Staying fit and flexible is a good idea for everyone, but is particularly important when you live with rheumatoid arthritis. RA does throw some extra factors into the mix, such as avoiding stress on the joints and dealing with pain. Physical therapy can be a useful tool in developing an exercise program that protects your joints, as well as helping you to manage pain. To find out more about how this kind of therapy can help people who have RA, I interviewed Danielle McCormack, a physical therapist with The Arthritis Society of Canada.

Please tell us a little about what you do.
I am a physical therapist and I have worked for The Arthritis Society for more than 15 years. My role is to provide an assessment and treatment recommendations for people with all types of arthritis. We see people in clinic sites all over Ontario and if need be, in their homes when they are unable to travel to a clinic.

Why is it so important to exercise when you have RA?
When exercise is done properly, it is now known to help reduce overall pain with no negative effect on disease activity. It improves joint nutrition and mobility of the joint, improve muscle strength and joint stability. Exercise also helps fitness level which helps reducing stress and anxiety and improves sleep.

Many people live with RA find it difficult to find the type of exercise that doesn't make their symptoms flare. How can physiotherapy help with this?

Exercise should not make RA flare. Overuse of actively swollen joints may aggravate your arthritis so it is important to know your joints and adjust your exercise routine accordingly.

• Using ice before exercising may help.
• Not working into pain is very important.
• Not stretching an inflamed joint is also important.
• Hydrotherapy (exercise in warm water) can help with decreasing the load on weight bearing joints.
• Using splints or braces to protect vulnerable joints.
• Pacing is an important strategy.

What kinds of exercise may be recommended for a person who has RA?
There are several types of exercise.
• The first type is ROM (range of motion) exercises to help reduce stiffness and pain. They are intended to maintain full movement of the joint by moving the joint through its full available range. They are gentle and are safe to do every day, especially on stiff joints.
• Strengthening exercises help build strong muscles around the joints. They help stabilize the joints when doing activities. It is better to talk to your physiotherapist before using weights and proper positioning.
• Stretching exercises help to increase flexibility or the elasticity of the muscles and tendons, especially after strengthening exercises.
• Aerobic exercise improves the health of heart and lungs. Examples are walking, biking and swimming and can be done in minimum 10 minute bouts up to 120 minutes per week at low to moderate intensity. Allowing a warm up and a cool down period is important and should be enjoyable and painfree.