Exercise With Severe RA: Making Tea Countsby Lene Andersen, MSW Patient Advocate
Severe RA and Physical Activity
When you have severe damage from rheumatoid arthritis (RA) or are in a heavy flare, exercise is almost impossible. Pushing beyond the limits can make you flare more. On the other hand, physical activity helps keep your joints moving and builds muscle to support those joints. Both are essential to maintaining - or even improving - your level of ability, as well as reducing pain. So what do you do? Don't despair, there are ways to keep moving.
Moving counts, part one
Not everything you do as a person with severe RA looks like regular exercise. In our video showing exercises for all Levels of RA, several present and past writers for RAHealthCentral show what they do to stay active. It ranges from kickboxing to yoga to something very different that I do. 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.
Moving counts, part two
My attendants are not here for most of the day, so the rest of the time, I manage on my own. 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 what I need.
Making tea can be a workout, part one
I make 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.
Making tea can be a workout, part two
Still leaning forward, I place the filled cup in the microwave. This stretches my arm through its range of motion, while using strength to hold the cup. Leaning forward is particularly useful. I do it every time I make tea, reach for something on my desk, brush my teeth and so on. Every time I lean forward, it's a type of sit-up. Although I'm not 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!
Range of motion exercises
And it's not just about leaning forward. Simply taking care of myself as much as I can involves a variety of range-of-motion movements. 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!
23 ½ hours, part one
Going through your regular routine can help maintain your current level of ability. But what if you want to get better? This is where Mike Evans’ 23 1/2 hours can help. In a nutshell, Dr. Mike Evans says that you can do whatever you want for 23 and half hours a day, but you should 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.
23 ½ hours, part two
If someone with severe RA starts to move 30 minutes a day, you're virtually guaranteed a flare. So, start slow. Approach this not with small steps, but with baby steps. Maybe the first day you move for two minutes and see what happens. If your body is unhappy, move for one minute the next day. The point is that you're moving. When that's comfortable, slowly increase the time or activity you do. Gradually, you'll start being able to do more.
Increasing activity to 30 minutes
Eventually, you may find yourself ready for 30 minutes of activity. What you do 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! And remember as always, on really bad days, showering and getting dressed counts.
More than range of motion
After gradually increasing your level of activity, you may be able to do some gentle exercises. Start with range of motion to stretch out morning stiffness — this can even be done in bed. Other gentle exercises include yoga, tai chi, walking or exercises in water. The Arthritis Foundation has arthritis-friendly yoga videos. You could also join a community program, but talk to the instructor about modifying the exercises for you. Talk to your rheumatologist before starting any exercise program.
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 one pound takes four pounds of strain off your knees!
Losing weight with RA
Pay attention to what and how you eat. Manage portion sizes and make healthy food choices. I try to follow the principle that my plate should be half vegetables, a quarter protein and a quarter starch. Snack on baby carrots instead of cookies or chips. You can also invest in a good blender or a NutriBullet to make healthy smoothies. 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.
Change how you think to improve your life
Changing how you think about exercise can help you be more active with severe or flaring RA. Taking care of yourself and doing chores in your home can 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 difference in building muscle and energy. When you start to feel better, ask your doctor for a referral to a physical therapist who can put together an exercise program that respects your limits, yet makes you stronger.