Is gym exercise or hot yoga more suitable for patients with rheumatoid arthritis?

Exercise Recommendations for Rheumatoid Arthritis: Gym vs. Hot Yoga

For patients with rheumatoid arthritis, consistent engagement in traditional gym exercise is generally more suitable than hot yoga, though both can be beneficial when properly tailored to the individual's disease state and capabilities. 1

General Exercise Recommendations

• The American College of Rheumatology (ACR) strongly recommends consistent engagement in exercise over no exercise for patients with rheumatoid arthritis (RA), based on moderate certainty evidence showing improved physical function and pain 1
• Exercise programs should be tailored to each patient's disease trajectory, capabilities, and access to facilities 1
• Exercise is safe for RA patients and has consistently shown RA-specific benefits including improved disease activity, reduced symptoms like fatigue and pain, and improved function and mental health 2

Gym Exercise for RA

• Consistent engagement in resistance exercise (typically performed in gym settings) is conditionally recommended for RA patients based on evidence showing improvements in both physical function and pain 1
• Options for resistance exercise include weight machines, resistance training with elastic bands, and isometric exercises 3
• 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
• Aerobic exercise (available in gym settings) is conditionally recommended for RA patients, showing improved physical function 1
• Walking on a treadmill and cycling on stationary bicycles are effective aerobic options that can reduce impact on joints 3
• Exercise programs are more effective when supervised by physical therapists or in class settings rather than performed alone at home 1, 3

Yoga for RA

• Mind-body exercise (including yoga) is conditionally recommended for RA patients based on very low to low certainty evidence showing improved physical function but no difference in pain 1
• Yoga may be beneficial for improving physical function, disease activity, and grip strength in patients with RA 4
• A meta-analysis showed that yoga practice in RA patients helped decrease disease activity through improvement of pain and joint inflammation 5
• However, the ACR makes no specific recommendations regarding hot yoga for RA patients 1
• Hot yoga may present additional challenges for RA patients due to the high temperature environment, which could potentially exacerbate symptoms in some individuals 1

Important Considerations and Cautions

• Avoid vigorous, repetitive exercises that use unstable joints and overstretching for RA patients 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
• The Voting Panel and patient panel emphasized the importance of appropriate prescription and supervision of resistance exercise by physical therapists or other qualified exercise professionals to prevent harm 1

Practical Implementation

• 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
• Exercise programs are more effective when combined with self-efficacy training and self-management interventions 1, 3
• Comprehensive physical therapy and occupational therapy are conditionally recommended for RA patients 1

Conclusion

While both gym exercise and yoga can benefit RA patients, traditional gym-based exercise programs offer more comprehensive options with stronger evidence supporting their use. The structured environment of a gym allows for supervised resistance training, which has shown benefits for physical function and pain in RA patients. Hot yoga specifically may present additional challenges due to the high temperature environment, which could potentially exacerbate symptoms in some individuals. The decision should be guided by patient preference, access, and disease state, with proper supervision from qualified professionals.