Please note

that these recommendations have been produced specifically to help people with, or at risk of, a long term condition, aiming to do moderate activity only.

Rheumatoid Arthritis prescription

Rheumatoid Arthritis and Physical Activity

Rheumatoid arthritis causes inflammation, pain and swelling of joints. Severity can vary from mild to severe. Modern medical treatments attempt to prevent progression and ease pain. Unfortunately, many people wrongly believe that activity causes further damage to the joints. Poor posture, incorrect movement and pain develop if you avoid movement as a result of discomfort. Being regularly active, therefore, helps to keep your joints healthy by preventing weakness and stiffness.

Being active also helps reduce the higher risk of cardiovascular disease seen in people with rheumatoid arthritis. Overall, if you have rheumatoid arthritis then moderate levels of activity has no ill effects on your joints and importantly it has a very positive effect on reducing the risk of weakening bones (osteoporosis), cardiovascular disease and fatigue. 1 2 Try to keep your body moving and help the muscles become stronger by being more active. Even a small increase will help you live a healthier, longer life.

Regular physical activity also gives you more energy, builds confidence and can help you to sleep more soundly at night. You can combine your activity time with family and friends or use it as an opportunity to reflect on things and listen to your favourite music.

Physical Activity Recommendations for inactive adults with Rheumatoid arthritis

Aim to do the following three types of activity:
  • Aerobic activity at relative moderate intensity for at least 150 minutes (2 hours and 30 minutes) a week – one way to approach this is to do 30 minutes on at least five days each week.
  • Muscle strengthening activity on two or more days a week which work all major muscles groups (legs, hips, back, abdomen, chest, shoulder and arms)
  • Flexibility exercises on a daily basis
Do not worry if you struggle to meet the Guideline, because by trying to become more active, you are still gaining some health benefits.

The Three Types of Activity and Rheumatoid arthritis

You may find the following weekly approach useful if you have been inactive for a while.

Aerobic activity

aerobic

Aerobic activity, also known as endurance activity, is when large muscle movements, maintained over a period of time, make the heart and lungs work harder.

Activity? – Any type that you can main comfortably is ideal. Choose exercises that you enjoy, such as walking, cycling or group fitness classes. Types of activity may need to be adapted depending on which joint are being affected from time to time. Examples for different types of activities can be seen overleaf.

How long (duration)? – You can split your total activity amount into minimum bouts of 10 minutes if needed. If you have been inactive for a long time, start with short daily amounts and increase this as your body allows and you feel more confident. Remember not to sit for hours. A regular break from sitting every hour is healthy.

How hard (intensity)? – Try to progress gradually over time to a relatively modeProgress slowly to a relatively moderate-intensity activity. When doing moderate intensity activity you will feel warm, mildly out of breath and mildly sweaty. The ‘talk test’ is a simple way to measure moderate intensity. This means that you can still talk, but not sing, during the activity. Intensity levels reached will vary from time to time according to any painful joints

How often (frequency)? – If you aim to do 30 minutes per day then do this at least 5 times per week so that you reach the 150 minutes total per week. Distribute the sessions over the week and aim to have no more than 2 consecutive days without physical activity. When you start any new activities make sure you give your body enough time to recover and adapt between sessions.


Muscle Strengthening

strengthening

Painful joints often lead to weaker, smaller muscles. Strength training aims to prevent this from progressing over time. Specific exercises for the most effected joint can be recommended by your doctor or physiotherapist.

Aim to do strengthening activities on at least 2 days a week. Some activities, such as climbing stairs, digging the garden or walking up hill, combine aerobic and muscle strengthening types. They should work all the major

muscle groups in your body such as legs, hips, back, chest, abdomen, shoulders and arms. Begin with simple movements and add loads such as your own body weight or additional weights when you feel confident and you have a good range of joint movement. If you have difficulties moving the joint fully then do not use additional weights.

If you are using weights such as dumbbells, try to do at least 1 set of 8-12 repetitions per activity. The correct weight choice is the one which is hard to complete by the end of the set. A repetition is one complete movement of an activity, like doing a sit up or bicep curl.


Flexibility Exercises

stretching

Daily flexibility exercises can prevent pain, stiffness, and injury of muscles and joints. People often experience a sense of wellbeing and relaxation during flexibility exercises. Some quick and simple movements can be found in our separate exercise sheet. Yoga, Tai Chi and Pilates are examples of some activities which combine strength and flexibility as well as balance training.


Examples of Aerobic Activities for adults with joint pain

Activity Description
Walking This is safe and inexpensive. Wear well supported shoes with good absorption. Walk on flat, even ground.
Cycling Cycling avoids heavy joint load and increases fitness and muscle strength. You can progress to outdoor cycling which can help with balance. Choose a comfortable bike seat and adjust the seat height so that the knee’s angle is 10-15 degree when most extended. Cycling does requires 90 degrees of bending at the knee.
Swimming and Running in Water This type of exercise avoids heavy stress on joints.
Treadmill Easy to use but requires good balance. Choose a treadmill with soft surface and handrails. Avoid downward grades.
Fitness classes Choose aerobic classes that have the least amount of high impact. Some classes such as step-aerobics are a great way to keep fit but the impact involved may be too high for your weight bearing joints.
 

Safety considerations

  • If you have led a very sedentary lifestyle, begin by doing low intensity exercise of short duration, e.g. 10 minutes.
  • Stop exercising if you feel dizzy, sick, unwell or very tired.
  • See a doctor if you are having chest pain, black outs or breathlessness on mild exertion.
  • Starting physical activity and exercise can often cause pain. This temporary increase in pain is seen as harmless soreness caused by new stresses being put through disused joints and muscles. Don’t let this put you off because your body will adapt to this with time.
  • If you experience pain which persists or gets worse on the following day you may have increased your intensity or your session time too quickly. Lower the amount you are doing and build up gradually again.
  • Ice packs wrapped in a damp towel should be applied to painful joints if you feel that you have overdone things or if the joint is swollen after exercise. See your doctor if symptoms are more than what you would expect or if things do not settle down
  • If you have difficulty moving the joint in full range of motion, do not use additional weights.
  • If your joints become hot or swollen, leave out strengthening exercises until it settles down again.

Please see the following safety considerations if you have other long term health conditions.

Disclaimer

This leaflet has been provided for information only. ALWAYS check with your doctor if you have any concerns about your condition or treatment. Prescription4exercise.com is not responsible or liable, directly or indirectly, for ANY form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by this information.

Further reading

  • Start Active, Stay Active – a report on physical activity for health from the four home countries ‘ Chief Medical Officers. UK Department of Health, July 2011. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128209
  • ACSM’s Guidelines for Exercise Testing and Prescription, American College of Sports Medicine, 2009
  • Swedish National Institute of Public Health. Physical Activity in the Prevention and Treatment of Disease. Professional Associations for Physical Activity, Sweden, 2010. Rheumatoid Arthritis. 567-577. www.fyss.se

References:

  1. De Jong Z et al. Safety of exercise in patients with rheumatoid arthritis. Current Opinion in Rheumatology 2005: 53:410-7
  2. Metsios GS et al. Rheumatoid arthritis, cardiovascular disease and physical exercise: a systematic review. Rheumatology 2008;47(3):239-48

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