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How to Adapt Exercises for Rheumatoid Arthritis

Medically Reviewed by Brunilda Nazario, MD on September 29, 2020

Rheumatoid arthritis can make it uncomfortable to work out, but there are many benefits to being physically active when you have this condition. Exercise and stretching can ease joint pain, help make joints flexible, help you overcome fatigue, and more.

The first step to starting a workout routine is talking to your doctor. Discuss limits you might have and exercises that could be extra beneficial for you. You may also need to see a physical or occupational therapist.

Plan to work out when you have the least amount of pain. Remember that it’s OK to take lots of breaks. You should also listen to your body and use the severity of your symptoms as a guide for your activity.

It’s important to work out safely, and that means you may have to make some changes for your rheumatoid arthritis. Here’s how to prevent pain and agitation and get the most out of your efforts:

Warm Up and Cool Down

Aim for 10-15 minutes of activity that boosts circulation and raises body temperature. If you want to stretch, do it while you cool down or after the warmup. A warmup and cool-down aren’t necessary if you are working out for less than 10 minutes or walking at an easy pace.

Here are some warmup ideas:

  • March in place.
  • Make 20 clockwise and counterclockwise circles with your arms out to each side at shoulder height and palms facing the ground while standing with your feet shoulder-width apart.
  • Do other flexibility or range-of-motion moves throughout your body while sitting, beginning with your head and neck. Try to use the muscles you plan to work that day.

After your workout, you can cool down for 5-10 minutes. Some options include:

  • Static stretching, in which you hold in each pose for 10-30 seconds or up to a minute. Stretches should never hurt. Don’t overdo it.
  • Slow the pace of your aerobic exercise (walking, etc.) over time.
  • Do range-of-motion moves, such as making circles with your shoulders.

Aerobic Exercise

This type of activity gets your heart rate up and increases your breathing. With RA, it’s best to keep it low-impact (think of swimming, hiking, or biking instead of running) and do more over time. You may be able to do high-intensity aerobic exercise like running if your rheumatoid arthritis doesn’t impact weight-bearing joints and you don’t have an artificial hip or knee, but you should check with your doctor first.

Build up to get at least 150 minutes of moderate-intensity aerobic exercise, 75 minutes of high-intensity aerobic exercise, or a mixture of both weekly. Change up the exercise you do within a workout or a week to give your joints a break. You may also benefit from splitting up one long workout into multiple shorter ones.

Lighten it up if swelling and pain strike. Using an elliptical, doing exercises in a warm-water pool (88-96 F), and biking are good options. Try exercises, like walking, that involve more weight when you’re feeling better.

No matter what activity you’re doing, make sure you’re wearing the right clothing and footwear. You can help protect your lower body by using a shoe insert with cushioning and arch support and wearing athletic or other supportive shoes.

Here are tips for tailoring aerobic exercise for rheumatoid arthritis:

Walking

  • Even, flat surfaces are best. But when you’re outside, choose smooth, dirt trails instead of concrete or asphalt, and try not to walk down hills.
  • Don’t increase the incline above 5%-10% when you’re on a treadmill. You should also make sure you feel good walking without any incline for 30 minutes straight before adding it.

Bicycling

  • Use a stationary bike, or ride on level ground.
  • If you have knee or back issues, try using a chair-like recumbent bike instead of a traditional outdoor or upright stationary bike.
  • Your seat should have cushioning and be wide enough that your body weight is even on both sides. It should also be high enough to create a small bend in your knee when you push your leg.
  • Use a bike with handlebars that don’t make you round your back. You can also limit shock with padded cycling gloves when you ride outdoors.
  • You’re less likely to use the right muscles if your foot pedals have straps. It’s also hard to steady yourself quickly if you start to fall.

Using an elliptical trainer

  • Don’t use this machine if you struggle with coordination or stability.
  • You can better control your balance and comfort if your elliptical has handles that move with you and handles that stay still.
  • You have more stance options if the machine has wide pads for your feet. They aren’t in the right place for your frame, though, if you can’t see your shoes while standing straight and not moving.
  • Make sure you can change the resistance and incline so you can work out in a way that suits your needs and abilities.
  • Your chances of straining joints and muscles, plus falling, are higher when the speed and incline adjust without warning or so quickly you can’t keep up. This can happen with preset training plans.

Water activities

  • If you don’t know how to swim or aren’t a strong swimmer, take lessons first.
  • A therapist can help you create a swim program that accommodates neck or shoulder issues. A snorkel and mask could be beneficial too.
  • The breaststroke can make pain in your knees and hips worse. Stick to freestyle or another stroke that feels good while swimming.
  • A cut from a joint replacement procedure should heal before you get in the water.
  • You can learn how to water walk correctly by attending a class with a teacher.
  • Be mindful of how much exercise you’re doing, and make sure you don’t do too much. It can be easy to irritate joints and wear yourself out.

Rowing

  • Stay away from a machine with cables if rheumatoid arthritis affects your wrists or hands. Choose one with a bar instead.
  • You should also opt for a machine without a stack of weights. Air and liquid resistance are easier on your joints because they’re smoother.

Strength Training

You can make it easier to do everyday tasks and undo muscle loss that happens as you get older by doing resistance exercises. For guidance, you can work with a certified exercise professional or physical therapist to master your techniques and breathing. You can also contact an occupational therapist to learn a routine that adjusts for rheumatoid arthritis affecting your wrists and hands.

Here’s some advice to get you started:

  • Talk to a physical therapist who’s familiar with arthritic knee issues if your knees are hyper-flexible or extra mobile (lax), or have deformities (malalignment) to make sure you aren’t doing strength training exercises that will make your condition worse. You also shouldn’t put too much force on knees or fingers that have alignment problems.
  • Do safe wrist and hand exercises each day that reduce pain and strengthen your grip and muscles. You can make this a habit by doing it after a shower or bath, when your hands are limber and warm.
  • Train 2-3 days a week, and take a rest day after every session. Rest doesn’t have to mean doing nothing. You can be active, but don’t train the same areas day after day.
  • Begin with very light weight such as 1-2 pounds for your arms. Add more weight gradually, and make sure your movement is fluid.
  • Your grip on equipment shouldn’t be overly tight. You should also not hold your breath as you exercise.
  • Start with the muscles near joints most impacted by your rheumatoid arthritis, then target the major muscle groups.
  • It’s better for your joints if you do a set of leg moves then a set of arm moves, or vice versa, and go back and forth.
  • If you have discomfort during a certain part of an exercise, do the part that feels comfortable. Add more parts of the complete motion when strength goes up and discomfort goes down.
  • Change things up if something starts to hurt while you train. It may be as simple as changing how you do the move by using a different position or hand placement. You may need to use less resistance or lower the number of repetitions in your set. There is also the option of working the muscle with another exercise. For your wrists and hands, it might be easier to use machines or resistance bands.
  • When you have a flare-up, don’t train impacted joints.

Advice for choosing the right equipment:

  • For some assistance with upper body training, try hand and wrist braces.
  • Rheumatoid arthritis in your wrists, hands, or fingers can make it hard to use dumbbells that let you change the weight. Use dumbbells with a preset weight instead.
  • Your joints will thank you for using free weights with a rubberized grip.
  • If you can’t hold free weights, try ones with Velcro that you can put around your wrists and ankles.
  • It’s hard to have the right technique with weights that don’t have handles, or you can’t wear. Stay away from these because it’s easier to hurt yourself while using them.
  • Choose resistance bands that have a tube in between two handles. Before you start your exercise, feel the tube and search for signs that it’s breaking.
  • An exercise ball might not be for you if your knee isn’t fully mobile or you don’t have strong balance. If you do want to use one, get guidance from a personal trainer or physical therapist.

Yoga

This mind-body exercise can soothe stress and make your rheumatoid arthritis less active.

  • Look for a class that focuses on form and doesn’t rush through poses. Iyengar yoga is a good starting option.
  • Chair yoga is better if your rheumatoid arthritis is severe.
  • Ask the teacher to show you a comfortable resting pose you can do when other participants are doing a pose that doesn’t work for you. You should also let them know if you need any poses modified.
  • Don’t do plough, shoulder stand, and headstand poses.
  • Use a slip-resistant yoga mat.

Tai Chi

You focus on slow, graceful movements when doing this martial art.

  • You may need to do it while sitting down if you struggle with balance or your rheumatoid arthritis is severe.
  • Tell the teacher you need a modified movement if you can’t fully do one.

Flexibility

You can stay flexible through stretches that you hold or exercises that involve a joint’s complete range of motion.

  • Stretching shouldn’t hurt. You should feel tightness instead.
  • Try to do exercises for flexibility every day. If you do them before you go to bed, you may be less stiff when you wake up.
  • Perform range-of-motion exercises 10 times on joints your rheumatoid arthritis impacts.
  • Be careful when stretching joints that are lax or have malalignment.
  • Rolled-up towels or a yoga block can prevent you from stretching your wrists too much when on your hands and knees.
  • To safely stretch your neck, try carefully leaning your head to the left and keeping it there for 5 seconds. Then, bring your head back to the center and carefully lean it to the right, and keep it there for 5 seconds. Repeat that 10 times. You can also slowly rotate your head. In general, be gentle with your neck and keep pressure off the back of it.
  • Do flexibility exercises that are less intense when your rheumatoid arthritis is more active.

It Shouldn’t Hurt

Working out will challenge your body. But if you feel pain, pay attention to it and adjust or stop the exercise as needed. It’s also important that you don’t take more pain medicine than is necessary before you’re active. You don’t want to push yourself too hard.

If you want to continue your workout routine during an RA flare-up, make your sessions shorter and less strenuous.

Show Sources

SOURCES:

UpToDate: “Lateral neck flexion,” “Patient education: Arthritis and exercise (Beyond the Basics).”

Mayo Clinic: “Tai chi: A gentle way to fight stress.”

Exercise is Medicine: “Exercising with Rheumatoid Arthritis,” “Being Active When You Have Rheumatoid Arthritis.”

National Center for Complementary and Integrative Health: “Yoga: What You Need To Know.”

International Osteoporosis Foundation: “What is Sarcopenia?”

Arthritis Foundation: “Best Exercise Equipment for Arthritis,” “14 Ways to Work Out With Arthritis,” “High-intensity Exercise and Rheumatoid Arthritis,” “7 Dynamic Warm Ups,” “Best Exercises for Rheumatoid Arthritis.”

Rheumatoid Arthritis Support Network: “RA and Exercise: Does Exercise Help with Pain and Inflammation?”

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