ARTHRITIS AND EXERCISE
This fact sheet answers
general questions about arthritis and exercise. The amount and
form of exercise recommended for each individual will vary depending
on which joints are involved, the amount of inflammation, how
stable the joints are, and whether a joint replacement procedure
has been done. A skilled physician who is knowledgeable about
the medical and rehabilitation needs of people with arthritis,
working with a physical therapist also familiar with the needs
of people with arthritis, can design an exercise plan for each
patient.
What Is Arthritis?
Arthritis is a general
term that refers to many rheumatic diseases that can cause pain,
stiffness, and swelling in joints and other connective tissues.
These diseases can affect supporting structures such as muscles,
tendons, and ligaments and may also affect other parts of the
body. Some common types of arthritis are osteoarthritis, rheumatoid arthritis,systemic lupus
erythematosus,gout,juvenile rheumatoid
arthritis,ankylosing spondylitis,
and psoriatic arthritis.Osteoarthritis
is the most common.
Should People With
Arthritis Exercise?
Yes. Studies have
shown that exercise helps people with arthritis in many ways.
Exercise reduces joint pain and stiffness and increases flexibility,
muscle strength, and endurance. It also helps with weight reduction
and contributes to an improved sense of well-being.
How Does Exercise
Fit Into a Treatment Plan for People With Arthritis?
Exercise is one part
of a comprehensive arthritis treatment plan. Treatment plans
also may include rest and relaxation, proper diet, medication,
and instruction about proper use of joints and ways to conserve
energy (that is, not waste motion) as well as the use of pain
relief methods.
What Types of Exercise
Are Most Suitable for Someone With Arthritis?
Three types of exercise
are best for people with arthritis:
-
Range-of-motion
exercises help maintain normal joint movement and relieve
stiffness. This type of exercise helps maintain or increase
flexibility.
-
Strengthening
exercises help keep or increase muscle strength. Strong
muscles help support and protect joints affected by arthritis.
-
Aerobic or
endurance exercises improve cardiovascular fitness,
help control weight, and improve overall function. Weight
control can be important to people who have arthritis because
extra weight puts extra pressure on many joints. Some studies
show that aerobic exercise can reduce inflammation in some
joints.
How Does a Person
With Arthritis Start an Exercise Program?
People with arthritis
should discuss exercise options with their doctors. Most doctors
recommend exercise for their patients. Many people with arthritis
begin with easy, range-of-motion exercises and low-impact aerobics.
People with arthritis can participate in a variety of, but not
all, sports and exercise programs. The doctor will know which,
if any, sports are off-limits.
The doctor may have
suggestions about how to get started or may refer the patient
to a physical therapist. It is best to find a physical therapist
who has experience working with people who have arthritis. The
therapist will design an appropriate home exercise program and
teach clients about pain-relief methods, proper body mechanics
(placement of the body for a given task, such as lifting a heavy
box), joint protection, and conserving energy.
| Step Up to
Exercise: How To Get Started |
-
Discuss
exercise plans with your doctor.
-
Start
with supervision from a physical therapist or qualified
athletic trainer.
-
Apply
heat to sore joints (optional; many people with
arthritis start their exercise program this way).
-
Stretch
and warm up with range-of-motion exercises.
-
Start
strengthening exercises slowly with small weights
(a 1 or 2 pound weight can make a big difference).
-
Progress
slowly.
-
Use cold
packs after exercising (optional; many people with
arthritis complete their exercise routine this way).
-
Add aerobic
exercise.
-
Consider
appropriate recreational exercise (after doing range-of-motion,
strengthening, and aerobic exercise). Fewer injuries
to arthritic joints occur during recreational exercise
if it is preceded by range-of-motion, strengthening,
and aerobic exercise that gets your body in the
best condition possible.
-
Ease
off if joints become painful, inflamed, or red and
work with your doctor to find the cause and eliminate
it.
-
Choose
the exercise program you enjoy most and make it
a habit.
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What Are Some Pain Relief Methods?
There are known methods
to stop pain for short periods of time. This temporary relief
can make it easier for people who have arthritis to exercise.
The doctor or physical therapist can suggest a method that is
best for each patient. The following methods have worked for
many people:
-
Moist heat
supplied by warm towels, hot packs, a bath, or a shower
can be used at home for 15 to 20 minutes three times a day
to relieve symptoms. A health professional can use short waves,microwaves, and ultrasound to deliver deep heat
to noninflamed joint areas. Deep heat is not recommended
for patients with acutely inflamed joints. Deep heat is
often used around the shoulder to relax tight tendons prior
to stretching exercises.
-
Cold supplied
by a bag of ice or frozen vegetables wrapped in a towel
helps to stop pain and reduce swelling when used for 10
to 15 minutes at a time. It is often used for acutely inflamed
joints. People who have Raynaud’s phenomenon should not
use this method.
-
Hydrotherapy
(water therapy) can decrease pain and stiffness. Exercising
in a large pool may be easier because water takes some weight
off painful joints. Community centers, YMCAs, and YWCAs
have water exercise classes developed for people with arthritis.
Some patients also find relief from the heat and movement
provided by a whirlpool.
-
Mobilization
therapies include traction (gentle, steady pulling),
massage, and manipulation (using the hands to restore normal
movement to stiff joints). When done by a trained professional,
these methods can help control pain and increase joint motion
and muscle and tendon flexibility.
-
TENS(transcutaneous
electrical nerve stimulation) and biofeedback are two additional
methods that may provide some pain relief, but many patients
find that they cost too much money and take too much time.
TENS machines cost between $80 and $800. The inexpensive
units are fine. Patients can wear them during the day and
turn them off and on as needed for pain control.
-
Relaxation
therapy also helps reduce pain. Patients can learn to
release the tension in their muscles to relieve pain. Physical
therapists may be able to teach relaxation techniques. The
Arthritis Foundation has a self-help course that includes
relaxation therapy and also sells relaxation tapes. Health
spas and vacation resorts sometimes have special relaxation
courses.
-
Acupuncture
is a traditional Chinese method of pain relief. A medically
qualified acupuncturist places needles in certain sites.
Researchers believe that the needles stimulate deep sensory
nerves that tell the brain to release natural painkillers
(endorphins). Acupressure is similar to acupuncture, but
pressure is applied to the acupuncture sites instead of
using needles.
How Often Should
People With Arthritis Exercise?
-
Range-of-motion
exercises can be done daily and should be done at least
every other day.
-
Strengthening
exercises also can be done daily and should be done at least
every other day unless you have severe pain or swelling
in your joints.
-
Endurance
exercises should be done for 20 to 30 minutes three times
a week unless you have severe pain or swelling in your joints.
What Type of Strengthening
Program Is Best?
This varies depending
on personal preference, the type of arthritis involved, and
how active the inflammation is. Strengthening one’s muscles
can help take the burden off painful joints. Strength training
can be done with smallfree weights, exercise machines, isometrics,
elastic bands, and resistive water exercises. Correct positioning
is critical, because if done incorrectly, strengthening exercises
can cause muscle tears, more pain, and more joint swelling.
Are There Different
Exercises for People With Different Types of Arthritis?
There are many types
of arthritis. Experienced doctors, physical therapists, and
occupational therapists can recommend exercises that are particularly
helpful for a specific type of arthritis. Doctors and therapists
also know specific exercises for particularly painful joints.
There may be exercises that are off-limits for people with a
particular type of arthritis or when joints are swollen and
inflamed. People with arthritis should discuss theirexercise
plans with a doctor. Doctors who treat people with arthritis
include rheumatologists, general practitioners,
family doctors, internists, and rehabilitation specialists (physiatrists).
How Much Exercise
Is Too Much?
Most experts agree
that if exercise causes pain that lasts for more than 1 hour,
it is too much. People with arthritis should work with their
physical therapist or doctor to adjust their exercise program
when they notice any of the following signs of too much exercise:
- Unusual or
persistent fatigue
- Increased
weakness
- Decreased
range of motion
- Increased
joint swelling
- Continuing
pain (pain that lasts more than 1 hour after exercising)
Should Someone With
Rheumatoid Arthritis Continue To Exercise During a General Flare?
How About During a Local Joint Flare?
It is appropriate
to put joints gently through their full range of motion once
a day, with periods of rest, during acute systemic flares or local joint flares. Patients
can talk to their doctor about how much rest is best duringgeneral
or joint flares.
Are Researchers
Studying Exercise and Arthritis?
Researchers are comparing
the development of musculoskeletal disabilities, including arthritis,
in long-distance runners and nonrunners. Preliminary results
show that running does not increase the likelihood of developing
osteoarthritis.
Researchers also
are looking at the effects of muscle strength on the development
of osteoarthritis. Other researchers continue to look for and
find benefits from exercise to patients with rheumatoid arthritis,
spondyloarthropathies, systemic lupus erythematosus, and polymyositis.
Where Can People
Find More Information on Arthritis and Exercise?
- Arthritis Foundation
1330 West Peachtree Street
Atlanta, GA 30309
404/872-7100 or call your local chapter (listed in the telephone
directory)
800/283-7800
World Wide Web address: http://www.arthritis.org
This is the major
voluntary organization devoted to arthritis. The Foundation
publishes a free pamphlet on exercise and arthritis and a monthly
magazine for members that provides up-to-date information on
all forms of arthritis. Local chapters organize exercise programs
for people who have arthritis, including People with Arthritis
Can Exercise (PACE) and an aquatic exercise program held in
swimming pools. The Foundation also can provide physician and
clinic referrals.
- PACE Catalog Center
Arthritis Foundation
P.O. Box 9020
Pittsfield, MA 01202-9945
800/PACE-236 (722-3236)
This center sells
PACE exercise videotapes at two levels, basic and advanced.
Each videotape is approximately 30 minutes long and includes
a warm-up section, a gentle or moderate exercise routine, and
a rhythmic movement sequence to help improve endurance. The
videotapes are available for $19.50 per tape, plus shipping
charges.
- Spondylitis Association
of America (SAA)
P.O. Box 5872
Sherman Oaks, CA 91413
818/981-1616
800/777-8189
World Wide Web address: http://www.spondylitis.org
This nonprofit, voluntary
organization helps people who have ankylosing spondylitis and
related conditions. SAA sells books, posters, videotapes, and
audiotapes about exercises for people who have arthritis of
the spine.
- American College
of Rheumatology/Association of Rheumatology Health Professionals
60 Executive Park South, Suite 150
Atlanta, GA 30329
404/633-3777
Fax: 404/633-1870
World Wide Web address: http://www.rheumatology.org
This association
provides referrals to physical therapists who have experience
designing exercise programs for people with arthritis. The organization
also provides exercise guidelines developed by the American
College of Rheumatology.
Acknowledgments
The NIAMS gratefully
acknowledges the assistance of Jeanne Hicks, M.D., and Naomi
Lynn Gerber, M.D., both of the Rehabilitation Medicine Department,
and Stanley R. Pillemer, M.D., Office of the Director, NIAMS,
at the National Institutes of Health, in the preparation and
review of this fact sheet.
The National Arthritis
and Musculoskeletal and Skin Diseases Information Clearinghouse
(NAMSIC) is a public service sponsored by the NIAMS that provides
health information and information sources. The NIAMS, a part
of the National Institutes of Health (NIH), leads the Federal
medical research effort in arthritis and musculoskeletal and
skin diseases. The NIAMS sponsors research and research training
throughout the United States as well as on the NIH campus in
Bethesda, MD, and disseminates health and research information.
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