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 2
- Cycling on stationary bicycles is another effective aerobic option that reduces impact on joints 2
- Aim for 30-60 minutes of aerobic activity, 3-7 days per week 3
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 2
- 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 3
- 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 3
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 2
- Particularly beneficial for patients with significant joint pain or those who have difficulty with weight-bearing exercises 2
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 4
Implementation Approach
Exercise Prescription Guidelines
- Start with repeated short bouts of low-intensity exercise daily, progressively increasing duration 3
- For cardiovascular exercise, begin with brief 10-minute sessions, adding 5 minutes per session until reaching 30 minutes 3
- Exercise affected joints using a pain-free range of motion for flexibility training 3
- Overall, exercise programs are more effective when supervised by physical therapists, sometimes in a class setting, rather than performed alone at home 2
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 5
- Enhances cardiovascular health, reducing the excess cardiovascular risk associated with RA 6
- Improves muscle strength and helps reverse "rheumatoid cachexia" (accelerated muscle loss) 5
- Reduces fatigue and pain symptoms 4
- Improves psychological health, self-esteem, and sleep quality 7
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 2
- Avoid vigorous, repetitive exercises that use unstable joints and overstretching 3
- Avoid exercising joints during disease flare-ups 3
- 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 3
- Morning exercise may need to be avoided if RA-related morning stiffness is present 3
Practical Implementation
- Exercise recommendations should focus on patient preferences and access, which are important barriers to participation 2
- Exercise programs are more effective when combined with self-efficacy training and self-management interventions 2
- Healthcare provider recommendation is one of the strongest factors associated with patients engaging in physical activity 4
- Patient education about the safety and benefits of exercise is essential to overcome fears of joint damage 4