Exercising with Arthritis
Let’s talk a little big about exercising with a disease that make it hard to have motivation to work out…
Benefits of high-intensity exercise and Rheumatoid Arthritis
Strength and cardio training can boost mood and energy.
For people with rheumatoid arthritis (RA), exercise — namely high-intensity exercise, such as running or jogging — was considered a no-no for many years. But studies suggest it may be OK — even beneficial — to kick it up a notch.
“My research shows that people who participated in high-intensity exercise, such as sports, jogging or strength training, at least twice a week, improved in daily functioning and mood,” says Zuzana de Jong-Strakova, MD, PhD, rheumatologist and researcher at Leiden University Medical Center in the Netherlands.
Her research also found that high-intensity exercise did not speed up the rate of joint damage. In fact, for the minority of patients who did experience rapid progression of damage, the culprit was more aggressive disease activity. “There is a group of patients who have progressive damage, whatever they do,” says Dr. de Jong-Strakova.
Ready to ramp it up? The first thing you should do is talk to your doctor. After that, use common sense, says Dallas rheumatologist Scott Zashin, MD. Here are a few tips to get you going.
Evaluate the location of affected joints. “If you have no damage to the weight-bearing joints, there would be no reason you couldn’t participate in high-intensity exercise, such as aerobics or jogging,” Dr. Zashin says. “If you have damage in the lower extremities, then no jogging or hard aerobics. If it’s in the upper extremities, exercise that involves these joints, such as boxing and heavy weight lifting, could pose a problem.”
Exercise slowly at first. Stephanie Siegrist, MD, an orthopaedic surgeon in private practice in Rochester, N.Y., says the key to sticking with high-intensity workouts is knowing when to pick up the pace. “Start with a basic level of fitness that incorporates strength, endurance and flexibility, such as walking, and then work your way up. When it becomes easy, then it’s OK to kick it up a notch to see how your body responds,” she says.
Listen to your joints. “Adjust your workout to accommodate your body,” Dr. Siegrist says. “If you take a spinning class and it hurts when standing on the pedals, sit — but keep pedaling. By modifying your activities, you can do the things you want to do.”
Staying Fit with Arthritis
Studies show an engaged patient is a healthier patient. Staying fit and focused on your health and wellness, and remaining accountable for it, is one of the most important things to managing your arthritis. Our experts share their experiences and best insights.
- Pace yourself. It’s especially important if you’re just starting to workout. Ramping up slowly not only helps to avoid injury and exhaustion, but it also increases your chances of sticking with your routine.
- Respect your pain. Some discomfort is normal when exercising, but it should be minimal — about a 2 on a scale of 1 to 10. If you experience more discomfort or a sharp feeling, stop. You may need to do decrease your time and intensity and slowly build it up. And you can get much of the same benefits from three 10-minute walks as you can from one 30-minute walk.
- Buddy up. Working out with a friend can help keep you on track with your fitness goals. Studies show that, in addition to the social benefits, exercising with others can provide motivation and help keep you accountable.
- Make any necessary modifications. Modify moves, and if possible, equipment to meet your specific needs. For example, many exercises can be done while seated as opposed to standing, which can prove helpful on days when you have more pain and/or less energy. Equipment modifications could include using a slightly deflated exercise ball to make it more stable to lay on, or wrapping jump ropes, dumbbells or other handles in foam tape, like tennis grip tape, to make them easier and more comfortable to grip.
- Shop for shoes late in the day. Our feet swell as we walk and workout, so it’s best to shop for fitness footwear after we’ve on the go for a while. Choose shoes with solid ankle support and they should be comfortable immediately and require zero “break-in” time.
- When in doubt, consult a fitness expert. But not just any expert. Look for a physical therapist or certified personal trainer who has had experience working with others who have arthritis. They can help with modifications and create a workout customized to your needs.
Top workout mistakes to avoid
Exercise is essential for managing your arthritis, but if you aren’t doing it correctly, you could be doing your body more harm than good. According to the American Council on Exercise (ACE), people tend to make the same fitness mistakes repeatedly — regardless of their age or physical ability. Avoid these top workout mistakes to keep your joints strong and injury free.
1. Skipping the warm-up
Warming up raises your body temperature and increases blood flow to loosen the muscles. If you skip it, you risk injury and stiffer joints the day after. It doesn’t have to be complex. Something as simple as marching in place for five minutes will do the trick.
2. Not stretching
Stretching gives muscles a full range of motion and is key in preparing for aerobic activity, especially when dealing with stiff joints. The best stretch? Hamstring stretches. When a hamstring is tight, it can cause misalignment in the pelvis and knees.
Stretching as a warm-up prior to exercise may be a practice you learned back in grade school gym class. Today, experts debate its effectiveness. The truth? “Stretching is helpful,” says Amy Ashmore, PhD, an exercise physiologist with the American Council on Exercise. Stretching particularly benefits those with arthritis by lubricating joints and enhancing and maintaining range-of-motion.
Keep these basics in mind:
Avoid stretching a cold muscle
Only perform “static stretching” (stretch and hold) after a five to 10 minute warm-up, says Ashmore. A warmed-up muscle can stretch longer and endure more, says Duane Knudson, PhD, professor and chair of the department of health, physical education and recreation at Texas State University.
Use dynamic or “active” stretching as a warm-up
Dynamic stretches mimic movements used in the sport or activity. Dynamic warm-ups prepare the body for activity by helping to increase blood flow and muscle temperature.
If you’re preparing to play tennis, for example, you’ll want to practice side and front lunges as part of your warm-up — movements you’ll use to reach for the ball.
If you’re walking, you’ll want to start off at a slow pace and gradually pick up speed.
“Light, gentle rhythmic movements work best for the average person,” says Ashmore. “Go through a shallow range of motion (i.e. a half-squat vs. a full squat) until you’re thoroughly warmed up.”
Even professional football players use dynamic warm-ups before a game. “You’ll see players high-kicking down the field and going through a full range of motion instead of partner stretching for 10 minutes like they used to do,” says Knudson.
Of course, you should always consult your physician or physical therapist before trying new stretches.
Stretch at the end of your workout
“Stretching at the end of the cool-down phase, after exercise when your muscles are still warm, helps to maintain long-term flexibility benefits,” Knudson says.
3. Not cooling down
A proper cool-down, which includes deep breathing and long stretches, will get your heart rate, breathing and blood pressure safely back to normal while improving flexibility.
4. Heading straight for the heaviest dumbbells
Weight training increases energy and stamina but be careful not to overdo it. Lifting too much too soon can damage the tissue. When weight training, you should feel fatigue by the 12th or 15th repetition, be it a 1-pound or 100-pound weight. Once that becomes easy, add more weight.
5. You excessively huff and puff
A workout that’s too intense can put you in an anaerobic state, which means you aren’t getting enough oxygen into your system. That causes joint and tissue pain. How do you know if you’re getting the right combination of aerobic activity and oxygen? Find your target heart rate (subtract your age from 220), then shoot for 40 to 70 percent of that rate. Research has shown that you can improve pain levels and weight loss in an aerobic capacity anywhere after 40 percent.
6. You go too easy
To lose weight, build muscle and maintain energy levels, a good workout means breaking a small sweat and working out at 40 to 70 percent of your target heart rate. However, there is a fine line for people with arthritis. If your pain levels are high and find you are hurting a lot after a workout, you may need to dial down the intensity.
7. Don’t hydrate
When you work out, your body needs extra water to cool off and keep blood circulating. If you’re dehydrated, you aren’t doing either. Drink plenty of water prior to exercise and get another 6 to 8 ounces for every 15 minutes of exercise. Follow the workout with more water to replenish what was lost.
8. You eat for exercise
Unless you are training for a marathon, you do not need extra calories before working out. Also, be mindful of when you eat before working out. If you eat two hours before exercising, your blood flow will be focused on digestion instead of on keeping muscles warm and bringing oxygen to your body. This can result in muscle cramps and nausea.
9. You’re a “leaner”
It’s easy to lean over and rest on the armrests when using stationary equipment, such as a stair climber, but resist the temptation. Leaning may feel easier, but bad posture will only exacerbate joint pain.
10. You’re not focused on form
Make sure you’re using the proper form. Look at yourself in a mirror or ask a trainer to evaluate your positioning. Using the wrong form can cause injury and hyperextend your joints.
11. You’re a little too tough
Pushing through pain is not the thing to do. If your joints are hot or swollen, exercise can increase the damage and cause more pain. Remember, arthritis pain and pain from a strenuous workout are not the same. A little soreness a day or two after a workout is OK. Anything more than that is not.
Working Out Through Pain
Learn when to keep moving through exercise pain and when to stop.
Exercise is crucial if you have arthritis. But knowing just how much activity to do when you’re hurting can be tricky. After all, research has shown that moderate activity can help prevent the progression of arthritis and improve overall function. But while mild muscle soreness after a workout is normal, sharp pain during or immediately after can signal injury. And sometimes simply the fear of pain can keep you from wanting to do any kind of exercise at all. Here’s how to determine when it’s OK to work through exercise pain — and when it’s not.
If you have mild to moderate pain in a specific joint area before you work out: Some mild pain or discomfort is typical when you first start to move, but after a few minutes you’ll usually start to feel better, says A. Lynn Millar, PhD, a professor of physical therapy at Winston Salem State University in Winston-Salem, N.C. “Our joints and muscles get nutrition through movement,” she explains. “Once you start to move around a little you’ll improve the lubrication and circulation around that joint.” Start with some gentle, active range of motion movements and if that feels OK, progress to some low-impact activity like walking, she advises.
If you have moderate to severe pain in a specific joint area before you work out: You may need to focus on a different area for a day or two. For example, if your knees hurt, you should decrease the intensity of the leg workout. If the pain becomes worse, then stop the lower body moves and work your upper body instead. “Continuing to put pressure on a joint when it’s especially sore could contribute to joint damage, so it’s best to ease up for a while,” says physical therapist Richard Kassler, supervisor at the Orthopaedic and Sports Therapy Center at New York University Hospital for Joint Diseases, in New York City.
If you have moderate to severe joint pain during exercise: Stop immediately. “Most people with arthritis can work through mild pain safely. But if you’re experiencing a lot of pain while you exercise, even if you’re not doing a particularly joint-taxing workout, it may be a sign that you have inflammation in the joint, or even joint damage that requires treatment,” says Kassler.
If you consistently have joint pain (not muscle pain) after exercise: Switch to a workout that puts less pressure on your joints. “If you need an elaborate brace or have to pop ibuprofen constantly, it’s a pretty good sign that your activity is too hard on your joints,” says rheumatologist James O’Dell, MD, rheumatology chief, University of Nebraska Medical Center. Swimming, water aerobics and biking are all good options for people with joint pain.
If you occasionally have moderate to severe joint pain the day after you work out: Cut back on the intensity of your workout. “If you’re really sore the next day, you probably were exercising too hard or too long,” says Dr. O’Dell. He suggests taking a day off, then doing a shorter, less strenuous workout. If your pain still doesn’t let up, switch to a less intense form of exercise, such as trading your elliptical workout for water aerobics.
How Hard Should You Work Out?
Are you working out at the right intensity? These easy tests can help you make the most of any activity.
You already know that regular strength and cardiovascular exercises can boost your overall health and improve your flexibility, joint function and your mood. But if you’re not sure how hard you should be working out to get the most benefit and least risk of injury, take these self-assessment tests.
The Talk Test
Experts have long recommended the “talk test” for a cardio workout: If you can talk but not sing during an activity, you’re probably working at moderate intensity — enough to improve fitness, but not to the point of risking injury.
If you are very physically fit, you may need to train at a higher intensity — where talking is difficult — to improve athletic performance, according to a study published in the Journal of Sports Science. But for most people the talk test works just fine, says Carl Foster, PhD, director of the Human Performance Laboratory at the University of Wisconsin-La Crosse.
“For the non-athlete, there is almost no time when you would not want to be talking comfortably,” says Foster. Plus, moderately intense exercise is more efficient than strenuous exercise at burning fat, and because it is more pleasant, you are more likely to stick with it long-term, he adds.
The Strength Test
For strength training exercises complete each exercise with light weights. Go slowly, using a “two-up, four down” count for each repetition. Then ask yourself these questions.
1. Were you able to complete two sets of 10 repetitions in good form?
Yes. Good, keep it up.
No. Reduce the weight to an amount that you can lift 10 times in good form; rest for one or two minutes, then do a second set.
2. After completing 10 repetitions, do you need to rest because the weight is too heavy to complete more repetitions in good form?
Yes. You’re working at the proper intensity. Don’t increase the weight.
No. If you can do only a few more repetitions (not another set of 10 without a break), then at your next workout you should do the first set of repetitions with your current weight and your second set with the next weight up. For example, if you’re currently using 1-pound dumbbells, use 2- or 3-pound dumbbells for your second set.
But if you could have done all 20 repetitions without a break, use heavier dumbbells for both sets of repetitions at your next session,
The Two-Hour Pain Rule
If you have more joint pain two hours after exercising than before you started, you’ve overdone it. Ease up at your next workout.
Tracking Your Heart Rate
The American Heart Association recommends monitoring your heart rate when participating in any fitness program — even one as simple as walking — to make sure you aren’t overdoing it. Some tips to keep you on target:
• First, calculate your approximate maximum heart rate by subtracting your age from 220. Then multiply that number by .50 and by .75. That will give you a target heart rate range of 50 percent to 75 percent of maximum heart rate. For example: If you are 66 years old, your approximate maximum heart rate is 154 (220–66 = 154). Fifty percent of that number is 77; 75 percent is about 115. So your target heart rate range during exercise would be 77 to 115 beats per minute. You can find this number by wearing a heart rate monitor, or simply by checking your pulse for 10 seconds and multiple by six.
- When you start a program, aim for 50 percent of your target heart rate. If you have been walking for some time, try to reach 75 percent. It can help to combine both heart rate and talk test — so if you’re able to say a few words or short phrases (“I’m doing great!”) you’re probably in a moderate zone; if you can only say one or two words at a time, you may be going too hard and need to back off. On the other hand, if you can easily hold a detailed conversation, you may want to increase intensity a bit.
