Exercising and arthritis

Yes, people with arthritis should exercise. Whilst exercising may seem counter-intuitive when you are suffering from arthritis and have knee, hip or other joint pain, it can be more helpful than resting.

People with arthritis who exercise regularly have reduced joint pain and stiffness and increased flexibility, strength and endurance. Exercise can also help in weight control, which can reduce the risk of further wear and tear on your joints and reduce joint-damaging inflammation.

Osteoarthritis occurs when the cartilage covering the bony surfaces of joints breaks down or when spurs (osteophytes) develop on the edges of the end of the bone. In addition to this physical degeneration of the joints caused by wear and tear, emerging research is showing that in overweight or obese people, an inflammatory process is also at work. Scientists have shown that fat cells release inflammatory chemicals which may also be involved in attacking the cartilage and damaging it.

Osteoarthritis affects only joints and not internal organs. Most affected are the weight-bearing joints such as the spine, hips, knees and feet. People with osteoarthritis usually have joint pain and limited movement.

Osteoarthritis can rob you of mobility and flexibility and can add up to a reduced quality of life, which is why it’s important to keep exercising to support your joints.

What are the benefits of exercise if you have osteoarthritis?

Exercise can help people with arthritis in many ways. In fact, doctors have gone so far as to say that exercise is a crucial component of treating osteoarthritis. Some of the ways that exercise can help symptoms of osteoarthritis are to:

  • Strengthen the muscles supporting your joints. Stronger muscles improve stability of the joint and also reduce some of the load on a joint. For example, weak quadriceps muscles (thigh muscles) have been shown to be a risk for developing osteoarthritis of the knee. Exercises to strengthen your thigh muscles protect the joint and help prevent your knee from giving way.
  • Improve range of motion of a joint. Exercises to improve range of motion get the joints moving and improve stiffness. Improved flexibility leads to better posture and blood flow to a joint.
  • Increase energy. Regular aerobic exercise can improve a person’s energy levels.
  • Reduce pain. Strengthening exercises for muscles supporting joints have been shown to reduce pain. Aerobic exercise can release endorphins – the body’s natural pain relieving chemicals.
  • Reduce stiffness in joints. Range of motion exercises done in the morning can reduce stiffness that builds up overnight.
  • Improve balance. Often in people with arthritis their posture is affected and they don’t have such good sense of body position – this can result in reduced balance and a risk of falling. Exercises that can help improve balance include tai chi, yoga and pilates.
  • Weight control. A combination of aerobic and strengthening exercise can help with weight control, which helps to limit damage to joints from load bearing and from inflammation.

Remember to exercise the whole body, not just the muscles around the affected joint.

What kind of exercise is good for arthritis?

Four main types of exercise are recommended as being beneficial for people with arthritis.

  1. Exercises that will help keep your joints moving (range of motion exercises)
  2. Exercises that will keep and improve muscle strength (strength training)
  3. Exercises that will maintain your general health and fitness (aerobic exercise)
  4. Exercise that improves your body awareness.

Range of motion exercises

Range of motion exercises improve flexibility and can be done every day. They help to lubricate your joints and maintain their mobility. If you suffer from arthritis pain you may tend to restrict movement in an effort to avoid pain, but this is not a good move in the long term, leading to shortened muscles and reduced mobility.

Examples of range of motion exercises are shoulder rolls, ankle circles and neck bends. Pilates and Tai Chi both have range of motion exercises in their repertoire.

Strength training exercises

Strength training exercises can be carried out using resistance bands such as TheraBands, free weights (e.g. dumbbells), ankle strap weights, your own body weight or machines in the gym. Strength training leads to stronger muscles which will support your joints better and stabilise the joint more than weak muscles.

Strength training exercises are generally done 2-3 times a week, so as not to exercise the same muscle group 2 days in a row. Examples of strength training exercises are bicep curls and wall squats.

Aerobic exercise

Aerobic exercise should be of the low-impact variety, so as not to cause problems for your joints. This includes walking, cycling, swimming, dance, aqua aerobics, or using a treadmill or elliptical trainer. Aerobic exercise can improve sleep, reduce pain, improve your mood and give you more energy. Avoid rapid repetitive movements of the painful joint, at least to start with.

Exercising in warm water is a helpful way for people with arthritis to exercise while the joints are supported. An added bonus is that the warm water (hydrotherapy pools are generally at 34 degrees Celsius) can relieve joint pain. Some hydrotherapy pools have sloping steps or a ramp to make it easier to enter and leave the pool. Arthritis organisations in most Australian States offer warm water exercise classes for people with arthritis and musculoskeletal conditions or can point you in the direction of local hospital or community hydrotherapy pools.

All Australians are recommended to do at least 30 minutes of physical activity on most days of the week. This can be broken up into shorter sessions.

Body awareness exercise

Exercises that improve body awareness and awareness of the position of joints, such as pilates, yoga or tai chi can improve balance, lessen the risk of falling, improve posture and promote relaxation.

How to start exercising if you have arthritis

If you have arthritis, discuss exercise options with your doctor, rheumatologist or physiotherapist. There are different types of arthritis and what is helpful for one type may be a hindrance for another. Your doctor or physio should be able to advise you what sport or exercises you can do, and what you can’t.

Appropriate exercise can depend on a number of factors to do with your joints, such as which ones are affected, their stability and whether you have had joint replacement surgery. Also, if your joints have flared up and are swollen and inflamed they will be able to advise you on an exercise plan that doesn’t irritate your joints further.

You may be referred to a physiotherapist who has experience with people who have arthritis. A special exercise programme can then be designed for you including information on pain relief, the mechanics of lifting and protection of your joints.

You will need to start slowly if you haven’t been active for a while.

What if my arthritis pain gets worse after exercising?

If you are starting to exercise after not being active for some time, you may experience some pain after a session. Two hours seems to be the agreed ‘pain limit’. If pain caused by your exercise lasts longer than that, it’s too much. If you notice any of the following, check with your doctor or therapist to modify your programme.

  • After exercising, the pain lasts longer than one to 2 hours.
  • Increased joint swelling.
  • Unusual or persistent fatigue.
  • Increased feeling of weakness.
  • Decreased range of motion (flexibility).

Warning

Whatever activity you choose, always start off gently and remember that regular exercise is better than overdoing it every once in a while. Always warm up before exercising, and try to find the most beneficial level at which you can exercise without causing pain. Use common sense to balance rest and activity.

Mobility: use it or lose it

If you’re thinking that nothing will make you move those painful, stiff joints, consider this: gentle, regular exercise will result in less pain due to more flexibility, you’ll have greater strength and endurance, a better mood and outlook, you’ll get a better night’s sleep, maintain weight and, as a bonus, have a healthier heart.

Above all, be realistic: you may not be able to climb mountains or begin training for the Olympics, but taking a relaxing walk in the park might be just what you need.

If you're suffering from arthritis pain, the last thing you may want to do is exercise. But studies have shown that exercise can reduce joint pain and stiffness and increase flexibility, strength and endurance.

But before you go out and join a gym or enter a triathlon, discuss a planned programme with your doctor.

To begin, though, some simple stretching exercises will help keep your joints moving, particularly those joints that are affected by arthritis. These involve gentle bending and straightening and should improve your flexibility.

You should try these every 2 days, although you can do them every day, but take it slowly. One to 2 hours seems to be the agreed ‘pain limit’ for pain to last after exercise, and if it's any longer than that, check with your doctor.

Basic exercises

  • Neck bend
  • Neck turn
  • Shoulder circles
  • Forward arm lift
  • Elbow bend
  • Wrist bend
  • Finger tuck
  • Finger touch
  • Side bend
  • Hip swing
  • Hamstring stretch
  • Ankle circles
  • Foot roll
neck bend

Neck bend

Make sure that your head is centred. Now, keeping your eyes straight ahead, lower your head towards your left shoulder, then back to the centre. Repeat slowly to the right side, and then bring your head back up to the centre, all the time keeping your eyes straight ahead.

neck turn

Neck turn

Make sure your head is centred. Slowly and gently, turn your head to the left and look over your shoulder. Don't strain, go as far as you can without too much discomfort. Then turn your head to the right and look over your right shoulder, and then back to the centre.

shoulder circles

Shoulder circles

Relax your shoulders and arms. Let your arms hang at your side. Slowly roll your left shoulder forward, then down and around to complete a circle, first clockwise, then anti-clockwise. Repeat with your right shoulder. Then do both shoulders together.

arm lift

Forward arm lift

Relax shoulders and arms. Let your arms hang at your side. Slowly lift your arms up and back towards your head as far as you can without pain, keeping them straight at the elbow. Now lower gently back down to your sides.

elbow bend

Elbow bend

Relax shoulders and arms. Let your arms hang at your side. Very slowly and gently, raise your forearm to the front, bending at the elbow until your hand touches your shoulder. Lower back to your side. Repeat with the other arm.

wrist bend

Wrist bend

Relax shoulders and arms. Let your arms hang at your side. Slowly bring your left arm up, bending it at the elbow and keeping your elbow tucked into your side until it is horizontal to the floor. Hold the top of your forearm with your other hand to keep it steady. Bending at the wrist, bring your hand toward you, then away from you (a slow, stretching wave movement). Repeat with the right arm.

finger tuck

Finger tuck

Holding your hand up, with fingers straight as if it were pointing to 12 o'clock, slowly and gently bend your fingers only, as though you were waving only with your fingers. Then slowly bend the fingertips down, tucking them into the hand. Then back open again. Repeat with the other hand.

finger touch

Finger touch

Using your other hand to keep your wrist steady, form the letter ‘O’ by touching your index fingertip with your thumb. Repeat with each finger, then repeat with the other hand.

side bend

Side bend

Make sure that your head is centred. Now, keeping your eyes straight ahead, stand with your feet apart. Bring your right arm up and over your head to the left. Lean into the exercise, letting your left hand slide down your left leg. Then back to the centre and repeat with your left arm. Try not to lean forward or let your head move forward.

hip swing

Hip swing

For this one, use a chair or handrail to keep you steady. Holding lightly onto the back of the chair, slowly swing one leg forward, back to the centre and then towards the back. Try to make the movement come from the hip and not the knee. Try to keep your back straight. Repeat with the other leg.

hamstring stretch

Hamstring stretch

You'll need to sit down for this one. Bring yourself forward until you are sitting on the edge of your chair, then straighten your leg and prop your heel either on the floor or on another chair. Slowly, stretch forward from the waist keeping your back straight, until you feel a gentle tug along the back of your leg. Hold the position for about 15 seconds to half a minute, and then repeat with the other leg.

ankle circles

Ankle circles

For this one, sit up straight in a chair, lift your leg and straighten it. Slowly draw a forward, then a backward circle in the air with your toe. Repeat with the other leg.

foot roll

Foot roll

You can do this one sitting down or standing up. If you are standing up, make sure you hold on to something, such as the back of a chair, for balance. You can use a small, rolled up towel or something similar. Place it under the arch of your foot and slowly roll backwards and forwards.

References

1. American College of Rheumatology. Exercise and arthritis. Reviewed April 2015. http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Living-Well-with-Rheumatic-Disease/Exercise-and-Arthritis (Accessed Sept 2016).
2. Mayo Clinic. Exercise helps ease arthritis pain and stiffness. http://www.mayoclinic.org/diseases-conditions/arthritis/in-depth/arthritis/art-20047971 Reviewed Jan 2016. (Accessed Sept 2016).
3. Arthritis Australia. Strength training. http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2016/Final_ArthAus_StrengthTraining2705.pdf (accessed Sept 2016).
4. Arthritis Australia. Water exercise. http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2015/General%20management/Waterexercise.pdf (accessed Sept 2016).
5. Arthritis Research UK. Exercise for osteoarthritis. http://www.arthritisresearchuk.org/arthritis-information/conditions/osteoarthritis/what-can-i-do-to-help-myself/exercise-for-osteoarthritis.aspx (accessed Sept 2016).
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