Dr. MJ Bazos MD,
Q & A
About Arthritis and Exercise
This fact sheet answers general questions about
arthritis and exercise. The amount and form of exercise recommended for each
individual will vary depending on which joints are involved, the amount of
inflammation, how stable the joints are, and whether a joint replacement
procedure has been done. A skilled physician who is knowledgeable about the
medical and rehabilitation needs of people with arthritis, working with a
physical therapist also familiar with the needs of people with arthritis, can
design an exercise plan for each patient.
What Is Arthritis?
Arthritis is a general term that
refers to many rheumatic diseases that can cause pain, stiffness, and swelling
in joints and other connective tissues. These diseases can affect supporting
structures such as muscles, tendons, and ligaments and may also affect other
parts of the body. Some common types of arthritis are osteoarthritis, rheumatoid
arthritis, systemic lupus erythematosus, gout, juvenile rheumatoid arthritis,
ankylosing spondylitis, and psoriatic arthritis. Osteoarthritis is the most
Should People With
Yes. Studies have
shown that exercise helps people with arthritis in many ways. Exercise reduces
joint pain and stiffness and increases flexibility, muscle strength, and
endurance. It also helps with weight reduction and contributes to an improved
sense of well-being.
Exercise Fit 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, and instruction about proper use of
joints and ways to conserve energy (that is, not waste motion) as well as the
use of pain relief methods.
Types of Exercise Are Most Suitable for Someone With Arthritis?
Three types of exercise are best
for people with arthritis:
•Range-of-motion exercises help maintain
normal joint movement and relieve stiffness. This type of exercise helps
maintain or increase flexibility.
•Strengthening exercises help keep or
increase muscle strength. Strong muscles help support and protect joints
affected by arthritis.
•Aerobic or endurance exercises improve
cardiovascular fitness, help control weight, and improve overall function.
Weight control can be important to 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.
How Does a Person With Arthritis
Start an Exercise Program?
arthritis should discuss exercise options with their doctors. Most doctors
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. The
doctor will know which, if any, sports are off-limits.
The doctor may have suggestions about how
to get started or may refer the patient to a physical therapist. It is best to
find a physical therapist who has experience working with people who have
arthritis. The therapist will design an appropriate home exercise program and
teach clients about pain-relief methods, proper body mechanics (placement of the
body for a given task, such as lifting a heavy box), joint protection, and
Step Up to
Exercise: How To Get Started
•Discuss exercise plans with your doctor.
•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
•Start strengthening exercises slowly with
small weights (a 1 or 2 pound weight can make a big difference).
•Use cold packs after exercising
(optional; many people with arthritis complete their exercise routine this way).
•Add aerobic exercise.
•Consider appropriate recreational
exercise (after doing range-of-motion, strengthening, and aerobic exercise).
Fewer injuries to arthritic joints 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.
•Ease off if joints become painful,
inflamed, or red and work with your doctor to find the cause and eliminate it.
•Choose the exercise program you enjoy
most and make it a habit. What Are
Some Pain Relief Methods? There are
known methods to stop pain for short periods of time. This temporary relief can
make it easier for people who have arthritis to exercise. The doctor or physical
therapist can suggest a method that is best for each patient. The following
methods have worked for many people:
•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. A health professional can use short waves,
microwaves, and ultrasound to deliver deep heat to noninflamed joint areas. 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 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 (water
therapy) can decrease pain and stiffness. Exercising in a large pool may be
easier because water takes some weight off painful joints. Community centers,
YMCAs, and YWCAs have water exercise classes developed for people with
arthritis. Some patients also find relief from the heat and movement provided by
a whirlpool. •Mobilization therapies
include traction (gentle, steady pulling), massage, and 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
(transcutaneous electrical nerve stimulation) and biofeedback are two additional
methods that may provide some pain relief, but many patients find that they cost
too much money and take too much time. TENS machines cost between $80 and $800.
The inexpensive units are fine. Patients can wear them during the day and turn
them off and on as needed for pain control.
•Relaxation therapy also helps
reduce pain. Patients can learn to release the tension in their muscles to
relieve pain. Physical therapists may be able to teach relaxation techniques.
The Arthritis Foundation has a self-help course that includes relaxation therapy
and also sells relaxation tapes. Health spas and vacation resorts sometimes have
special relaxation courses.
•Acupuncture is a traditional
Chinese method of pain relief. A medically qualified acupuncturist places
needles in certain sites. Researchers believe that the needles stimulate deep
sensory nerves that tell the brain to release natural painkillers (endorphins).
Acupressure is similar to acupuncture, but pressure is applied to the
acupuncture sites instead of using needles.
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 also can be
done daily and should be done at least 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. 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, and resistive water exercises. Correct
positioning is critical, because if done incorrectly, strengthening exercises
can cause muscle tears, more pain, and more joint swelling.
Are There Different Exercises for
People With Different Types of Arthritis?
There are many types of arthritis.
Experienced doctors, physical therapists, and occupational therapists can
recommend exercises that are particularly helpful for a specific type of
arthritis. Doctors and 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 doctor. Doctors who
treat people with arthritis include rheumatologists, general practitioners,
family doctors, internists, and rehabilitation specialists (physiatrists).
How Much Exercise Is too Much?
Most experts agree that if exercise
causes pain that lasts for more than 1 hour, it is too much. People with
arthritis should work with their physical therapist or doctor to adjust their
exercise program when they notice any of the following signs of too much
exercise: •Unusual or persistent
fatigue •Increased weakness
•Decreased range of motion
•Increased joint swelling
•Continuing pain (pain that lasts
more than 1 hour after exercising) Should
Someone With Rheumatoid Arthritis Continue to Exercise During a General Flare?
How About During a Local Joint 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.
Patients can talk to their doctor about how much rest is best during general or
joint flares. Are Researchers
Studying Exercise and Arthritis?
Researchers are comparing the
development of musculoskeletal disabilities, including arthritis, in
long-distance runners and nonrunners. Preliminary results show that running does
not increase the likelihood of developing osteoarthritis. Researchers also are
looking at the effects of muscle strength on the development of osteoarthritis.
Other researchers continue to look for and find benefits from exercise to
patients with rheumatoid arthritis, spondyloarthropathies, systemic lupus
erythematosus, and polymyositis.
Spondylitis Association of America (SAA):
College of Rheumatology: http://www.rheumatology.org