principles and methods to help you reach your goals. Whether that be going about your day pain-free, building muscle, improving stamina, or feeling better about yourself, we are here to help.
Get in touch with us today to schedule a free consult by clicking the link below.
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References
American College of Rheumatology. (2022). 2022 American College of Rheumatology guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis.
Oliver, J. E., & Silman, A. J. (2009). Why are women predisposed to autoimmune rheumatic diseases?. Arthritis research & therapy, 11(5), 252. https://doi.org/10.1186/ar2825
Hu, H., Xu, A., Gao, C., Wang, Z., & Wu, X. (2021). The effect of physical exercise on rheumatoid arthritis: An overview of systematic reviews and meta-analysis. Journal of advanced nursing, 77(2), 506–522. https://doi.org/10.1111/jan.14574
Modarresi Chahardehi, A., Masoumi, S. A., Bigdeloo, M., Arsad, H., & Lim, V. (2022). The effect of exercise on patients with rheumatoid arthritis on the modulation of inflammation. Clinical and experimental rheumatology, 40(7), 1420–1431. https://doi.org/10.55563/clinexprheumatol/fohyoy
Teuwen, M. M. H., van Weely, S. F. E., Vliet Vlieland, T. P. M., van Wissen, M. A. T., Peter, W. F., den Broeder, A. A., van Schaardenburg, D., van den Hout, W. B., Van den Ende, C. H. M., & Gademan, M. G. J. (2024). Effectiveness of longstanding exercise therapy compared with usual care for people with rheumatoid arthritis and severe functional limitations: a randomised controlled trial. Annals of the rheumatic diseases, 83(4), 437–445. https://doi.org/10.1136/ard-2023-224912
Pedersen, B. K., & Saltin, B. (2015). Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian journal of medicine & science in sports, 25 Suppl 3, 1–72. https://doi.org/10.1111/sms.12581
Cooney, J. K., Law, R. J., Matschke, V., Lemmey, A. B., Moore, J. P., Ahmad, Y., Jones, J. G., Maddison, P., & Thom, J. M. (2011). Benefits of exercise in rheumatoid arthritis. Journal of aging research, 2011, 681640. https://doi.org/10.4061/2011/681640
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Hörnberg, K., Pomeroy, J., Sandberg, C., Södergren, A., Ångström, L., Sundström, B., & Wållberg Jonsson, S. (2020). Physical activity in rheumatoid arthritis: relationship to cardiovascular risk factors, subclinical atherosclerosis, and disease activity. Scandinavian journal of rheumatology, 49(2), 112–121. https://doi.org/10.1080/03009742.2019.1657491
Canning, J., Williams, R., & de Souza, S. (2023). Patient experiences of physical activity and exercise in rheumatoid arthritis. Rheumatology advances in practice, 7(1), rkac098. https://doi.org/10.1093/rap/rkac098
Kelley, G. A., Kelley, K. S., & Hootman, J. M. (2015). Effects of exercise on depression in adults with arthritis: a systematic review with meta-analysis of randomized controlled trials. Arthritis research & therapy, 17(1), 21. https://doi.org/10.1186/s13075-015-0533-5
Cosman, F., de Beur, S. J., LeBoff, M. S., Lewiecki, E. M., Tanner, B., Randall, S., Lindsay, R., & National Osteoporosis Foundation (2014). Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 25(10), 2359–2381. https://doi.org/10.1007/s00198-014-2794-2
Stavropoulos-Kalinoglou, A., Metsios, G. S., Veldhuijzen van Zanten, J. J., Nightingale, P., Kitas, G. D., & Koutedakis, Y. (2013). Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis. Annals of the rheumatic diseases, 72(11), 1819–1825. https://doi.org/10.1136/annrheumdis-2012-202075
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van den Ende, C. H., Hazes, J. M., le Cessie, S., Mulder, W. J., Belfor, D. G., Breedveld, F. C., & Dijkmans, B. A. (1996). Comparison of high and low intensity training in well controlled rheumatoid arthritis. Results of a randomised clinical trial. Annals of the rheumatic diseases, 55(11), 798–805. https://doi.org/10.1136/ard.55.11.798
de Jong, Z., Munneke, M., Zwinderman, A. H., Kroon, H. M., Jansen, A., Ronday, K. H., van Schaardenburg, D., Dijkmans, B. A., Van den Ende, C. H., Breedveld, F. C., Vliet Vlieland, T. P., & Hazes, J. M. (2003). Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial. Arthritis and rheumatism, 48(9), 2415–2424. https://doi.org/10.1002/art.11216
de Jong, Z., Munneke, M., Jansen, L. M., Ronday, K., van Schaardenburg, D. J., Brand, R., van den Ende, C. H., Vliet Vlieland, T. P., Zuijderduin, W. M., & Hazes, J. M. (2004). Differences between participants and nonparticipants in an exercise trial for adults with rheumatoid arthritis. Arthritis and rheumatism, 51(4), 593–600. https://doi.org/10.1002/art.20531
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