New AMA/ACSM Fitness Guidelines Managable for People With RA

Patient Expert

The American College of Sports Medicine together with the American Medical Association have recently published updated exercise guidelines for adults under 65. New new set of guidelines was published to clarify and improve the previous guidelines published in 1995. The guidelines, as well as tips for starting an exercise program can be found on the ACSM website at

The basic recommendations are:

  • Do moderately intense aerobic exercise 30 minutes a day, five days a week, or
  • do vigorously intense aerobic exercise 20 minutes a day, 3 days a week, AND
  • Do eight to 10 strength-training exercises, 10-15 time repetitions of each exercise 2-3 times per week, AND
  • If you are at risk of falling, perform balance exercises, AND
  • Have a physical activity plan.

These guidelines offer a plan for good health by lowering disease risk, improving cardio-vascular health, and helping to control body weight. BUT, they represent only the minimum needed to improve health and maintain bodyweight. Losing weight will require added effort.

There are three parts of the guidelines that I think are especially important for people with RA. First, it's ok if you can't get at least 30 minutes of aerobic activity all at once. A really good 10 minutes several times throughout the day is better than "30 minutes" that include rests and drink breaks (my usual cheating methods) or not exercising at all. This might be a more manageable goal for those who have lots of pain or are deconditioned from lack of exercise. 30 minutes and more is a goal to work toward.

Second, the new guidelines include strength training, which is just as important for people with RA as stretching to improve range of motion and aerobic activity. Some of the medications used to treat RA have a negative impact on bone density. Weight-bearing exercise like walking and strength training can help maintain muscle mass and bone density. You don't have to buy dumbells or join a gym. Exercise bands, cans of soup and half-gallon plastic cartons filled with water all work just fine. I keep my exercise ball, bands and weight in a basket next to my tv as a constant reminder to do something while I watch my favorite shows. Good old sit ups, leg lifts and push-ups against the wall all count as strength training.

Finally, the guidelines note that physical activity (aerobic activity, strength training and proper stretching) helps make everyday tasks, like housekeeping and walking, easier.

For me, and I think for many people, the three hardest parts of meeting the guidelines are setting aside the 3.5 hours or more a week required for exercise, not cheating on the exercises I do, and getting back into the swing of exercise after a flare up of my arthritis. I think many of us are guilty of cheating, whether we realize it or not. For me, its easy to skip exercising when I get home from work and I'm tired and hungry and just want to relax. Or when I do crunches or other strength training exercises, I don't always concentrate on doing them properly, which negates the effort a little. Or, when I'm walking and talking to a friend or not listening to really upbeat music, I tend to slow down the pace to more of a stroll rather than working to keep my heart rate up.

The guidelines are definitely doable for people with RA, especially if you work with a health professional to develop your activity plan and schedule. This will help you start off at the right pace, manage risks, and find the exercises that one enjoys to help keep motivation strong.