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Arthritis and Exercise Q&A

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.

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 (e.g., dance) help maintain normal joint movement and relieve stiffness. This type of exercise helps maintain or increase flexibility.
  • Strengthening exercises (e.g., weight training) help keep or increase muscle strength. Strong muscles help support and protect joints affected by arthritis.
  • Aerobic or endurance exercises (e.g., 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.

How does a person with arthritis start an exercise program? People with arthritis should discuss exercise options with their doctors and other health care providers. 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.

What are some pain relief methods for people with arthritis? 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 15-20 minutes three times a day to relieve symptoms. A health professional can use short waves, microwaves, and ultrasound to deliver deep heat to non-inflamed 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 stop pain and reduce swelling when used for 10-15 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 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. 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 much exercise is too much? Most experts agree that if exercise causes pain that lasts for more than one 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 one hour after exercising)

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. Available at: www.niams.nih.gov/hi/topics/arthritis/arthexfs.htm. Accessed June 19, 2006.

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 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.