Influence of Rheumatoid Arthritis on physical activity

Joint pain and their morning stiffness are the most common symptoms of Rheumatoid Arthritis (RA), which can develop into deformities, extensive impairment of functionality, and loss of mobility. It is a systemic inflammatory disease that usually first affects smaller joints of hands, wrists, feet and elbows on both sides. As the disease progresses, larger joints such as the knees, hips, and less commonly the spine can also be affected. Pain and impairment of function with progression become more severe and begin to interfere with normal daily movements. This has a major impact on mobility and quality of life. In most cases, the progression of the disease is slow, but more aggressive cases can occasionally occur. Some other signs are also malaise, loss of appetite, weight loss, fatigue, rarely slightly elevated body temperature. RA also increases the risk of cardiovascular disease in patients.

Influence of physical activity on RA

Painful, swollen and stunted joints and increased fatigue would distract many people from physical activity, thinking that less they move, the less pain there will be. But it is not correct! Regular exercise has been proved to help relieve pain, improve functionality, reduce depression and fatigue, and improve sleep quality and general well-being. To achieve the desired goals, it is important to know which physical activity brings positive effects, as inappropriate exercise can also worsen the symptoms. People with RA should avoid jumping exercises, running and very heavy loads. Recommended physical activity includes: walking, swimming, stretching exercises, strength exercises, yoga, stability exercises, Pilates, water exercise, cycling, etc.

Review of physical activities

Exercises such as aerobics, strength training and stretching exercises can improve joint mobility, increase strength and endurance, and have a positive effect on heart function and well-being. Of course, you have to be careful with inflamed joints and exercise. Adjust the intensity to your abilities and choose the type of exercise in which you notice the greatest positive effect. If you also have any other illnesses or injuries, and you are not sure which exercises you can do, consult your doctor or any other health and exercise professional before performing physical activity.

Aerobic activities

Activities, such as walking, cycling, swimming, water exercise and dancing have a positive effect on the cardiovascular and respiratory system. Due to the increased risk of cardiovascular disease, aerobic activities are important for patients with RA. Cycling and swimming also affect muscle strength and joint mobility. Adjust the intensity of the exercise according to your abilities and illness.

Recommendations:

Type of activity	Intensity	Exercise length	Frequency
Aerobic activity (walking, cycling…)	60-80% of maximum heart rate	30-60 min	3-5 times a week

WALKING

Walking is suitable for almost anyone, except in cases where the disease has progressed to the point where walking is too painful or impossible for other reasons. Walking has a good effect on the cardiovascular and aerobic system as well as well-being. The speed or intensity should be adjusted to your abilities and be especially careful not to hit the ground with your heel, which can happen quickly, especially when walking downhill.

CYCLING

Cycling is a good aerobic exercise that improves the functioning of the cardiovascular system. Also, it strengthens the leg muscles, improves the mobility of the lower extremities and their endurance. Today’s exercise bikes also offer a range of options to adjust the difficulty to your abilities.

Strength training

Due to the observed loss of muscle mass and joint functionality in people with RA, exercise that encourages muscle hypertrophy and strengthens muscles and joints is desirable. Numerous studies have found positive effects of strength training in RA patients, including decreased loss of muscle mass, a decrease in fat tissue, and an improvement in motor skills. Exercises involving larger muscle groups have been proven to be most effective. In a two-year study by A. Häkkinen, in addition to higher muscle strength, improvements in symptoms, such as reduced pain and joint stiffness were also noted.

While strength training, pay special attention to performing the exercises correctly, as improper performance increases the possibility of injury or unwanted long-term effects. Adjust the intensity of the exercise to your abilities. If you have any other health problems that prevents you from performing certain exercises, adjust the selection of exercises and / or discuss the selection with your doctor or specialist. It is recommended to do 8 to 10 different exercises per workout for larger muscle groups and muscles of the whole arm, including the fingers and palms, which the disease often attacks first.

Recommendations:

Type of activity	How	Intensity	No. of repeats	No. of series	Frequency
Strength training	Free weights, own weight, fitness equipment, elastic bands	60-80% maximum heart rate	8-12	2-3 with 3 min breaks in between the series	2-3 times a week

Some examples of exercises you can do at home

Soft ball squeezing exercises

Perform the exercise simply by squeezing a soft ball in the palm of your hand. The ball should be soft to allow greater mobility of the movement; a tennis ball is not suitable. You can also replace the ball at home with a car cleaning sponge, just cut it to the appropriate size. Follow the instructions in the table above and squeeze the ball 8-12x in three series.

Squats

Squat is a good exercise that involves large muscle groups and has a good effect on slowing down the spread of the disease to the knee and hip joints. Adjust the load to your own abilities by adjusting the number of repeats. In case you can easily do 3 sets of squats with 15 repeats, you can make the exercise more difficult by adding weights. On the contrary, if squats are too demanding for you, you can perform it with a chair, while also adjusting the height and helping yourself with your hands if necessary. Be careful not to fall on the chair, but to sit down in a controlled manner.

Lift on your toes

Perform the exercise by simply lifting yourself on your toes, staying like this for 2-3 seconds, and lowering yourself down again. Keep your hands resting on a wall or other surface to help maintain balance, but do not facilitate lifting on your toes if this is not necessary. You can perform the exercise with both feet or in a more difficult way with one foot. You can also make the exercise easier by leaning a pillow against the wall and sitting on the floor with your feet against the pillow. Then push the pillow against the wall with your foot for 2-3 seconds and let go again. Be sure to perform the exercise with your foot, so if possible, perform the exercise with your legs outstretched.

Hand squeeze with your arms outstretched in front of you

It is an isometric contraction in which you tense your muscles without making your body move. Place your palms side by side as if clasping at chest height. Press them hard against each other and hold them for 5 seconds, then rest for 5 seconds. You can make the exercise more difficult by extending the pressing time to 15 seconds per repeat. If this is too easy for you, you can instead perform push-ups with your hands on a raised support. Pay attention to performance and your own abilities.

Exercise for joint flexibility and mobility

These include mainly yoga, Pilates, tai chi and stretching exercises. Stretching exercises can improve joint mobility, reduce stiffness, and increase range of motion in joints. The ideal set of stretching exercises can vary between individuals according to the affected joints, disease progression, symptoms, and other potential health factors. Stretching exercises are recommended to be performed several times a week, and especially in the morning as regular routine exercise can help you reduce morning stiffness and improve your mobility in the long run. Warm up well before performing the exercises, as it will improve the effectiveness of the exercises, reduce the possibility of injury and increase the range of motion.

Recommendations:

Type of activity	How	Intensity	Duration	Frequency
Flexibility and mobility	Stretching exercices, yoga, Tai-chi	Low to moderate	10-20 min	Daily or at least twice a week more intensively

Some examples of stretching and mobility exercises you can perform at home

Fingers stretching

Make a fist and then open your palm at a moderate pace and extend your fingers as far as you can. Repeat this several times, depending on your abilities up to 20 times. You can do the exercise daily or even twice a day. Above all, be careful that it is not too painful. The goal is to gradually improve mobility.

Palm stretching

The exercise you can do in sequence is to rotate your wrist and stretch it. Rotate slowly or at a moderate pace and achieve the deviations allowed by your wrist. Rotate 10 times in one direction and then 10 more times in the other direction. To stretch in the forearm, bend your wrist and point your palm down, you can increase the stretch with your other hand by pushing your palm into an even greater wrist flexion. Hold for up to 30 seconds and repeat alternately with each hand twice. After, perform the exercise pointing your palm upwards.

Elbow extension

Place your palm in front of your face and turn it towards you. Then extend your elbow so that your palm gets further and lower of your face. If you are not able to fully extend your elbow, help yourself with the other hand to avoid severe pain. Hold the elbow extended for 30 seconds and repeat it alternately with each hand twice.

Key tips

Keep moving and try to find out which exercises work for you. Remember that many of the symptoms of rheumatoid arthritis that affect your movement can be alleviated by physical activity. Adjust the exercise according to your own abilities and spatial possibilities. If you are unsure or you would like to learn more, consult your personal physician or movement expert.

Boštjan Holobar, kinesiologist