Arthritis and Exercise - Arthritis and Exercise

Arthritis and Exercise

Medical College of Wisconsin

There are over 100 forms of arthritis and other rheumatic diseases. These diseases may cause pain, stiffness, and swelling in joints and other supporting structures of the body such as muscles, tendons, ligaments, and bones. Some forms can also affect other parts of the body, including various internal organs.

Many people use the word "arthritis" to refer to all rheumatic diseases. However, the word literally means joint inflammation; that is, swelling, redness, heat, and pain caused by tissue injury or disease in the joint. The many different kinds of arthritis comprise just a portion of the rheumatic diseases. Some rheumatic diseases are described as connective tissue diseases because they affect the supporting framework of the body and its internal organs. Others are known as autoimmune diseases because they are caused by a problem in which the immune system harms the body's own healthy tissues. Examples of some rheumatic diseases are:

Osteoarthritis
Rheumatoid arthritis
Fibromyalgia
Systemic lupus erythematosus
Scleroderma
Juvenile rheumatoid arthritis
Ankylosing spondylitis
Gout
Arthritis and Exercise
Studies have shown that exercise helps people with arthritis in many ways. Exercise reduces joint pain and stiffness and increases flexibility, muscle strength, cardiac fitness, and endurance. It also helps with weight reduction and contributes to an improved sense of well-being.

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.

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 their exercise plans with a doctor. Doctors who treat people with arthritis include rheumatologists, orthopaedic surgeons, general practitioners, family doctors, internists, and rehabilitation specialists (physiatrists).

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.

Types of Exercise
Three types of exercise are best for people with arthritis:

Range-of-motion exercises (e.g., stretching, dance) help maintain normal joint movement and relieve stiffness. This type of exercise helps maintain or increase flexibility. Range-of-motion exercises can be done daily and should be done at least every other day.
Strengthening exercises (e.g., weight training) help keep or increase muscle strength. Strong muscles help support and protect joints affected by arthritis. Strengthening exercises should be done every other day unless you have severe pain or swelling in your joints. The best type of strengthening program 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 small free 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.
Aerobic or endurance exercises (e.g., swimming, bicycle riding) 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. Endurance exercises should be done for 20 to 30 minutes three times a week unless you have severe pain or swelling in your joints. According to the American College of Rheumatology, 20- to 30-minute exercise routines can be performed in increments of 10 minutes over the course of a day.
Most health clubs and community centers offer exercise programs for people with physical limitations.

Getting 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 joints affected by arthritis 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.
Overdoing It
Most experts agree that if exercise causes pain that lasts for more than 1 hour, it is too strenuous. 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 strenuous 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)
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 during general or joint flares.

Pain Relief
There are known methods to help 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. In TENS, an electrical shock is transmitted through electrodes placed on the skin's surface. TENS machines might cost between $80 and $800. The inexpensive units are fine. Patients can wear them during the day and turn them on and off 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. 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.
Research
Researchers are looking at the effects of exercise and sports on the development of musculoskeletal disabilities, including arthritis. They have found that people who do moderate, regular running have low, if any, risk of developing osteoarthritis. However, studies show that people who participate in sports with high-intensity, direct joint impact are at risk for the disease. Examples are football and soccer. Sports involving repeated joint impact and twisting (such as baseball and soccer) also increase osteoarthritis risk. Early diagnosis and effective treatment of sports injuries and complete rehabilitation should decrease the risk of osteoarthritis from these injuries.

Researchers also are looking at the effects of muscle strength on the development of osteoarthritis. Studies show, for example, that strengthening the quadriceps muscles can reduce knee pain and disability associated with osteoarthritis. One study shows that a relatively small increase in strength (20% to 25%) can lead to a 20% to 30% decrease in the chance of developing knee osteoarthritis. Other researchers continue to look for and find benefits from exercise to patients with rheumatoid arthritis, spondyloarthropathies, systemic lupus erythematosus, and fibromyalgia. They are also studying the benefits of short- and long-term exercise in older populations.

The information in this article has been made available by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health.

Article Created: 2001-05-01
Article Updated: 2005-07-22

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.

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