How to Exercise When You Have Arthritis

People with arthritis should always discuss their exercise plans with a healthcare provider. The amount and form of exercise recommended for you will vary depending on:

• Which joints are involved
• The amount of inflammation
• How stable the joints are
• Whether a joint replacement procedure has been done

You should work with a skilled healthcare provider who is knowledgeable about the medical and rehabilitation needs of people with arthritis, and/or a physical therapist who can design an exercise plan for your specific needs.

Should People With Arthritis Exercise?

Studies have shown that exercise helps people with arthritis in many ways. Exercise reduces joint pain and stiffness and increases:

• Flexibility
• Muscle strength
• Cardiac fitness
• Endurance

It also helps with weight reduction and contributes to an improved sense of well-being.

How Exercise Fits Into a Treatment Plan for People With Arthritis?

Exercise is one part of a comprehensive arthritis treatment plan. Treatment plans also may include:

• Rest and relaxation
• Proper diet
• Medication

Treatment also may include instruction on:

• Proper use of joints
• Ways to conserve energy
• Other pain relief methods

3 Types of Exercise Are Best for People With Arthritis

• Range-of-motion exercises, like dance, help maintain normal joint movement and relieve stiffness. This type of exercise helps maintain or increase flexibility.
• Strengthening exercises, such as weight training, help keep or increase muscle strength. Strong muscles help support and protect joints affected by arthritis.
• Aerobic or endurance exercise, such as bicycle riding, improves cardiovascular fitness, helps control weight, and improves overall function.

Weight control can be important for people who have arthritis because extra weight puts extra pressure on many joints. Some studies show that aerobic exercise can reduce inflammation in some joints.

Most health clubs and community centers offer exercise programs for people with physical limitations.

How to Start an Exercise Program

People with arthritis should discuss exercise options with their healthcare providers. Most practitioners recommend exercise for their patients. Many people with arthritis begin with easy, range-of-motion exercises and low-impact aerobics. People with arthritis can participate in a variety of, but not all, sports and exercise programs. Your healthcare provider will know which, if any, sports are off-limits.

Your healthcare provider may have suggestions about how to get started or may refer you to a physical therapist. It is best to find a physical therapist who has experience working with people who have arthritis. The physical therapist will design an appropriate home exercise program and teach you about:

• Pain-relief methods
• Proper body mechanics (placement of the body for a given task)
• Joint protection
• Conserving energy

How to Get Started

• Discuss exercise plans with your healthcare provider.
• Start with supervision from a physical therapist or qualified athletic trainer.
• Apply heat to sore joints (optional; many people with arthritis start their exercise program this way).
• Stretch and warm up with range-of-motion exercises.
• Start strengthening exercises slowly with small weights (a 1- or 2-pound weight can make a big difference).
• Progress slowly.
• Use cold packs after exercising (optional; many people with arthritis complete their exercise routine this way).
• Add aerobic exercise.
• Ease off if joints become painful, inflamed, or red, and work with your healthcare provider to find the cause and eliminate it.
• Choose the exercise program you enjoy most and make it a habit.

Consider appropriate recreational exercise (after doing range-of-motion, strengthening, and aerobic exercise). Fewer injuries to joints affected by arthritis occur during recreational exercise if it is preceded by range-of-motion, strengthening, and aerobic exercise that gets your body in the best condition possible.

How Often Should People With Arthritis Exercise?

• Range-of-motion exercises can be done daily and should be done at least every other day.
• Strengthening exercises should be done every other day unless you have severe pain or swelling in your joints.
• Endurance exercises should be done for 20 to 30 minutes three times a week unless you have severe pain or swelling in your joints. According to the American College of Rheumatology, 20- to 30-minute exercise routines can be performed in increments of 10 minutes over the course of a day.

Are Researchers Studying Arthritis and Exercise?

Researchers continue to look for and find benefits from exercise to patients with:

• Rheumatoid arthritis
• Spondyloarthropathies
• Lupus
• Fibromyalgia

Researchers are also studying the benefits of exercise in older populations.

Exercise for Specific Types of Arthritis

There are many types of arthritis. Exercises that are particularly helpful for a specific type of arthritis can be recommended by:

• Experienced healthcare providers
• Physical therapists
• Occupational therapists

Healthcare providers and physical therapists also know specific exercises for particularly painful joints. There may be exercises that are off-limits for people with a particular type of arthritis or when joints are swollen and inflamed. People with arthritis should discuss their exercise plans with a healthcare provider. Medical professionals who treat people with arthritis can include:

• Rheumatologists
• Orthopedic surgeons
• General practitioners
• Family doctors
• Internists
• Rehabilitation specialists

What Type of Strengthening Program Is Best?

This varies depending on personal preference, the type of arthritis involved, and how active the inflammation is. Strengthening one's muscles can help take the burden off painful joints. Strength training can be done with:

• Small free weights
• Exercise machines
• Isometrics
• Elastic bands
• Resistive water exercises

Correct positioning is critical because if done incorrectly, strengthening exercises can cause:

• Muscle tears
• More pain
• More joint swelling

How Much Exercise Is Too Much?

Most experts agree that if exercise causes pain that lasts for more than 1 hour, it is too strenuous. People with arthritis should work with their physical therapist or healthcare provider to adjust their exercise program when they notice any of the following signs of strenuous exercise:

• Unusual or persistent fatigue
• Increased weakness
• Decreased range of motion
• Increased joint swelling
• Continuing pain (pain lasting more than 1 hour after exercising)

Should Someone With RA Exercise During a Flare?

It is appropriate to put joints gently through their full range of motion once a day, with periods of rest, during acute systemic flares or local joint flares. However, an inflamed joint should not be stretched. During an active flare, swelling in the joint can cause tendons, ligaments, and the joint capsule to be stretched at baseline, and further voluntary stretching may cause laxity and damage to the joint.

You can talk to your healthcare provider about how much rest is best during general or joint flares.

What Are Some Pain Relief Methods for People With Arthritis?

There are known methods to help stop the pain for short periods of time. This temporary relief can make it easier for people who have arthritis to exercise. Your healthcare provider or physical therapist can suggest a method that is best for each patient. These methods have worked for many people.

Moist Heat

Moist heat supplied by warm towels, hot packs, a bath, or a shower can be used at home for 15 to 20 minutes three times a day to relieve symptoms.

Deep Heat

A health professional can deliver deep heat to noninflamed joint areas by using:

• Short waves
• Microwaves
• Ultrasound

Deep heat is not recommended for patients with acutely inflamed joints. Deep heat is often used around the shoulder to relax tight tendons prior to stretching exercises.

Cold

Cold supplied by a bag of ice or frozen vegetables wrapped in a towel helps to stop pain and reduce swelling when used for 10 to 15 minutes at a time. It is often used for acutely inflamed joints. People who have Raynaud's phenomenon should not use this method.

Hydrotherapy

Hydrotherapy (water therapy) can decrease pain and stiffness. Exercising in a large pool may be easier because water takes some weight off painful joints. Many community centers have water exercise classes developed for people with arthritis. Some people also find relief from the heat and movement provided by a whirlpool.

Mobilization

Mobilization therapies include:

• Traction (gentle, steady pulling)
• Massage
• Manipulation (using the hands to restore normal movement to stiff joints)

When done by a trained professional, these methods can help control pain and increase joint motion and muscle and tendon flexibility.

TENS Units

TENS (transcutaneous electrical nerve stimulation) may provide some pain relief. In TENS, an electrical shock is transmitted through electrodes placed on the skin's surface. You can wear a TENS unit during the day and turn it off and on as needed for pain control.

Biofeedback

Biofeedback may help relax muscles and control your responses to pain.

Relaxation

Relaxation therapy also helps reduce pain. People can learn to release the tension in their muscles to relieve pain. Therapists may be able to teach relaxation techniques.

Acupuncture/Acupressure

Acupuncture is a traditional Chinese method of pain relief. Researchers believe that the needles stimulate deep sensory nerves that tell the brain to release natural painkillers.

Acupressure is similar to acupuncture but uses pressure instead of using needles.