Exercising with Arthritis

Some kinds of exercise can increase strength and flexibility, combat fatigue, help weight loss which takes pressure off the joints and – most importantly – reduce pain.

You should always consult your doctor or your practice nurse, if you've never exercised before, or have any concerns.

Three main types of exercise

Being fit means different things to different people. For some, it means being able to run a marathon or lift a heavy weight, while for others it means having the energy and mobility to get up the stairs, walk the dog or play with grandchildren. Whatever your fitness goals, the key thing is to get – and keep – the body moving. Unfortunately, you can’t ‘store’ fitness, so it’s a matter of finding activities you enjoy that you will maintain for life. But not all physical activity has the same effect. There are three main pieces of the fitness puzzle: aerobic fitness (also called endurance or stamina), strength and mobility (also called flexibility). A balanced exercise plan should contain a mix of all three – but your condition makes some aspects of fitness more important than others.

1. Aerobic fitness

   As far as health is concerned, aerobic exercise is the gold standard. It helps to strengthen your heart and lungs, keeps blood vessels healthy, reduces blood pressure and cholesterol levels and helps to control body weight by burning lots of calories. Just 30 minutes a day has been shown to reduce the risk of heart disease. Exercise to improve your aerobic fitness means anything that you can do for a sustained period which gets your heart beating faster, making you feel warm and breathless. Even gentle activities, like slow walking or tai chi, can have a benefit, but if you are capable, you should opt for moderate to vigorous activities, which are associated with an even greater reduction in risk of many health problems, including heart disease. But don’t sacrifice duration for intensity. It’s better to go slow to begin with and exercise for longer than to go all-out for just a couple of minutes before you have to give up! The golden rule? Do as much as you can, as often as you can.

2. Strength

   When it comes to muscle strength, the old adage ‘use it or lose it’ couldn’t be more apt. Muscles adapt to cope with the demands you place on them, so if the greatest challenge you give them is sitting on the sofa, then that’s what they’ll adapt to, making more demanding activities feel challenging and most likely, causing you to become less active. Strength training is particularly important as we age, because muscle strength and mass (the amount of muscle we have) tends to decline as we get older. Increasingly, experts believe that maintaining (or regaining) strength is crucial for good health. Stronger muscles, tendons and ligaments are less susceptible to injury, while stronger bones mean you are less likely to suffer from osteoporosis, a bone-thinning disease associated with frailty, falls and fractures. To build or maintain strength, we have to get our muscles to exert a force (for example, by lifting a heavy item) or resist one (for example, by standing up from a seated position, resisting the force of gravity). It’s through doing this that your muscles and surrounding structures (like tendons and ligaments) get stronger and more robust. And remember, it’s all relative: for one person, lifting a 1lb bag of sugar may provide enough of a challenge to stimulate muscles to get stronger – for another, it may need to be a 10lb bag of rice. Building muscle has another benefit: a higher level of muscle mass increases energy demand, contributing to weight control. When you train to build strength, remember that it is specific to each area. (In other words, training your arms won’t help your legs!) A full body programme, performed 2-3 times a week, is the best approach.

3. Mobility/flexibility

   Flexibility isn’t just about being able to touch your toes. It’s about being able to reach something off the top shelf, turn your head to reverse the car or do up your bra strap. As we age, joints tend to stiffen and muscles tighten. This situation is made worse by a sedentary lifestyle where poor posture has become the norm. Without exercise, our ‘range of motion’ (how far a joint can move, or how much a muscle can lengthen) will get smaller and smaller, making daily tasks more challenging. But the good news is that with regular mobility training, you can maintain – and even regain – your flexibility. While you can mobilise your joints at any time (first thing in the morning is a good way of getting the day off to a good start), you should not stretch muscles unless they are warm. That means after a hot bath, perhaps, or straight after aerobic exercise. Generally, flexibility exercise should be performed 2-3 times a week. You should always consult your doctor or your practice nurse, if you've never exercised before, or have any concerns.

What’s the right type of exercise for me?

All three types of exercise can help you with arthritis – a balanced exercise regime will contain a mix of aerobic exercise, strength training and mobility work.

1. Mobility exercises

   When joints feel stiff or painful due to arthritis, we don’t feel inclined to move them. But through gentle mobility or ‘range of motion’ exercises, such as bending, extending and rotating, we enhance the flow of the sticky liquid called synovial fluid that coats joint surfaces, making movement easier and less uncomfortable. Keep your movements smooth and controlled – don’t jerk or overstretch. Ideally, mobilise every joint from head to toe – repeating each movement 3-10 times, depending on how it feels, but if you are pushed for time, focus on your particular trouble zones.

2. Strength training

   The reason strong muscles are important for arthritis is that they help to stabilise joints, supporting good posture, alignment and efficient movement, which in turn, can reduce discomfort and fatigue and lowers the risk of further joint damage. While strength training entails ‘overloading’ muscles by getting them to exert or resist a force greater than they are accustomed to it certainly doesn’t have to mean going to a gym and hoisting dumbbells around! You can use just your own bodyweight, or items such as resistance bands, bottles or cans as weights. And, if you are past the first flushes of youth, don’t think it’s too late to start! Top tip: If your hips and knees are affected by arthritis, there are plenty of seated and lying exercises you can do to strengthen muscles whilst taking the weight off your legs. For example: Try sitting in a chair, back straight with feet flat on the floor. Straighten one leg out in front of you and hold for a second, then lower. Repeat with the other leg. Aim to build up to lifting each leg 10 times. Once you can do that, ‘write’ your initials in the air with your big toe while your leg is raised!

3. Aerobic exercise

   It’s no secret that most of us – arthritis sufferers or not – don’t get enough aerobic exercise. The latest exercise guidelines from the Department of Health state that for health, we need to get 30 minutes a day, on at least five days of the week. The reason aerobic exercise is so important is that it has great benefits for heart health – just 30 minutes a day can help reduce the risk of heart disease. It also increases calorie expenditure, helping you achieve or maintain a healthy weight. But the benefits don’t end there – regular aerobic activity can help you gain more energy, sleep better and feel less stressed. Aerobic activity means low to moderate activity that gets your heart rate up and leaves you feeling slightly breathless and warm. It doesn’t mean donning Lycra tights to work out to music in an aerobics class (although that is an option!). Activities that can work particularly well for you as an arthritis sufferer are those in which your body weight is partly supported – for example, swimming or aqua aerobics, in which the water provides support, or cycling, in which the bike takes some of your weight. But the choices are endless and the key thing (as with any form of exercise) is finding an activity that you enjoy. If you don’t get any pleasure from the activity you choose, you’ll be less likely to do it regularly and won’t benefit so much. You should always consult your doctor or your practice nurse, if you've never exercised before, or have any concerns.

When’s the best time for me to exercise?

You know your body and your lifestyle best, so it’s up to you to decide when the best time is to fit in exercise. But there are a few things to bear in mind:

• Many people with arthritis wake with morning stiffness, so it’s generally not the best time of day for a vigorous aerobic workout. However, starting the day with your mobility exercises can help to dissipate the stiffness, get you thinking about your posture and set you up for the day.
• A warm bath and or shower before exercise can help ease your muscles and joints a little.
• It’s best to schedule exercise for when you are in the least pain. But while painkillers are a valuable weapon in your armoury against arthritis, be wary of using them to mask pain so that you can push yourself harder during workouts.
• During a flare-up, when pain inflammation and swelling are at their worst, you will need to re-assess and possibly curtail your usual exercise regime. But that doesn’t mean you have to give it up altogether. If only one area is affected, you can still exercise other areas.

7 tips for exercising safely

• Always warm up before exercising. A warm shower or bath can help start the process. Performing your mobility exercises before strength training is a good warm-up, making the joints and muscles more supple and free. Start your aerobic activity very gently and allow a few minutes for your heart rate and body temperature to rise before increasing the intensity.
• Exercise ‘little and often’ if you find it challenging. You can gradually work towards longer blocks of activity as you get fitter. Every little helps!
• It’s normal to have some soreness/fatigue after exercise but if you’re in pain, rather than discomfort, seek advice.
• Applying warmth to specific areas before exercise can help ease joints and muscles in. Apply ice afterwards to any sore areas.
• Always obey the TWO HOUR RULE: If you feel more pain 2 hours after you exercised than you did beforehand, do less next time.
• Don’t continue with any exercise that is causing severe pain.
• Monitor how your body responds to exercise. Do you have more energy for afternoon sessions? Is your chosen activity exacerbating a joint pain? Do you need to give yourself longer to build up the duration of your workouts? Keep a note of what you do and how it feels.

You should always consult your doctor or your practice nurse, if you've never exercised before, or have any concerns.

Getting started

If you are currently sedentary, or if you plan to start a new form of activity, it is advisable to check with your doctor and/or physiotherapist before you begin.

Step 1. Begin with the mobility exercises. Ideally, work through the whole body but if you can’t, then just focus on the areas that are worst affected. You may only be able to do 3 or 4 to begin with but over time you will be able to build up the number of repetitions of each exercise. Do these every day. You may benefit from doing them twice a day.

Step 2. When you are comfortable with the mobility exercises, introduce aerobic exercise. While the ultimate aim is to do 30 minutes on at least 5 days of the week, you may want to aim for just 10-15 minutes per day to begin with. Progress to 20-30 minutes by breaking exercise down into bite size chunks of 10 minutes or so, and work towards continuous activity for 30 minutes. It’s advisable to start with low-impact options, such as cycling, swimming or walking.

Step 3. When you are comfortable with regular mobility and aerobic exercise, try some strength training exercises. Aim for 2-3 days per week and always have a day off between each session. Pilates and yoga are great ways of strengthening muscles – but ensure that the instructor is suitably qualified and able to advise you on which exercises are suitable for you and your condition.

Taking it further

If you already exercise regularly, don’t rest on your laurels! The body is very good at adapting to the physical demands you place upon it – and it’s only by moving the goalposts a little further away every now and again that you can make further fitness gains. There are three ways you can progress, nicely summed up by the acronym FIT.

F for frequency: you can exercise more often.

I for intensity: you can push yourself harder during exercise.

T for time: you can increase the duration of your workouts.

Top tip: Pick just one letter at a time to work on! Don’t try to increase the duration and intensity of an exercise activity all at once.

What you need to know:

• As a non-impact activity, swimming is kind on joints but it doesn’t offer the bone-boosting benefits of weight-bearing exercise like walking or jogging.
• Breaststroke can be hard on arthritic knees. Opt for backstroke or freestyle.
• Try not to swim with your neck craned and head out of the water. This will put the spine out of alignment and stress the neck and lower back. Invest in a pair of goggles so you can put your head under the surface.
• Since warmer water helps to relax muscles, a warmer pool is better than a chilly one. If you have to swim in colder water, keep moving (no lingering at each end for a chat!).
• Going to the pool doesn’t just have to mean swimming – many pools offer aqua aerobics or other water-based classes, often set to music. The deeper the water, the more supportive it is to your joints. If you’re not sure it’s for you, you could always watch a class first.

Cycling

A great form of aerobic exercise, particularly good for strengthening the leg muscles. The bike supports much of your weight, so cycling is a low impact activity, making it kind on joints. At a moderate pace (12-14 miles per hour), a 60kg woman will burn 500 calories in an hour so it’s a good fat burner, too.

The other benefit of cycling is that you can opt for a stationary bike (which you can ride with no hands, if your fingers and wrists are sore) or cycle outdoors. If you are a bit rusty in the saddle, start with traffic-free spaces such as parks until you get more confident.

Should I exercise when I’m in severe pain?

Try to maintain your mobility exercise but reduce other activities during times of pain and severe inflammation or swelling, both in terms of how long you do them for and how hard you work. You may need to stop aerobic and strength activities completely in bad times.