Should Rheumatoid Arthritis Patients Exercise?
Can we talk about exercise?
There is an elephant in the room. Not a cute and helpful one like Horton. It is one of those proverbial elephants no one wants to address. It’s a big and annoying issue that won’t go away, yet everyone tries to ignore.
I do not fancy myself an elephant tamer. However, I have a constant urge to state the unspoken. So, let’s get this out in the open.
Exercise is a touchy subject in the world of Rheumatoid Arthritis.
Proponents of exercise strongly advocate it. No one I know actually opposes exercise, but it does raise several questions. I wonder why I do not hear them asked.
Early in 2006, when I began to suspect that I had RA, I began to read research articles about it. I was leery of internet Quackdom, so I limited myself to medical universities / hospitals like Cleveland Clinic, Mayo, and Johns Hopkins. Soon, I learned to expand to other reputable websites like WebMd and About.com. I just wanted the legitimate information, not fairy-world cures.
I read about protecting my joints by not doing things that caused pain or stress. That sounded very important to me, so I printed off lots of pages about it. Later, when I began to hear how some RA-ers are pressured to exercise, it struck me as odd. The two ideas are in direct conflict. I cannot protect my inflamed joints from use at the same time that I am using them to exercise.
I read about every theory I could find to explain the causes of Rheumatoid Arthritis. I did not read any which pointed to laziness or lack of exercise as a reason for RA. I am sorry to be blunt, but if sloth did not cause my RA, then workouts will not cure it.
My doctors have prescribed vitamins, chemo shots, newfangled funky Biologic drugs, rest, anti-inflammatory medicines and even a high Omega-3 diet to attempt to gain control of my RA. Funny, they have not prescribed exercise. Why not?
It would have been an appropriate prescription if I had come into the office with one of many other conditions. But, I was disabled by RA, not idleness. Some people are truly disabled by RA. And they cannot exercise for either fun or strength.
There are others who have RA, but who are not disabled. Many have times between flares, however brief, when they can safely exercise. And a few other RA-ers actually have only a small number of joints that are affected. Of course, they can exercise using the unaffected joints.
I do not feel comfortable asserting this position. But, frankly, I am never comfortable anymore. I am in pain. It’s not endearing or attractive to say so, but it’s true.
I am very uncomfortable to sound like I am opposing something as wonderful as exercise. I half expect to be stoned. But, of course
I am not arguing with exercise
I am arguing with the preposterous proposition that if RA’ers would just exercise, they would feel better or get well. That is so absurd that I can’t think anyone really believes it. If they do, I am willing to walk in their shoes. Can they stand in mine?
I wish that RA’ers would not have to ever defend themselves about exercise. We did not get Rheumatoid Arthritis because we were less active; we became less active because we have RA.
Related posts:
- Should Rheumatoid Arthritis Patients Exercise, Part 2
- The Truth About Rheumatoid Arthritis Will Be Told! (exercise, part 3)
- Rheumatoid Arthritis Makes Things Difficult
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I've been pretty fortunate in that those around me, and my close friends at yoga and pilates, know that when I am unable to exercise it is through no fault of my own.
For me this is a rough issue, as I've worked so hard during the past two years to improve my physical fitness. Now that my RA has progressed, I worry about not being able to do more, but in the end I am happy with whatever I am able to do.
My rheumatologist continues to recommend exercising in the pool, but I've never been a big fan of getting in the water other than in my bathtub…
This goes right back to the old "Use it or lose it" comment. what people don't seem to understand is if we use it, we can possibly lose it. I would love to be able to start running again. I would love to get into a really good exercise routine. I so badly want to go and buy P90X. I feel that great! I am getting an opportunity that others may not get. But at the same time, I am terrified. I still worry that one of these steps I take is going to result in the sharp stabbing pains in my ankles coming back. I worry that I may cause a flare if I do anything strenuous. I'm afraid that by doing yoga I may stretch some tissues the wrong way. I still worry about joint damage. Tell me, how do you enjoy even walking around the mall with all that worry? People still tell me I should exercise. Well, here, borrow my painfully swollen joints for your 10 mile run then we can talk when you get back.
RA Guy,
BWHahahaha!
Yes, swimming is awesome! And the few days that I could do it, I was so blessed!! Felt on top of the world.
May you be rewarded for your efforts to be fit!
Hey GF-
Is this a deja vu moment? Have I read that somewhere before?
Yes to the trading places thing. Yes, yes. Can they walk in these shoes?
Hey RA Guy! You're lucky you got understanding peeps around you. My old Rheumy actually said to me that if I lose the 50 pounds I have to lose, it would make the RA more manageable. Well duh! Iknow I need to lose 50 pounds. Was it really her job to point it out? I think not. What I should have said is that if she was doing her job and actually finding a med that worked, maybe I could do things like, oh I don't know, walk from one end of a room to the next
without having to sit down on the way. I'm pretty sure that would burn off a few calories!
I understand completely about worrying about what I can and can't and shouldn't do.
Have you ever thought of getting a hot tube? We all know how great a hot shower feels, right? Hot-tubbing is highly reccommended for us and many insurance plans will pay for some or all of one. You'd have to get with your rhuemy and work on that together. I highly reccommend you check out http://www.thermospas.com and look at the exercise tubs. They are really long and you can swim in them! And I think you can choose the jets you want. But the tub is cool. They also have a healing spa. It's square but really deep. The tub I'm looking at is on the site http://www.hotsprings.com and it's called Vista. It has a ton of jets, which is why I like it. Hopefully I can afford it!
Hi Kelly-
I saw this on FB and needed to respond, but I got alot to say! First of all I understand wanting to be able to be active and exercise from an RA perspective. I am lucky that my case is 'moderate' yet not quite controlled. I do have days/weeks where I feel the anger along with the pain and exhaustion of not being able to do close to what I used to do. I look back at my former self who was training for a mini-triathlon kicking butt at the gym, keeping a clean home, being a good mom (the mom I wanted to be), mowing the lawn and doing lord knows what else in a day while also pregnant. Today I can do a mere fraction of that and it saddens me to no end. Knowing that my house is a disaster, my kids' patient, fun and playful mother has soured into an short tempered and seemingly lazy shadow of her former self is beyond frustrating. I now have to choose between all of those things and some of them (like running etc) I can't do anymore. It totally bites when physical activity is one of your 'mental' outlets and you are not able to do it anymore. It also sucks when you gain 50lbs and 5 sizes because you physically can't do what you used to do.
What I do know is this though. I feel a ton better when I am able to get out and just walk. It helps my mental angst and slight depression. It also helps my heart. And since depression and heart issues are common with RA then maybe I'll be able to beat those things, as well as loose the excess weight I've been carrying around since my world fell apart when I was diagnosed. That is if I can keep away from the m&ms…
Hugs to you because yes, it totally SUCKS ROCKS!
Heather
Wow, Heather.
Thanks for sharing that. I start to think I am immune to tears because I've heard it all; ha.
You brought up so much I wish I could have said, you wet my eyes.
I choose my words carefully, because I want folks to read them… But I wish people knew about the times I have tried to use my old "willpower" to "get 'er done." RA will not be ignored. More than once, I have used my iron will to try to exercise and found myself unable to move well for days. RA plays by different rules.
While your walking is far from the triatholon of before, kudos to you to do what you can!
I love to walk on the beach (actually, I prefer to run), but when I do, I pay a high price. Most days, I limp, shuffle, and drag myself everywhere I go. But I do not give up.
Very well said! I can't stand it when people tell me that if I would just exercise I would feel better. I want to reply and say, well, the next time you haven't slept in a couple of days, jammed all of your fingers and toes, sprained both ankles, your knees are the size of watermelons, have a slight case of whiplash, and you feel like you have the flu — I will come and get you so that we can go for a jog – it will make you feel better.
Thanks!
Courtney
Thank you Courtney!
When I was first demonstrating the symptoms of RA and Fibromyalgia (no dx at that time), I was serving on the board of our local YMCA. Having been a very active member who usually worked out more than an hour 6 days a week, they knew me well. The training manager told me point blank that I need to exercise. His ex-wife had developed RA and couldn't even do laundry or lift a basket and then she started walking and in a month was doing everything she wanted to.
I tried….it did not work for me. Now I have a dx, more pain, more stiffness and usually a cane. Yeah…exercise is the cure all.
HA! Courtney that was GREAT!!! Can I use that line? Angie
Well said. I am wondering if anyone advised swimming? I was a competitive swimmer, and nowadays I really need exercise that does not injure my joints too. I have found that swimming is the one exercise that really gets my heart rate up and feels great on all other areas for the lack of impact. I also use a natural pain cream called Topricin that feels wonderful. It is safe and it helps with any inflammation. Again, great points here! Caroline
Robin, Thanks for the excellent comment.
About the guy's ex: I wish people knew about the various courses of RA. Some people get remissions, either permanent or between flares. And no one knows what causes the remissions. So, they may credit exercise or vitamins or their favorite purple t-shirt. Who knows?
Happy for them, but if it doesn't happen for me, am I to be blamed?
Caroline,
When I can swim, I am in heaven!
For the reasons you say, it is wonderful.
Maybe this sums up my view: If you can, you should. If you can't, you shouldn't.
Sometimes, I cannot lift my hands above my head… But other days, I can manage it.
I was very active before RA hit and I try to be as active as I feel comfortable with whatever my symptoms of the day are. For me, I want to continue doing whatever I can because I believe the stronger my body, the easier it is to deal with the flare-ups. But, there are more days than not that all I can do is take a walk with the dog and call it a day. But, hey, I am still doing that!
I did have a guy tell me the other day that if I just worked out I could get rid of the swelling/pain in my knee. I was in shock. I did share with him what RA is and came to find out he didn't know.
Way to go, Cathy! On all counts.
This is such an important topic. I'm new to RA diagnosis, but not new to the symptoms.
My primary care doc stands by the AMA recommendations that everyone needs 30-minutes-a-day exercise, 6-days-a-week. So before I was diagnosed, I did what I could do, when I could do it, pushed myself to do more, then paid the price by being in pain and exhausted for the next two to three days.
Then RA symptoms flared, and I could barely function, much less do any exercise. Finally found a good rheumatologist and was diagnosed with RA.
Primary care doc still doesn't get it. She sticks to the "You need to exercise…" ADA guidelines. I wish she would read this blog, Kelly! (I'm too chicken to take it to her, though.)
The point of my post is that under-informed/misinformed doctors push RA patients to do things that are sometimes impossible, sometimes even DAMAGING to the body. For me, when I couldn't accomplish the impossible (not yet knowing I had RA), I felt like a failure.
People struggling with RA do not need excessive guilt placed on them by the very people they turn to for help.
Thank you, Kelly and all who have posted, for validating the reality of RA limitations we do not ask for but have to live with!
Caysea
Caysea, thank you for sharing that!
You are right about the "excessive guilt" – how is that a help? I keep asking the same questions. Why is the same activity which they warn will be destructive, suddenly considered "healthy" if it's in the context of exercise?
For example, I can't lift heavy cans, so why would it be good or "safe" to lift little weights that weigh the same thing? Some of our members here use wheelchairs or carts; should they go running? Obviously not.
IS IT OK IF WE SAY IT THIS WAY: If you can do exercise, you should. If you can't, you should not.
Hi Caysea. I'm Angie. Nice to meet you.
If I may offer up something…my doc (pcp)was the same way. I was actually diagnosed by an urgent care doc while I was camping.
I ended up finding a new pcp. It wasn't worth it to me to continue to try to educate my doc when he wasn't willing to listen. I needed to find someone who was going to treat me so I walked.
My new doc (pcp) is great. She listens and works closely with my other docs that are conducting a drug study I'm doing. I also got rid of my rheumy for the same reason. She was unwilling to liten, unwilling to try anything but methotrexate, and she made a couple of big mistakes with my treatment that could have really harmed me physically. I was on methotrexate for 10 months with no changes in my RA but my side effects were horrible. She just kept changing the dose.
I still haven't found a new rheumy but I feel much better not having the one I had.
I know that dumping a doc isn't easy but you should talk to your rheumy and get their opinion. Maybe they can reccommend a pcp for you.
i had no idea that what i had was RA. the doctor told me it was a tennis elbow. i remember "over-using" my hands on the cellphone and PC, so i thought that might've been it. soon the pain was all over my body. the steroid injection wasn't working. the pain relievers made me quite dependent. i hurt badly if i didn't take them. eventually, i stopped the pain relievers and went to a physiatrist. the Physical Therapist taught me stretching exercises that slowly relieved me totally of the pain, except for my elbow, that i could never straighten, until now. the stretching exercises helped me in my joint pains in the legs, ankles, and everywhere else. that was 5 years ago. i haven't had any episode since, until early this year. i tried to do the same stretching exercises, went to the gym, jogged, etc. but the more i exercised and stretched, the more inflamed muscles i had. today, i can see that the muscles most susceptible to inflammation are those muscles that get strained that would've just recovered quickly if i didn't have RA. maybe exercise does work at the initial stages of the disease. it worked for me. at that time, i only had a general feeling of unwellness, stiff joints and muscles, but over-all i didn't have seriously inflamed joints like i do now.
I’ve had RA for about three years. As strange as it sounds, I just started an exercise program for the first time ever…last year. Of course, some people might say that calling what I do exercise would be a stretch…it works for me. On days that my joints are stiff and swollen, I don’t even attempt it. But, on my good days I find that it helps my mind, body, and spirit. I have found that the elyptical machine works well for me. It is much easier on my joints than the treadmill. I do my cardio on it and then move to the weights. I am always careful to avoid the machines that aggravate any tender joints and only do low impact exercise. So, I say…to each his own. One size does not fit all of us when it comes to exercise.
“.. if RA patients would JUST exercise, they would feel better”
I think the key word here is ‘just’.
I am pro-exercise for RA patients, BUT it requires a customized RA training program. I followed the RAPIT (RA Patients In Training) program her in the Netherlands for a year and then joined a gym run by physical therapists. My exercise regime is taylor-made and reviewed regularly, but it has been far from easy. I have been at it for four years and have regularly taken a few steps back in order to move forward again. I am very fortunate with my physical therapist, she understands my RA better than my rheumy, on occasion she has sent me home to chill, when I was overdoing it.
I go to this gym twice a week and enjoy it. My body has never looked as it good as it does now (I bench press 25kg) , but I still have RA, I still suffer from fatigue, I am still in constant pain and still get flares. But I can do more than I could 4 years ago and I can, in moderation, actively play with my 4 year old son.
Don’t rule out exercise for RA completely, it’s a matter of finding the best form for you and taking it slow.
Dadwithra,
Thank you for your excellent comments.
You sound very lucky with your physical therapist. I wish everyone were so well informed about RA. People usually tell me stories that are very different from that, unfortunately.
There are probably some other distinctions which we need to make, in addition to the one you point out. I have been giving this a lot of thought & research.
The most significant distinction is the particular course or severity of RA involved. For many, even on the highest doses of dmards, RA is unrelenting. All movement causes pain & exercise is not even possible. Many others are in wheelchairs or can barely walk. They send me tearful letters of how they used to run marathons or play on sports teams. They are not lazy or malingering. I know that they are telling the truth because I am like them in some ways. There are several other posts on exercise on the blog. I hope everyone interested will read more of this discussion here.
Also, while not on exercise, this post explains my point about movement and usage of joints.
I hope that someday I will be like you. I would give so much to be able to run again. Or even iron shirts.
Hey RAwarrior,
You make a very good point, RA is different for each RA patient, whether it is the way the disease manifests itself or how our bodies respond to it.
You are right, my physical therapist is amazing and I want to share an instance with you that relates to your tennis adventures in part 2 of your post on exercising with RA.
Last year in the summer, I decided I wanted to give tennis a go, I used to love to play pre-RA. So I asked my physical therapist what I should look out for. She gave me a look, a look that said: “Dude, what are you thinking, you have RA”. Then she sighed, seeing the enthusiasm in my eyes and told me to at least wear my wrist guards and to take it slow. I lasted 10 minutes on the court, it was too much for my wrists, even with the guard. I have had to let tennis go (though I can still play it on the Wii) but I have another way to exercise that suits me and my RA best even if it is not the activity I wish I could do.
There was a 72 year old man in my RAPIT group, who had lots of trouble walking and his hands were so affected, he could not shake anyone’s hand. After six months he was moving so much better and he could do little DIY jobs around the house again. He is a changed man.
I agree with you, exercise is not for everyone, but I guess my point is, do not underestimate what you as an RA patient are capable of doing with exercise.
Have a great weekend and an awesome festive season,
Dadwithra
This is a good discussion. I’ve been working on a 4th post on this subject. Here is a relevant comment I got yesterday.
Sometimes, people tell me that they feel like there is more than one kind of RA. I don’t know if I’d put it that way, but there are definitely different courses of RA. Two days ago, I ran a couple of errands and spent a day in the car. I still can barely walk. There is no way to express with words how much I want to be able to move around. If someone does not have RA or this kind of RA, it is impossible to explain exactly how it is to be so restricted with something so invisible.
There were a lot of tears in this house when we learned I could not do the Wii either. I cannot move my shoulders much.
Another disctinction: Take the a marathoner w/RA. She has RA in her wrists. Some of us have RA in every joint. It is just not the same. She does not have more fortitude. She has less RA.
Again, I so hope that I will be like you after a few months on Orencia. However, if that happens, I hope I will continue to represent those RA’ers who cannot exercise no matter how much they want to. We are all in one big RA brotherhood here.
RA Warrior,
I am so sorry about you not being able to play the Wii, I feel your pain. I’m sorry if I overstressed my point on exercise, I do realize and have said it is not for everyone.
I love your blog and your writing and have added a link to it from mine.
If you ever want more information on RAPIT or wish to visit our fine country and see a group in action, I’d be happy to show you around.
best wishes,
DadwithRA
Dadwithra, Your points are all well taken. And you did not overstep. I am sorry if I push my points hard also. It is very hard for my point to be heard; it is not being made anywhere else that I can see. I really do hope I can exercise some day. Really. RAPIT does sound good for anyone who is able to take advantage.
Hi everyone I am new to this whole forum thing but I have been finding that I have no one to confide in when it comes to my dieses. I was diagnosed with Rheumatoid Arthritis when I was just 18. I am only 21 now and can’t live the life your typical 21 year old guy should live. I too have now experienced the weight gain and absolutely hate it! Exercise has now become a daily struggle that I can’t seem to overcome. I want so badly to purchase the p90x system, but fear the consequences. Would anyone like to share their opinion…
Thanks
Kevin,
Welcome.
It’s true many people with RA can exercise. However, it will not be the same, you are right. First, the disease has to be controlled with medicines which will reduce the inflammation and pain. If you can get to the point where exercise helps you more than hurts you, then you still will need some guidelines or help to protect your affected joints. Using them in the wrong positions contributes to deformity in the long term. You may need to see a physical therapist or trainer who understands the idea of joint protection to guide you at first.
I am sorry you are going through this. I know it must be hard.
I came today looking for something specifically about exercise. I’ve packed on quite a few pounds since I’ve been diagnosed because of medication and my inability to exercise. I still try but the recovery time is just not worth it. I was wondering, how do you control weight with RA if you can’t exercise?
Ms. B,
That is a very good point. I guess I’m one of the lucky ones whose appetite is ruined by RA fever and methotrexate nausea is like a forced diet… Just kidding around.
I will definitely get back to this question soon.
I joined our local wellness center with the intent of gently exercising to “improve” my condition. I soon learned that even gentle movement in the pool could aggravate my pain. It feels great to stretch and move when my joints will allow, but I’m certainly not able to keep up with any routine. In fact, I spend most of my time in the hot tub or steam room which both feel really good. Some days I can’t get up and down the stairs to do laundry for my family. I can’t “waste” my precious movement time on the gym. Of course I know that I would feel better if I could lose some weight, but between the pred and the physical limitation, I don’t know how to make that happen. It’s so great to be able to talk about this with others who UNDERSTAND.
I hate that we have to have this discussion. I’d really just rather play tennis or swim…
It seems like you’ve figured out what you need to do: just do the best you can for your body. If it hurts you, you can’t think it’s good to do it.
If it hurts me too much to go up stairs, then why would it be good for me to do the same movement in the gym and call it “exercise”? Does not make sense.
Here’s a question: Should we redefine the word “exercise” for RA patients?
I read in some comments that exercise is compared to the exercise we did pre-RA. Some of us used to gym or run or in my case, play tennis. Could it be the case that we are setting the bar too high? Perhaps exercising with RA requires you to take it very slow, limit it to 5 minutes a day, perhaps even every other day. We do move around every day, that could be seen as physical activity. Walking around the block is exercise. Stretching in the shower is exercise too. As is climbing the stairs in your home (however difficult). If we’re more conscious of this, it may make us feel better, focussing on what we CAN do.
After my initial reactions on this post, I spoke to several physical therapist, rheumy’s and RA-researchers on this topic. All of them believe RA-exercise benefits RA patients. But one of them pointed something out, which I found interesting. There’s a difference in attitude towards exercise in different countries, when it comes to RA. The Dutch arthritis medical community are big advocates of exercise, whereas the Canadians, I believe, are very hesitant on the issue and the US is somewhere in the middle.
They also believe that telling an RA-patient to ‘just exercise’ is an ineffective way of getting someone to exercise. In some cases it’s even counter productive. You need an RA-customised exercise program and guidance is essential.