Moving when you have painful arthritis can seem counterintuitive. Who wants to move when aches and pains rule? However, regular exercise can lessen pain and energize you — two big positives when you have arthritis.
“Moving helps lubricate joints, decrease inflammation, and control your weight,” says Laura Keller, MPT. She’s the director of rehabilitation at the Stone Clinic in San Francisco, which specializes in orthopedic treatment, surgery, and rehabilitation from arthritis and sports-related injuries. According to Keller, movement also helps you sleep better, improves your mood and posture, boosts your immune system, increases your bone density, and reduces your risk of heart disease. In other words, if exercise were a drug, most of us would want to take it.
“Without exercise, joints stiffen and muscles and tendons tighten,” says Keller. “That puts more pressure on the joints, and the weakened muscles offer less support for the joints. Your triglycerides [blood fats], cholesterol, blood pressure, and insulin level may increase, which in turn increases inflammation. So, you feel more pain and want to move less, and the less you move, the more pain you’re in.”
Exercise may also help you put off replacement surgery. According to a 2013 study involving 109 people with hip osteoarthritis at Oslo University Hospital in Norway, people who took an hour-long strengthening and flexibility class at least two times a week for 12 weeks were 44 percent less likely to need hip replacement surgery after six years than a group that did not exercise.
The clear message: Moving is your ally when it comes to improving function and decreasing pain. Keller offers tips on how to get started and the kinds of exercise to do.
Start with a physical therapist
A physical therapist experienced with arthritis can help you figure out how much exercise you can do safely, and guide your progress without causing your arthritis to flare, says Keller. A 2014 study of 60 people with knee osteoarthritis at Copenhagen University Hospitals in Copenhagen, Denmark, found that 36 supervised exercise sessions over 12 weeks decreased pain and sensitivity to pain.
You can ask your rheumatologist to refer you to a physical therapist, or you can go to the American Physical Therapy Association website, www.apta.org, which offers a “Find a PT” section arranged by specialty.
Acknowledge exercise fears
Keller reports that, beyond concerns about the pain of exercise, people with arthritis often worry about their inability to exercise. A 2014 study involving 2,351 people with rheumatoid arthritis at the Karolinska Institute in Stockholm, Sweden, found that those who had the highest level of pain and the poorest health also had the greatest fears about physical activity.
Keller advises that people begin an exercise regimen with realistic goals that ensure success. “If you are afraid of doing standing exercise, start by doing something while seated — or even lying down,” she says. And share your fears with your physical therapist. “If you go too hard, you may get scared off and not be successful, but if you are too easy on yourself, you won’t get gains. It’s like Goldilocks and the Three Bears — you and the physical therapist have to “find the ‘just right’ amount.”
Another way to handle fear or anxiety about exercise is to do 5 to 10 minutes of exercise through the day — with your doctor’s OK — so that at day’s end, you’ve done 20 minutes. Gradually add minutes until you’re exercising 30 minutes most days of the week.
Warm up and cool down
Warming up can help prevent injury and muscle soreness. Keller suggests taking a warm shower or sitting in a hot tub for a few minutes before exercise to increase blood flow and oxygen delivery to the muscles. Then do a few minutes of gentle cardio or aerobic exercise: marching in place, walking slowly, and doing a few stretches.
Cool down by walking and stretching again. If a joint feels hot, or is swollen or red, Keller suggests icing it for 15 to 20 minutes. “A flexible gel pack is best because it conforms to the body,” she says. Put a barrier like a towel between your skin and the ice.
Choose low-impact cardio
To get the most benefit from exercise, include cardio, strengthening, and flexibility exercises in your routine. Cardio exercise stimulates the heart and lungs, increasing heart and breathing rate. “For cardio, choose low- to moderate-impact activities such as swimming,” says Keller. “Swimming — except the butterfly stroke — places no stress on the joints because of your buoyancy in the water.” And the water creates resistance as you move through it, which strengthens your muscles.
Walking on a dirt path, cinder track, or grass — to lessen the force of each step — is also excellent cardio exercise, says Keller. Avoid concrete, asphalt, and other hard surfaces; their lack of give can irritate joints.
And Keller mentions biking as another option: “There’s no impact on the joints unless the pedal resistance is too great, which can stress the knee joint.”
At the gym, the elliptical machine — a stationary exercise machine that places little stress on the joints — is a good choice. The rowing machine can be as well, says Keller, as long as you have the range of motion for it. “I don’t encourage the treadmill,” she says. “The belts are going one way and your feet the other, so it can put a shearing force on the joints.”
How do you know to slow down? If you can’t speak normally while doing cardio exercise, you are probably working too hard.
Tai chi — an ancient slow-moving form of Chinese martial arts — and yoga both increase strength and flexibility without working isolated muscles. “Isolating muscles, which some exercise machines do, puts undue force on the joint,” says Keller. “When you are doing strengthening exercises, you always want to use a chorus of muscles.”
So, for instance, if you lie down with knees bent and lift your butt while leaving your shoulders and head on the ground — the bridge pose — you’re working hamstrings (back of thigh), gluteal (buttocks), and abdominal muscles. Keller says that kind of exercise helps strengthen the way your body works when doing daily tasks like getting out of bed or lifting yourself off the floor.
You can also try strengthening exercises using dumbbells or bands. Keller recommends using a Theraband exercise band, which has no handles. (If a band with handles slips out of your grip, the flying handle can injure you.) A 2013 review of eight studies at Hiroshima International University in Japan found that non-weight-bearing strengthening exercise was more effective than weight-bearing strengthening or aerobic exercise for pain relief in people with arthritis. Examples of non-weight bearing strengthening exercise include swimming or seated/prone strengthening exercises.
Skip the twists
When you are picking a cardio exercise, avoid any activity that includes jumping and twisting. That puts the kibosh on basketball and singles tennis, and running may be out as well. “Running increases the forces going through your body two to three times,” says Keller. “It’s too high-impact.”
Keller notes that “people with even bad arthritis can usually handle doubles tennis because the amount of movement is minimized.” Still, speak to a physical therapist experienced with arthritis who can help you assess the best form of exercise for you.
Add flexibility exercises
Staying flexible reduces your chance of injury, improves your ability to continue to do active daily tasks, and improves your posture.
One way to stay flexible is to do range-of-motion (ROM) exercises — exercises that move each joint as far as it can go — ideally several times a day. Examples include gently swinging one leg forward and back while you are standing, or doing arm circles backward and forward. Doing ROM exercises in the evening can help with morning stiffness.
A 2014 review of eight studies of people with rheumatoid arthritis at the University of Groningen in the Netherlands found that ROM exercises may increase strength and daily functions without increasing disease activity or pain.
“When you do ROM exercises,” says Keller, “move each joint through its full range of motion. You may feel some discomfort, but don’t push into pain.”
Stretching exercises are another great way to stay flexible. “All stretches should be gentle enough so that you can tolerate holding them for 45 seconds to a minute,” says Keller. “If you can’t sustain a stretch because it’s painful, you’re pushing too hard.”
Do not bounce — bouncing can cause the muscle to tighten rather than relax. If you’re doing standing stretches, hold onto a chair or table for balance.
Stretching exercises work the muscles a bit more than ROM exercises; they help to strengthen the muscle, which then provides greater support to the joint. The American College of Rheumatology recommends a set of 8 to 10 exercises for the major muscle groups — the stomach muscles, arm and shoulder muscles, leg muscles, and back muscles — two to three times a week, doing 8 to 12 repetitions of each exercise.
Ask your physical therapist to recommend a set of stretching exercises that are safe and appropriate for you.
Move for balance
Balance exercises are important as you age, especially if you have trouble walking, if you’ve fallen in the past, or if you’re at risk of falling. According to the Centers for Disease Control, activities that can improve your balance include walking backward, standing on one leg (with a chair or wall nearby to hold onto if you totter), or taking tai chi.
To balance on one leg, Keller suggests you face your kitchen counter, both hands on the counter, then stand on one leg. When you feel stable, lift one hand, then the other — and be prepared to grab the counter when you feel wobbly.
Know danger signs
“If you feel a worsening of symptoms, your exercise program may not be right for you,” says Keller. However, don’t give up; instead, get a reassessment from your physical therapist, who can suggest gentler exercises.
Keller recommends watching for signs of injury such as sharp pain or severe swelling. If your muscles or joints feel sore, they should feel better within 48 hours — “if they don’t recover in that time frame, you may be over-exercising,” she says.
Be gentle during a flare
“You never want to push through a flare-up,” Keller says, “but continue doing gentle movements or exercises for your uninjured parts.” The CDC suggests that if your arthritis symptoms increase with exercise, temporarily cut the number of days that you exercise — say, from four to two. Also, decrease the amount of time, from perhaps 30 minutes to 15. And switch your activity from, for instance, walking to swimming. Once your symptoms decline, slowly return to your usual amount and kind of exercise.
Choose helpful exercise times
If you have trouble sleeping at night, avoid doing cardio exercise within two hours of bedtime. Elevating your heart rate and body temperature will keep you awake. However, a few gentle stretches and relaxation exercises such as deep breathing may help you fall asleep.
If you tend to be stiff in the mornings, ROM exercises and stretching may be helpful, but you may want to put off more strenuous exercise until later in the day.
So remember: You may not feel like moving, but challenging yourself to stay active is one of the best ways for you to take care of yourself and manage your arthritis.
Want to learn more about the role of exercise in treating chronic pain? Read “Exercise 101: Finding the Right Exercises for Pain Relief,” “Hiking With Arthritis,” and “Time for Yoga: Yoga Benefits for Arthritis.”