Being Physically Active with Severe RA
Every now and again, I run into an enthusiastic health professional who opines that I should exercise. I try telling them that exercise makes me flare. "What about range of motion exercises, then?" they chirp optimistically.
And that's when I tell them that my life is a range of motion exercise.
Severe RA and Physical Activity
When you have severe damage from RA as I do or are in a heavy flare, exercise is almost impossible. Pushing beyond the limits can make you flare more. On the other hand, exercise helps keep your joints moving and builds muscle to support those joints. Both are essential to maintaining — or even improving — your level of ability. So what do you do?
We’ve just released an exciting new HealthCentral video called Exercises for All Levels of RA! In the video, members of the RAHealthCentral team show you what we each do to stay active. We even enticed Cathy Kramer, who used to write for us, to take part! We range from having severe RA, through moderate and mild levels of the disease. All of us do things to stay active, but not all of it looks like regular exercise.
I have severe RA and can't exercise. I live independently, but receive attendant care on and off during the day to help me with showering, getting dressed cooking and so on. The rest of the time, I manage on my own and this keeps me physically active. Each task I do throughout the day involves working a number of muscle groups. Transferring with assistance from my wheelchair to the toilet involves weight-bearing and helps to maintain the strength in my legs. Making lunch has me moving back and forth in my chair. Buying groceries involves leaning out over my armrest to reach the apples.
I'll break down an example for you. If you watch the video, you'll see me making a cup of tea in the microwave. This works my abs, my back muscles and my shoulders and arms, both in terms of strength and stretching. When I sit in my wheelchair, I'm quite reclined due to lack of mobility in my hips. To put water in a cup, I have to take my feet off the footrests and put them on the ground while I lean forward on the edge of the seat (works the stomach and back muscles). I then reach for my dressing stick and use it to turn on the water. Still leaning forward, I rinse out the cup a couple of times, then move the filled cup into the microwave. This stretches out my arm through its range of motion, while using strength to hold the cup of water.
Leaning forward is particularly useful and I do it every time I make a cup of tea, reach for something on my desk, brush my teeth and so on. Every time I lean forward, it's a sit-up. Although I may not be able to do 100 crunches in a row, I probably do about 100 sit-ups throughout the day. In fact, my abs are probably the best developed muscles I have!
23 ½ Hours
Going through your regular routine throughout the day can help maintain your current level of ability. But what if you want to get better? This is where 23 1/2 hours can help.
I learned about this idea from a friend. She’d seen a video with a wonderful concept as part of a pain management course. In a nutshell, the video (by Dr. Mike Evans) said that you can do whatever you want for 23 and half hours a day, but move for the remaining 30 minutes It's a terrific way to think of being active. Half an hour is short enough to be attainable and it's therefore more likely that you'll incorporate this in your daily routine. Even better, it also lowers your risk of developing diabetes, heart disease and has many other health benefits.
What you do for the 30 minutes is up to you. Think about your pain levels, how active your RA is and how much energy you have. If you're having a good day, you may consider a walk in the spring sunshine. If your spouse is taking the day off, entice them into bed — sex is physical activity! On really bad days, showering and getting dressed counts.
Being active also helps us manage a healthy weight, which is very important when you have RA. When I interviewed Dr. Patience White from The Arthritis Foundation, she mentioned that "if you're overweight, you don't respond as well to the biologic drugs." She also explained that that losing just 1 pound takes 4 pounds of strain off your knees!
Losing weight can be difficult when you have limited mobility. Some RA meds can make it even more of a challenge — prednisone, for instance, can be useful in controlling symptoms, but is also an appetite stimulant. Paying attention to what and how you eat is the first step. Manage your portion sizes at meals and make healthy food choices. I try to follow the principle that your plate should be half vegetables, a quarter protein and a quarter starch. Between meals, snack on baby carrots instead of cookies or chips. You can also invest in a good blender or a NutriBullet to make green smoothies. Instead of pop, drink water and use milk instead of cream in your coffee. Working slowly, one pound at a time, weight loss can reduce your pain and therefore help you move more.
Changing how you think about physical activity can help you be more physically active, even with severe or flaring RA. Taking care of yourself and doing the chores in your home get you moving enough to maintain a certain level of strength and ability. Finding only 30 minutes a day to move a bit more can make a significant difference in building muscle and energy. When you feel a bit better, ask your doctor for a referral to a physical therapist who can put together an exercise program that stays within your limits, yet makes you stronger.
Lene is the author of Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain.