Rheumatoid Arthritis: The Essential Guide to Physical Activity

Understanding Rheumatoid Arthritis (RA) and Its Impact: Rheumatoid arthritis (RA) is a chronic autoimmune condition that primarily affects the joints, leading to pain, stiffness, and reduced mobility. The most common symptoms include joint pain and morning stiffness, which can progress into deformities and significant impairment of function over time. RA typically starts in the smaller joints of the hands, wrists, feet, and elbows, affecting both sides of the body symmetrically. As the disease advances, larger joints such as the knees, hips, and even the spine may become involved. This progression not only impacts physical function but also affects overall quality of life, making mobility a major challenge.

How Physical Activity Influences RA: Contrary to the belief that rest alleviates pain, regular physical activity has been proven to relieve pain, improve joint function, boost mood, and reduce fatigue in RA patients. The right types of exercise can even enhance sleep quality and overall well-being. However, not all exercises are suitable for individuals with RA, as some movements can exacerbate symptoms. It’s essential to know which activities are beneficial and how to adapt exercises to your current abilities.

Recommended Physical Activities for RA: Patients with RA should prioritize low-impact exercises that maintain joint health without adding undue stress. High-impact activities such as running or jumping and heavy lifting should be avoided. Below are some ideal physical activities for RA:

• Walking: A simple yet effective aerobic exercise that benefits the cardiovascular system and overall well-being. Adjust the pace to your comfort level and be mindful of foot placement, especially when walking downhill.
• Swimming and Water Exercises: The buoyancy of water supports body weight, reducing stress on joints while promoting flexibility and strength.
• Cycling: Improves cardiovascular health, muscle strength, and joint mobility. Stationary bikes are especially useful as they allow for adjustable difficulty levels.
• Yoga and Pilates: Help improve flexibility, strength, and balance while providing mental relaxation.
• Strength Training: Focuses on building muscle to support joint function. This is particularly important as RA can lead to muscle loss and joint instability.

Detailed Reviews of Physical Activities:

1. Aerobic Activities: Activities such as walking, cycling, swimming, and dancing can significantly benefit the cardiovascular and respiratory systems. Given the increased risk of cardiovascular disease in RA patients, aerobic exercises are essential. These activities should be done at a moderate intensity, around 60-80% of your maximum heart rate, for 30-60 minutes, three to five times per week.

   Recommendations for Aerobic Activity:

   • Intensity: 60-80% of maximum heart rate
   • Duration: 30-60 minutes
   • Frequency: 3-5 times per week

2. Strength Training: RA often leads to decreased muscle mass and joint functionality, making strength training an important component of any exercise regimen. Research has shown that strength training can reduce pain, improve joint stability, and help maintain muscle mass. Focus on exercises that work large muscle groups and those that target the smaller muscles of the hands and arms, which are often affected first by RA.

   Key Points for Strength Training:

   • Use free weights, resistance bands, or your own body weight.
   • Aim for 8-12 repetitions per exercise, with 2-3 sets.
   • Rest for about 3 minutes between sets.
   • Perform strength training 2-3 times a week.

   Examples of Strength Exercises:

   • Soft Ball Squeezes: Use a soft ball (not a tennis ball) to perform hand-strengthening exercises. Squeeze the ball 8-12 times for three sets.
   • Squats: A great exercise for larger muscle groups that supports knee and hip joint health. Adjust the repetitions and add weights if you’re comfortable.
   • Toe Lifts: Stand on your toes for 2-3 seconds and lower back down. This can be modified by performing the exercise while sitting on the floor and pushing against a pillow for resistance.

3. Flexibility and Mobility Exercises: Stretching and flexibility exercises like yoga, tai chi, and targeted stretching routines help maintain joint range of motion and reduce stiffness. These exercises are especially beneficial in the morning when RA stiffness is most pronounced.

   Recommendations for Flexibility Exercises:

   • Perform stretching exercises daily or at least twice a week for more intensive sessions.
   • Warm up before stretching to reduce the risk of injury.
   • Hold each stretch for 30 seconds and repeat as needed.

   Examples of Flexibility Exercises:

   • Finger Stretches: Make a fist and then open your hand, extending your fingers as far as possible. Repeat up to 20 times.
   • Wrist Rotations: Rotate your wrist 10 times in each direction. For a deeper forearm stretch, use your other hand to gently push your wrist into flexion and hold for 30 seconds.
   • Elbow Extensions: Extend your elbow with the palm facing forward. Use the other hand for support if needed, holding for 30 seconds and repeating twice on each side.

Tips for Safe Exercise:

• Always listen to your body and adjust the intensity of the exercises according to your capabilities.
• If you have any other medical conditions or injuries, consult your doctor or a physical therapist for guidance.
• Warm up before exercising to prepare your joints and muscles, reducing the risk of injury.

Managing Expectations and Staying Consistent: Living with RA requires a balanced approach. While exercise is beneficial, it’s important to rest when necessary, especially during flare-ups. Regular, moderate physical activity can improve symptoms over time, but results may not be immediate. Patience and consistency are key. Remember that a holistic approach combining medication, physical activity, a healthy diet, and stress management can greatly enhance your quality of life.

Final Thoughts: Physical activity is a powerful tool for managing RA. By choosing the right exercises and staying active, you can reduce pain, maintain joint function, and improve your overall well-being. If you’re unsure where to start, consult with a healthcare professional or a kinesiologist who can tailor an exercise plan to meet your needs.

Acknowledgment: Special thanks to Boštjan Holobar, kinesiologist, for his insights and recommendations.