What exercises are recommended during a rheumatoid arthritis (RA) flare-up?

Exercise Recommendations During Rheumatoid Arthritis Flare-Ups

During a rheumatoid arthritis flare-up, mind-body exercises like gentle yoga, Tai Chi, and Qigong are most recommended as they can improve physical function without exacerbating pain or inflammation. 1

Types of Exercise Recommended During Flares

• Mind-body exercises are conditionally recommended by the American College of Rheumatology during periods of active disease as they can improve physical function without worsening pain 2

  • Gentle yoga, Tai Chi, and Qigong can be performed with modifications to avoid stressing inflamed joints 1
  • These exercises focus on breathing, gentle movement, and mindfulness which may help manage pain during flares 2

• Aquatic exercises are particularly beneficial during flare-ups as they:

  • Provide a low-impact environment that reduces stress on inflamed joints 1
  • Combine aspects of aerobic fitness and range of motion exercises 1
  • Show improvement in physical function based on low certainty evidence 2
  • Are especially helpful for patients with significant joint pain 1

• Range of motion exercises can be performed within pain-free limits:

  • Focus on gentle movement through available range without forcing joints 1
  • Can help maintain mobility during flares 2
  • Should be performed only to the point of mild tension, not pain 1

Implementation Approach During Flares

• Start with very short sessions (5-10 minutes) of low-intensity exercise and gradually increase as tolerated 1

  • Monitor symptoms during and after exercise 2
  • Apply the "24-hour rule" - reduce exercise intensity if increased pain persists for more than 24 hours 2

• Thermal modalities can be applied before or after exercise:

  • Heat therapy before exercise can improve joint flexibility 3
  • Cold therapy after exercise may help manage post-exercise inflammation 3

• Consider professional guidance during flares:

  • Comprehensive physical therapy is conditionally recommended by the ACR 2
  • Occupational therapy can help with joint protection techniques during activities 2
  • Exercise programs are more effective when supervised rather than performed alone at home 1

Important Considerations and Cautions

• Avoid exercising severely inflamed joints during acute flares 1

  • Focus on exercising unaffected joints to maintain overall fitness 2
  • Resume more intensive exercise only when acute inflammation subsides 1

• Discontinue exercise if you experience:

  • Unusual or persistent fatigue 1
  • Increased weakness 1
  • Decreased range of motion 1
  • Joint swelling or pain lasting more than one hour after exercise 1

• Morning exercise may need to be avoided if RA-related morning stiffness is present 1

  • Consider exercising later in the day when stiffness has decreased 2

• Avoid high-intensity, weight-bearing exercises during flares, especially for patients with significant radiologic damage of large joints 4

Exercise Progression After Flare Resolution

• Gradually reintroduce aerobic and resistance exercises as inflammation decreases:

  • Begin with low resistance (40-60% of one repetition maximum) with fewer repetitions 1
  • For aerobic exercise, start with brief 10-minute sessions, adding 5 minutes per session until reaching 30 minutes 1
  • Aim to eventually reach 30-60 minutes of aerobic activity, 3-7 days per week 1

• Monitor disease activity during exercise progression:

  • Studies show that moderate or high-intensity exercise can decrease or stabilize disease activity in RA when appropriately prescribed 4
  • Regular exercise has been shown to decrease systemic inflammation in RA 5

Practical Implementation Tips

• Exercise preferences and access are important factors in maintaining adherence 1

  • Choose activities that are enjoyable and sustainable 2
  • Physical activity that is enjoyable is more likely to be sustained 2

• Combine exercise with self-management strategies for better outcomes 1

  • Exercise programs are more effective when combined with self-efficacy training 1
  • Address disease-specific barriers such as pain, fatigue, and fear of flare-ups 2