For Español click here
Physically active individuals are healthier, happier and live longer than those who are inactive and unfit. This is especially true for people with arthritis. Yet, arthritis is one of the most common reasons people give for limiting physical activity and recreational pursuits. Inactivity, in addition to arthritis-related problems, can result in a variety of health risks including Type II diabetes, cardiovascular disease and osteoporosis.
As well, decreased pain tolerance, weak muscles, stiff joints and poor balance associated with many forms of arthritis can be made worse by inactivity. For many older people with arthritis, joint and muscles changes due to aging can further complicate the matter. Therefore, for the person with arthritis, appropriate exercise is very important.
Fast Facts
-
Physical activity is made up of daily tasks or leisure activities that are usually restricted by arthritis. Regular exercise then becomes that much more important.
-
People with arthritis who exercise realize less pain, more energy, improved sleep and better day-to-day function.
-
Starting off slowly with a limited number of exercises and at a low intensity will help to ensure safety and success with your exercise program.
What exercises are helpful and safe?
 |
| Aquatic exercise is a safe form of aerobic exercise. |
|
The three main classifications or levels of exercise are therapeutic/rehabilitative, recreational/fitness and competitive/elite. Finding the right balance is key.
Therapeutic exercises, prescribed by health professionals, address specific joints or body parts affected by the arthritis or arthritis-related surgery. Following a therapeutic exercise program is often a necessary first step for individuals who have been inactive, have restricted joint motion or muscle strength, are experiencing joint paint or are recovering from surgery such as a joint replacement.
Recreational or general fitness activities can range from walking and swimming to cross country skiing and running. The most appropriate forms are those that can be done in a controlled and safe manner, have little risk of injury, and place minimal stress and impact on affected joints. In most cases, participating in recreational exercise does not eliminate the need for therapeutic exercises.
Competitive or elite level activities are performed at higher intensities, for longer durations and require greater skill and training. There are limited reports of people with arthritis continuing or returning to a competitive level of sport participation. However, as a general rule, exercising at this level is not recommended for individuals with inflammatory arthritis or with joint problems that may be adversely affected or impacted by the sporting activity (e.g. marathon running with hip or knee arthritis). If you have mild or early arthritis and wish to continue exercising at this level, first talk to your rheumatologist or physical therapist who has experience in arthritis and knowledge of the specific sport.
Who should exercise?
Everyone! Research shows that people with many forms of arthritis can participate safely in appropriate, regular exercise. Long term studies have shown that even people with inflammatory arthritis such as rheumatoid arthritis (RA) can benefit from moderate intensity, weight-bearing activity, and reduce the bone loss and small joint damage associated with this condition while not increasing pain or disease activity. For instance, weak thigh muscles (quadriceps) are risk factors for both developing osteoarthritis in the knee and having greater disability.
For individuals with osteoarthritis (OA) in the knee or elsewhere, research supports programs that combine strengthening and aerobic exercise to reduce symptoms, improve joint motion and function, enhance coordination and balance, and control body weight. Regular moderate exercise has even been found to improve cartilage health in individuals at risk for developing knee OA.
What exercises are best?
There are four major types of exercise that make up all comprehensive exercise programs, regardless of the level of participation. Each can have a positive effect on reducing arthritis-related pain and disability.
Flexibility exercises: Both range-of-motion (ROM) and stretching exercises help to maintain or improve the flexibility in affected joints and surrounding muscles. This contributes to better posture, reduced risk of injuries and improved function.
ROM exercises are usually performed 5 to 10 times on a daily basis. Those people with RA may find doing ROM exercises in the evening helps reduce joint stiffness the next morning. It is recommended that stretching exercises be done a minimum of 3 days a week with each stretch being held for about 30 seconds.
While ROM exercises are more common in therapeutic programs, stretching activities are important in all levels of exercise. Recreational activities such as yoga incorporate both ROM and stretching movements into their routines.
Strengthening exercises: These more vigorous exercises are designed to work muscles a bit harder. As the muscle becomes stronger, it provides greater joint support and helps reduce impact through the painful joint. Strong muscles, which also contribute to better function, help reduce bone loss associated with inactivity, some forms of inflammatory arthritis and the use of certain medications (corticosteroids).
One set of 8 to 10 exercises for the major muscle groups of the body 2 to 3 times a week is recommended. Most persons should complete 8 to 12 repetitions of each exercise. Older individuals may find 10 to 15 repetitions with less resistance are more appropriate. The resistance or weights need to be of sufficient intensity to challenge the muscles without causing increased joint pain. Resistance can take the form of lifting a limb against gravity, using hand-held weights or elastic bands, or pushing/pulling against resistance using a weight machine. Gradual progression in the amount or form of resistance is recommended for ongoing improvements in strength.
Aerobic exercises: Also referred to as cardiorespiratory conditioning, these exercises include activities that use the large muscles of the body in a repetitive and rhythmic manner. Aerobic exercise improves heart, lung and muscle function. For people with arthritis, this type of exercise has benefits for weight control, mood, sleep pattern and general health.
Safe forms of aerobic exercise include walking, aerobic dance, aquatic exercise, bicycling or exercising on equipment such as stationary bikes, treadmills or elliptical trainers. Daily tasks and leisure activities such as mowing the lawn, raking leaves, playing golf or walking the dog also are aerobic if carried out at a moderate intensity level.
Current recommendations for aerobic activity are for 30 to 60 minutes of moderate intensity exercise 3 to 5 days a week. This time requirement can be accumulated in several 10-minute bouts over the course of the day or week for similar health benefits as one continuous exercise session. This offers greater flexibility in scheduling aerobic exercise sessions, and allows those individuals with greater pain and fatigue to do shorter sessions within their personal tolerance level. Moderate intensity is the safest and most effective exertion level for aerobic exercise. This means the exerciser can speak normally (Talk Test), doesn't get out of breath or over-heated, and can carry on the activity for a sustained period of time in comfort.
Body awareness exercises : A fourth and less recognized, yet very important, group of exercises is referred to collectively as body awareness exercises. These include activities to improve posture, balance, joint position awareness (proprioception), coordination and relaxation. While some of these improvements can be addressed through the first 3 types of exercise, problems in these areas often require different exercises. Tai chi and yoga are examples of a recreational exercise that incorporates elements of body awareness.
When a joint and its surrounding muscles are affected by arthritis, or if a joint has been replaced, the result is often impaired coordination, position awareness, balance and an increased risk of falling. A health professional experienced in arthritis exercise prescription can determine which of these exercises would help improve overall physical function and reduce the risk of injury.
 |
| Tai chi and yoga are examples of a recreational exercise that
incorporates elements of body awareness. |
|
When to Exercise
Finding the right time of day to exercise will help you establish a routine and obtain the greatest benefits. For those with a lot of morning stiffness, gentle ROM exercises may be helpful, but getting to a fitness class may be too difficult. If fatigue is a problem, breaking up the exercise program into several short bouts during the day may be more manageable. Trouble sleeping at night? Avoid doing aerobic exercises within 2 hours of bedtime; however, stretching and relaxation exercises may enhance sleep.
It is important to be aware of any fluctuations in your arthritis symptoms such as periods of increased joint pain and stiffness. You may need more rest and less exercise during these times.
Where to Exercise
The best location to exercise is a personal choice. Some people prefer to exercise in the comfort, convenience and privacy of their own home with an exercise video such as the Arthritis Foundation’s People with Arthritis Can Exercise (PACE) video. Others enjoy the social aspect of getting out of the house and attending a class or gym in the community. A community-based program offers greater options than does exercising at home and, for some people, the support and guidance offered by an instructor or fitness trainer provides the necessary motivation to stick with a program.
Aquatic or pool-based exercise is another good option for people with arthritis. The effects of buoyancy in the water result in less stress on the weight bearing joints and many people with arthritis experience marked pain relief. The Arthritis Foundation’s Aquatic Program is a good starting point to learn appropriate exercises in the pool.
How to get started
Starting a regular exercise program can be very challenging. Understanding the benefits of exercise for people with arthritis and having the support and guidance from your rheumatologist will help. Physical and occupational therapists can suggest exercises that are safe and individualized to your specific needs, teach you how to monitor your body’s response to exercise, and modify your exercise routine as needed.
Make a plan or contract including when, how often and for how long you will exercise:
Discuss your exercise program and any concerns you have with your rheumatologist and/or other arthritis health professionals on a regular basis. With their support and guidance, you will be able to build regular physical activity and exercise into your daily routine and reap the benefits of an active and healthy lifestyle.
Points to Remember
-
Having several exercise options and locations keeps
you from becoming bored and provides alternatives on those days when
getting out of the house seems impossible.
-
Recent American
College of Rheumatology (ACR) guidelines suggest that exercise should
be one of the mainstays of treatment for OA of the hip and knee.
To find a rheumatologist
For more information about rheumatologists, click
here.
For a listing of rheumatologists in your area, click
here.
For more information
The American College of Rheumatology has compiled this list to give you
a starting point for your own additional research. The ACR does not endorse
or maintain these Web sites, and is not responsible for any information
or claims provided on them. It is always best to talk with your rheumatologist
for more information and before making any decisions about your care.
Arthritis Foundation
www.arthritis.org
The Arthritis Society
www.arthritis.ca
National Institute of Arthritis and Musculoskeletal and Skin Diseases
www.niams.nih.gov/hi/topics/arthritis/arthexfs.htm
American Academy of Orthopaedic Surgeons
http://orthoinfo.aaos.org
American Physical Therapy Association
www.apta.org
Updated June 2006
Written by Marie Westby, BSc.PT, and reviewed by the American College
of Rheumatology Patient Education Task Force.
