A number of my rheumatoid arthritis patients have approached me about exercise: Is it safe? Will it worsen their joints? Should a person "fight through" the pain and stiffness and fatigue to keep on a routine exercise regimen?
When a patient is diagnosed with rheumatoid arthritis, the first and foremost goal should be to get the disease under control. Before there is any worry about what one can and cannot do, the patient should see a rheumatologist and begin treatment -- assuming there are no contraindications -- with a disease-modifying antirheumatic drug (DMARD).
Rheumatoid Arthritis Symptoms Can Deter Exercise
Rheumatoid arthritis patients suffer a range of physical symptoms, including joints that are tender, swollen or stiff, and a general sense of not feeling well (fatigue and malaise come to mind). Studies have shown that people with any form of arthritis are less likely to be physically active, as common sense would have it.
And being human beings, rheumatoid arthritis patients must also deal with the emotional ramifications of the disease: Many patients develop fears of harming themselves should they "overdo it," and this in turn leads to further feelings of helplessness and a lack of self-confidence.
So, where is that happy middle ground? Where is the place on that spectrum between rest and exercise where a rheumatoid arthritis patient should place him or herself?
Rest More When RA Is Active, Exercise More When It Is Not
More rest is needed when the disease is active, because it is well-known that rest actually reduces joint inflammation and pain. On the other hand, more exercise is indicated when the disease is less active; the benefits are obvious: Muscle strength is maintained, sleep patterns improve, stress is relieved, a healthy weight is maintained, and osteoporosis risk is reduced. We should not forget, as has been evidenced by all the scientific literature in the past few years, the importance of heart health in the rheumatoid arthritis patients; exercise is always a key when it comes to cardiac risk reduction.
Of course, there are different types of exercise:
1. Stretching exercises are the simplest and easiest. This improves flexibility, and daily stretching is the basis for any exercise program.
2. Strength exercises involve working the muscles against resistance. Tthis strengthens the muscles and increases the amount of activity a patient can perform pain free.
3. Conditioning exercises (also known as aerobic exercise) improves cardiovascular fitness.
There was a study in Arthritis and Rheumatism in 2003 which showed that conditioning exercise in the early stages of rheumatoid arthritis had no significant harmful effects on the weight-bearing joints, except in those patients who already had considerable large joint damage. And the exercise group had a large improvement in aerobic fitness, muscle strength and emotional well-being. The exercises involved strength training with weights, bike riding, and sports such as badminton, volleyball, soccer and basketball.
Get Your Doctor's Help And Create An Exercise Plan
I encourage exercise in my patients if their disease is under control.
And this is the key to a normal life: get the disease in remission.
The more quickly the disease is controlled, the less damage to joints which in turn can lead to impairment and difficulty with exercise. The more quickly the disease is controlled, the better a patient feels, and the more ready the patient and his joints are for the rigors of exercise.
Patients need to ask their doctors whether they are ready for a particular type of exercise. For example, their arthritis might be in remission, but they are having chest pressure with physical activity? Obviously, such patients need to have a cardiac workup before they embark upon an aerobic/conditioning program. They can probably perform stretching exercises in the meantime. Once the doctor gives the OK for exercise, if a particular joint begins to hurt, by all means stop and consult the doctor again:
Pain is not always gain. Often, and particularly in the rheumatoid arthritis population, pain means something is wrong.
In conclusion, exercise can be a wonderful thing, for those of us with and without rheumatoid arthritis. But if a rheumatoid arthritis patient doses not feel he or she can exercise, both patient and doctor need to figure out why:
- Is the patient depressed?
- Is the disease not adequately controlled?
- Is there too much joint damage from previously uncontrolled disease, and if there is would such a patient benefit from joint replacement surgery?
The patient needs to ask the doctor: What can you do to allow me to feel that I can exercise?
And the doctor needs to answer.
Published On: February 19, 2008