Living with rheumatoid arthritis is often debilitating, and it can be very frustrating to have your activities curtailed by the condition. Many people believe that rest is the only answer to arthritic pain of all types, but this is incorrect when it comes to rheumatoid arthritis. For people who have rheumatoid arthritis, specific types of exercise and stretches can help.
Although some studies suggest gentle exercise to be helpful with managing the pain of rheumatoid arthritis, some key research suggests that strength training is, in fact, a very important part of an exercise regime for those living with the condition. Moderate or high intensity strength training has been shown to effectively increase or maintain muscle strength, with no recorded adverse effects on pain or progression of the disease. This is not a comprehensive solution, as more research is required in this area, but it is certainly proving effective for many people who live with rheumatoid arthritis.
Exercise to Reduce Rheumatoid Arthritis Pain
One major impact of Rheumatoid Arthritis on the body is the decline in muscle strength levels, both in patients who have lived with the condition for a long time and those who are in the early stages.
Studies show that reduced movement and lower levels of activity in those with rheumatoid arthritis may result in muscle weakness that puts the body until greater pressure. In many cases, this muscle weakness is particularly detrimental to the physical abilities of those living with rheumatoid arthritis, and exercise that builds strength can help. This is seen to have a much greater effect on mobility and movement in the long term than aerobic exercise, although this is also important for general fitness.
Experts recommend at least 30 minutes of moderate intensity physical activity most days for people of all ages, and aerobic exercise is often seen as the most beneficial type. However, for people with rheumatoid arthritis, the evidence suggests that this should be combined with strength training, which could have a very positive effect on many aspects of daily life with the condition. A cautious approach is advised by physical therapists at the American Physical Therapy Association, who suggest doing strength training no more than 2 – 3 times per week for 20-30 minutes.
Working with an expert in this field can help you to devise a fitness regime that is targeted to improve muscle strength and long term prognosis, and it is important to use an exercise plan that takes the condition into account. Several factors should be considered when setting up your plan, including developing the programme to increase the intensity of exercise sessions and the weights used within them.
Research shows that progression is often fast at first, when beginning a strength training routine, and this may be related to adaptations in the neural pathways acting on the nervous system. As training continues, there is a shift to an increased contribution from muscular hypertrophy, and it is in the long term that changes in the tendons, ligaments, cartilage and bone can be seen.
Types of Strength Training
There are three major types of strength training:
- Endurance strength. Endurance strength refers to stamina of the muscles, relating to the ability to maintain a low or medium level of strength or using the same muscles repeatedly. This requires light loads and high numbers of repetitions.
- Explosive strength. Explosive strength, also known as power training, is related to the speed at which one is able to lift or move loads that are sub maximal – that is, lower than the body is capable of lifting. In practical application, this means that you will be working with lower loads, with smaller numbers of repetitions than endurance strength training, but the contraction velocities will be much higher.
- Maximal strength. Maximal strength training involves lifting the largest loads possible at one time. This requires high loads and low repetitions, and is usually used to increase muscle mass and prevent muscle atrophy.
It is the combination of these three types of strength training that is seen to be particularly effective for people with rheumatoid arthritis.
Benefits of Regular Strength Training
It is common for people who are living with rheumatoid arthritis to experience painful swelling which leads to decreased levels of activity – and this can be exacerbated by surgery. Developing muscle tissue to restore normal function can be very challenging, but strength training can be very helpful here. Pre-immobilisation strength training can be particularly advantageous, but this is not always possible. The key to maintaining activity and strength also appears to involve training all major muscle groups in the body, and not focusing the efforts only on areas that are affected by rheumatoid arthritis.
It is important to remember that the beneficial effects of strength training – and, indeed, any exercise programme – depend upon this being incorporated into daily life on a regular basis, and on lifestyle change rather than occasional workout sessions. The rates of disability recorded in patients with rheumatoid arthritis tend to show a slow and steady decline until the age of 65, at which point decline becomes more rapid. Further studies are required in this area, but it is believed that regular and consistent strength training could help to improve these outcomes and protect against the gradual and rapid decline seen here.
Where strength training in patients with rheumatoid arthritis has been studied, there have some decreases in disease activity and pain, and no reported negative effects. It is also well established that physical exercise decreases the risk of falls by improving balance, coordination and reaction time, and this is another good reason to develop your physical exercise regime as part of your lifestyle and management plan for rheumatoid arthritis.
Strength Training and Exercise Empowers Patients with RA
Empowering patients to understand the impact of their lifestyle upon their condition is important for developing treatment in rheumatoid arthritis. Developing an understanding of the way in which their body responds to different exercise programs can enable patients to create and modify their own training programmes in conjunction with professionals, to relieve and manage pain and improve their own outcomes in the future.
It is evident, then, that moderate or high intensity strength training can be beneficial for people who live with rheumatoid arthritis, particularly in terms of increasing or maintaining muscle mass. It is, however, acknowledged that most of the studies in this area have short follow up times, and further studies are needed in order to assess the long term benefits of strength training on bone mineral density, functional capacity and radiologic progression.
Remember that if you have not exercised before, you should consult a doctor before beginning a new exercise regime. If you are working with a specialist for your rheumatoid arthritis, it is helpful to discuss your exercise plan with him or her as well.
How to Exercise Safely with Rheumatoid Arthritis
Whenever you exercise, it is important to take care of your body to prevent any further problems from developing. This is especially important if you have rheumatoid arthritis, and we suggest the following:
1. Stick with it. Don’t worry if you do not feel immediate benefits the first time you exercise, as the effects will be cumulative. If you are seeking relief from pain caused by rheumatoid arthritis, it is important to exercise every day, building up gradually to begin with. If you feel that the first type of exercise you try is not right for you, don’t give up! Encourage a friend to come along with you to build your confidence and give another type of exercise a try.
2. Use the right equipment. Don’t take risks that could worsen your condition or cause another problem for you. Make sure that you are wearing appropriate shoes that offer good support and conditioning for the feet so that joints and ligaments throughout the body are supported, and use equipment that is approved for safe exercise.
3. Don’t slip. Take care to protect your joints as you exercise, risk assessing your activities as you go. For example, you should always use a non-slip mat for yoga or pilates, and do not go walking or running on slippery surfaces or when it is raining. If you are swimming, take great care when walking around the swimming pool and in the changing rooms, as accidents are very common here and this could set back your training regime or cause further problems for your joints.
4. Embrace variety. It’s a good idea not to get stuck in a rut and exercise in a way that stretches only one set of muscles. It is important to vary the type of exercise that you do and to make changes to the duration and intensity of training sessions. This should help to prevent overuse and protect your joints as much as possible.
5. Seek support. If you are joining an exercise class or group, discuss your condition with the instructor so that he or she can take this into account and make adaptations where necessary. When lifting weights, it is especially important to learn the correct way to lift so that you are not putting additional pressure on your body. If you are working with a rheumatology practitioner, you can discuss your exercise regime and take advice on any aspects you may not have considered to ensure that you have a safe and effective workout.
Peter Browne, Consultant Rheumatologist in Tralee & Limerick
Dr Peter is a qualified rheumatologist who sees patients in Tralee and Limerick. To make an appointment, you will need to visit your GP or other healthcare professional, who can refer you to our rheumatology clinic. If you have a query, you can contact us online for more information.