Rheumatoid Arthritis and Safe Exercise

What is Rheumatoid Arthritis? 
​Rheumatoid Arthritis (RA) is an inflammatory autoimmune disease that occurs when our immune system begins to attack its own tissue. It usually targets joints and specifically the very thin, smooth membrane that lines the joint, providing it with lubrication and nourishment. When this happens, the joint lining (otherwise known as the Synovial Membrane) can become thickened and inflamed causing potential bone erosion or growths to form.

In this picture we can compare a healthy ‘normal’ joint on the left with a think layer of synovial fluid and synovial membrane surrounding the cartilage and bone, protecting the joint. In comparison on the right, we have a joint suffering from RA, with a significantly inflamed synovial membrane that is radiating into the surrounding bone and cartilage.

Am I the only one suffering? 
You are not alone if you have been diagnosed with RA, as over 456,000 people in Australia have reported having RA and it being 1.5 times more prevalent in Women compared to Men. Data has revealed that the initial onset of RA happens most commonly between the ages of 35-64 and those over 75 years old having the highest reported incidences of RA.

A study conducted by the Australian Institute of Health and Welfare that compared bodily pain levels in those with and without RA reported that in participants with RA, aged 45 and over, 68% experienced ‘moderate’ to ‘very severe pain’ in the 4-week study. This made those with RA 3.1 times more likely to experience pain classed as ‘severe’ or ‘very severe’ when compared to those without the condition

What can I do to ease the pain? 
The good news is RA pain levels and flare ups can be significantly reduced through REGULAR AND EXPERTLY PRESCRIBED EXERCISE. We understand that it can cause anxiety and worry when exercising with RA, in fear of increasing pain within the inflamed joints BUT, research tells us that exercise is a crucial element in managing pain and flare ups. 
We know that movement assists in DECREASING STIFFNESS AND INFLAMMATION as it increases lubrication within the joint. Decreasing the level of stiffness within the joint will also INCREASE ITS RANGE OF MOVEMENT, providing a prolonged improvement in mobility. Regular strengthening exercise will also increase the strength of those muscles surrounding the affected joint, REDUCING THE LOAD AND IMPACT they are required to endure. As WEIGHT LOSS can be a by-product of regular exercise this can also assist in reducing the load placed on the joint, decreasing inflammation and wear and tear. 
Not only will regular exercise reduce your RA flare ups and pain levels, it also PROVIDES ENDLESS BENEFITS TO YOUR PHYSICAL AND MENTAL HEALTH long term. This can include preventing the onset of other co-morbidities like heart disease, lifestyle-based diabetes, obesity and even other forms of arthritis. It also improves your mental health, mood, motivation and energy levels to help get you back to doing the things that you enjoy most. 

Should I exercise during a flare up? 
The research states that during a flare up the best practice is to rest the affected joint and COMPLETE LIGHT RANGE OF MOVEMENT BASED EXERCISES, to prevent prolonged stiffness building up within the joint. These movements should be done several times per day and pushed as far as is comfortable. Whilst gentle movements will help to reduce the overall flare up time, resistance and wights should not be used during these periods. 

So, what types of exercises are best? 
There is no one size fits all exercise program for those with Rheumatoid Arthritis and programs should be individualised and tailored to you are your specific presentation. BUT.. the best type of exercise is the one that you enjoy doing the most, as this increases your likelihood to engage in it long term. In regards to assisting with RA pain and flare ups, generally low impact movements are best suited to prevent aggravating the joint. There are 3 main goals involved in RA based exercise programs; 

1. REGAIN AND MAINTAIN RANGE OF MOVEMENT AND FLEXIBILITY WITHIN THE AFFECTED JOINTS. This is achieved through regular passive-based exercises that move a joint through its full range of movement and also stretching. 
2. IMPROVE MUSCLE STRENGTH AND ENDURANCE. Completing joint specific strengthening movements and varying the number of sets and repetitions completed of each movement will provide a good foundation of both muscular strength and endurance to support the joint long term. 
3. INCREASE AEROBIC CONDITIONING TO PREVENT FURTHER CO-MORBIDITIES ASSOCIATED WITH SEDENTARY LIFESTYLES. Engaging in low impact, regular cardiovascular aerobic based exercise such as walking, gentle swimming or bike riding improves heart and lung health to keep you active and healthy for years to come. 

EXERCISE PHYSIOLOGISTS ARE EXPERTS AT PROVIDING EVIDENCE BASED EXERCISE PROGRAMS FOR RHEUMATOID ARTHRITIS! Get in touch today to book an assessment so that we can help reduce your pain and get you back to living life to the fullest. 

By Aleisha Michael,
Accredited Exercise Physiologist.