What is the best exercise for patients with rheumatoid arthritis (RA)?

Best Exercise for Rheumatoid Arthritis

Consistent engagement in exercise is strongly recommended for all patients with rheumatoid arthritis (RA), with a combination of aerobic, resistance, and aquatic exercises providing the most comprehensive benefits for improving physical function and reducing pain. 1

Types of Exercise Recommended for RA

Aerobic Exercise

• Conditionally recommended for RA patients based on very low to low certainty evidence showing improved physical function 1
• Walking is one of the most commonly studied and accessible forms of aerobic exercise, either on a treadmill or as supervised community-based indoor fitness walking 1
• Cycling on stationary bicycles is another effective aerobic option that reduces impact on joints 1
• Aim for 30-60 minutes of aerobic activity, 3-7 days per week 1

Resistance Exercise

• Conditionally recommended for RA patients based on very low to low certainty evidence showing improvements in both physical function and pain 1
• Options include isokinetic weight machines, resistance training with elastic bands, and isometric exercises 1
• For patients with active RA, begin with lower resistance (40-60% of one repetition maximum) with 15-20 repetitions, focusing on proper form and breathing 1
• Initially start with as few as 2-3 repetitions based on pain threshold and gradually work up to 10-12 repetitions, 2-3 days per week 1

Aquatic Exercise

• Conditionally recommended for RA patients based on low certainty evidence showing improvement in physical function 1
• Combines aspects of aerobic fitness and joint range of motion exercises in a low-impact environment 1
• Particularly beneficial for patients with significant joint pain or those who have difficulty with weight-bearing exercises 1

Mind-Body Exercise

• Conditionally recommended for RA patients based on very low to low certainty evidence showing improved physical function 1
• Includes practices such as yoga, Tai Chi, and Qigong 1
• May provide additional benefits for stress reduction and mental health 2

Implementation Approach

Exercise Prescription Guidelines

• Start with repeated short bouts of low-intensity exercise daily, progressively increasing duration 1
• For cardiovascular exercise, begin with brief 10-minute sessions, adding 5 minutes per session until reaching 30 minutes 1
• Exercise affected joints using a pain-free range of motion for flexibility training 1
• Overall, exercise programs are more effective when supervised by physical therapists, sometimes in a class setting, rather than performed alone at home 1

Professional Support

• Comprehensive physical therapy is conditionally recommended for RA patients 1
• Comprehensive occupational therapy is conditionally recommended for RA patients 1
• For patients with hand involvement, hand therapy exercises are conditionally recommended 1

Benefits of Exercise in RA

• Improves disease activity measures and reduces systemic inflammation 3
• Enhances cardiovascular health, reducing the excess cardiovascular risk associated with RA 4
• Improves muscle strength and helps reverse "rheumatoid cachexia" (accelerated muscle loss) 3
• Reduces fatigue and pain symptoms 2
• Improves psychological health, self-esteem, and sleep quality 5

Important Considerations and Cautions

• There is no uniformly accepted level of pain at which a patient should or should not exercise; a shared decision-making approach between clinician and patient is advisable 1
• Avoid vigorous, repetitive exercises that use unstable joints and overstretching 1
• Avoid exercising joints during disease flare-ups 1
• Discontinue exercise if the patient experiences unusual or persistent fatigue, increased weakness, decreased range of motion, or if joint swelling or pain lasts more than one hour after exercise 1
• Morning exercise may need to be avoided if RA-related morning stiffness is present 1

Practical Implementation

• Exercise recommendations should focus on patient preferences and access, which are important barriers to participation 1
• Exercise programs are more effective when combined with self-efficacy training and self-management interventions 1
• Healthcare provider recommendation is one of the strongest factors associated with patients engaging in physical activity 2
• Patient education about the safety and benefits of exercise is essential to overcome fears of joint damage 2