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Patient education: Arthritis and exercise (Beyond the Basics)

Patient education: Arthritis and exercise (Beyond the Basics)
Literature review current through: Apr 2024.
This topic last updated: Jan 11, 2024.

ARTHRITIS AND EXERCISE OVERVIEW — Physical activity is known to have benefits for people with arthritis. Exercise can decrease pain and can enhance quality of life. Exercise is most beneficial when it is done on a regular basis.

Many people with arthritis do not exercise, often because of symptoms like joint or muscle pain, weakness, or fatigue. Being sedentary can lead to loss of joint motion, stiffness, and muscle weakness and tightness. These problems can worsen fatigue and can cause joints to become unstable.

Most people with arthritis can find a way to exercise without worsening their symptoms. This topic describes how to make an exercise plan for patients with arthritis, including disease-specific exercise recommendations. Information on general exercise can be found elsewhere. (See "Patient education: Exercise (Beyond the Basics)".)

SUCCESS WITH EXERCISE

Stick with it — A number of factors can improve the chances of sticking with an exercise program long-term, including:

Understanding the importance and benefits of exercise.

Following a simple regimen.

Setting attainable goals.

Pacing yourself by creating activity-rest cycles. Overdoing an activity can lead to pain and make people hesitant to do more exercise. Steps in starting a new exercise program could include:

Think about your tendency to overdo it.

Set a time limit that is a little less than you think you can do, and set an amount of time to rest.

Try the plan. When you reach the activity goal, stop and rest for the allotted time.

Record time on task, rest time, and how the exercise felt (eg, 10 minutes activity, 10 minutes rest, feeling good).

If delayed pain occurs, adjust your activity (eg, decrease activity time, intensity, or pace, or increase rest time).

Interacting with others while exercising (ie, with exercise groups or finding an exercise "buddy").

Following up regularly with a health care provider, such as a physical therapist or personal trainer, to provide encouragement and adjust the regimen.

Getting a referral to an occupational or physical therapist if you need guidance on starting or modifying an exercise program.

Ways to exercise — Exercise can be broken up into three or four 10-minute sessions per day; it does not need to be continuous to produce health benefits. Moderate-intensity exercise is most effective if it is performed on most days of the week. However, exercising only one or two days per week is better than not exercising at all. Reducing prolonged sitting and sedentary activities can be beneficial. Consider standing up or short walking breaks after 30 minutes of sitting and decreasing time spent watching television. Even small changes can benefit your health.

Exercise in a supervised setting may improve the chances of continuing for the long term compared with unsupervised, home-based programs. However, people who are self-motivated and exercise at home may enjoy the benefits of equal effectiveness, lower costs, and more convenience.

Some people are not interested in (or unable to participate in) a formal exercise program but can do daily activities that may benefit their health. These may include light housework, shopping, gardening, clearing walks and driveways, or caring for others (eg, a child, grandchild, or older person). There are also more gentle forms of exercise, including leisure walking or exercising in a pool.

Health benefits — Benefits of exercise include decreased pain and increased strength, mobility, and fitness, leading to an improved ability to perform daily activities. Exercise can also help to reduce depression and anxiety in people with arthritis and other conditions.

HOW CAN I PREPARE TO EXERCISE? — All people, especially those with arthritis, benefit from a balanced program of flexibility, strengthening, and endurance or aerobic exercise. Pain, stiffness, and fatigue are barriers to exercise success for many people with arthritis. Preparing for exercise can minimize these issues.

Talk to your doctor — Many people with arthritis can successfully exercise on their own. Before beginning an exercise program, contact your doctor or other health care provider to be sure it is safe. Specific questions to ask include the following:

Are there specific exercises or movements that should be avoided? For example, after hip replacement, patients often have hip movement restrictions early in the recovery; patients with inflamed joints may be told to do range-of-motion exercises only.

Are there specific exercises that should be included to maintain optimal health? For example, people with rheumatoid arthritis (RA) benefit from regular hand and wrist exercises to maintain range of motion and function. (See 'Disease-specific exercise suggestions' below.)

Do I need to be evaluated by a physical or occupational therapist before starting to exercise? If you answer "yes" to the questions below, an evaluation may be helpful.

Do stiffness, limited motion, or joint deformities make it difficult or painful to move?

Have past exercise attempts been unsuccessful because of pain that does not go away with rest or a reduced exercise program?

Warm up — The purpose of the warm-up is to improve circulation and to increase the temperature of muscles and joint structures so that the body is less stiff, movement is easier, and risk of injury is decreased. If you are successful, your body will feel slightly warmer than when you started. Some people benefit from a warm shower prior to exercise. Some people like to stretch after their warm-up.

People with arthritis may need a longer warm-up and cool-down. A three- to five-minute warm-up is recommended for the general population, while 10 to 15 minutes is optimal for people with arthritis. However, if you are walking slowly or exercising less than 10 minutes, you do not need a separate warm-up and cool-down.

Sample warm-up activities:

Walk or bike at half normal speed

Sit and perform range of motion exercises/flexibility exercises starting at the head and neck and progressing to the feet and ankles (ideally using the same muscles that will be involved in the exercise)

March in place

Cool down — The purpose of the cool-down is to return your heart rate to a few beats above normal. This prevents a sudden drop in blood pressure, feelings of nausea, fainting, and dizziness. Stretching is best done after your exercise session as part of your cool-down.

Sample cool-down activities:

Slowing down your walking, biking, etc gradually

Lifting light weights

Range of motion activities

Stretching exercises

Stretch — Stretching returns muscles to their full length and reduces soreness after exercise. People with arthritis need to be more cautious if they have lax joints (extra mobility or hyperflexibility) or malaligned joints (eg, hand deformities, bowlegged).

Flexibility exercises may be helpful for some patients with arthritis and can include stretching as well as modified yoga and tai chi (a Chinese martial art that involves slow, gentle movements).

ARTHRITIS EXERCISES — Exercises to improve muscle strength and build endurance are important components of an arthritis treatment program. Water- and land-based exercises can improve strength, function, and physical fitness. Tai chi and yoga should be performed carefully and should be supervised initially to make needed modifications and prevent injury.

Strengthening exercises — Strengthening exercises can help to improve joint stability and decrease pain. Examples of exercises that build strength include the use of free weights or weight machines. If you don't have access to a gym or weights, you can also build strength by doing "body-weight" exercises (eg, modified squats to strengthen the knees).

People with lax or malaligned knees should use caution with certain strengthening exercises because improving quadriceps strength (the muscles in the thighs) may speed the progression of preexisting arthritis. A physical therapist who specializes in treating arthritis-related knee problems can provide specific advice and recommend exercises to balance strength building. Treatment may include modified exercises and appropriate bracing.

Tips for success

Movements should be smooth, not jerky.

Care should be taken to avoid gripping the weight or exercise machine handle too tightly.

The weight should be light enough that the movement can be performed 8 to 10 times (one set) without pain or excessive fatigue.

To avoid fatigue and joint stress, alternate one set of arm exercises with one set of leg exercises (eg, one set of biceps curls, one set of quadriceps curls, one set of triceps curls, one set of hamstrings curls, then repeat the circuit).

The weight can be increased when 10 repetitions can be performed with ease and when the increased weight does not increase joint pain.

People with inflammatory arthritis should err on the side of caution, and they should start with a lighter weight and increase slowly. For example, arm exercises can start with as little as 1 to 2 pounds (0.5 to 1 kilogram).

Endurance exercises — Endurance exercises work to increase the heart and breathing rates, which can improve heart health, lower blood pressure, and improve fitness. Exercise does not need to be strenuous; during moderate-intensity endurance exercises, you should be able to carry on a conversation.

The type and amount of endurance exercise recommended depends upon a person's current fitness level. A person who has avoided exercise due to pain or lack of success might need to begin with just five minutes of slow walking. Low-impact exercises are preferable to minimize stress on the joints. Swimming and biking are low- or no-impact forms of endurance exercise that can be safely performed by most people with arthritis.

For people with access to a pool, aquatic exercises are of particular benefit for those with severe disease and/or a low fitness level, especially rheumatoid arthritis (RA). The buoyancy provided by water decreases pressure on joints and allows a person to exercise without the constraints imposed by body weight. Aquatic exercise programs often include group exercises in the water or walking in water. If you like to swim but have shoulder or neck issues that make it difficult to turn the head, you may need to consult with a therapist to design a successful swimming program. Some people can successfully reduce neck movement by using a snorkel and mask.

In general, exercise should start at a low intensity and for a short time. It is normal to feel some joint or muscle soreness after exercising. Delayed-onset muscle soreness is common and can last up to two days. The soreness should not be severe. Repeating some light warm-up exercises, stretching, or foam rolling can help with this.

Protect the joints — People with arthritis need to take a few extra precautions to protect their joints while exercising. The following tips are recommended.

Walk on flat, level surfaces, especially if prone to hip, knee, foot, or ankle problems.

Wear supportive footwear, such as athletic shoes, and use a shoe insert that supports the arches and provides cushioning to reduce impact on hips, knees, and feet. The shoe's original liner may be fine, although an insert with additional cushioning is often helpful for people with foot or knee pain. People who have foot pain or issues that prevent them from walking may benefit from custom orthotics (inserts) and consulting with a podiatrist or a physical therapist.

Avoid jarring movements and high-impact activities such as running.

Respect pain, do not ignore it, and monitor for it during exercise.

Start slow and increase activity gradually.

Pay attention to posture and alignment.

Do not take excess pain medication prior to exercise; this can mask pain and cause you to over-exercise.

Caution is recommended after a knee or hip replacement. High-impact sports such as running, football, baseball, basketball, and soccer are not recommended. However, participation in low- or no-impact sports such as swimming, cycling, or walking is encouraged.

Specific exercise instructions — Instructions for specific exercises for people with arthritis are available from the following resources:

Everyday guide to exercise and physical activity, available on the National Institute on Aging website

The Arthritis Helpbook by K. Lorig and J. Fries (Perseus Books, Cambridge, 2006)

Living a Healthy Life with Chronic Conditions by K. Lorig, H. Halsted, D. Sobel, et al (Bull Publishing, Boulder, 2020)

DISEASE-SPECIFIC EXERCISE SUGGESTIONS

Inflammatory arthritis — Inflammatory arthritis is a condition that causes swelling and pain in joints. Examples of inflammatory arthritis include rheumatoid arthritis (RA), psoriatic arthritis, spondyloarthropathy, and ankylosing spondylitis (AS). (See "Patient education: Arthritis (Beyond the Basics)", section on 'Inflammatory arthritis'.)

Do daily range of motion/flexibility as tolerated

Avoid high-impact activities, especially while taking oral steroids

Protect the joints, as described above (see 'Protect the joints' above)

During an acute flare-up, reduce the time and intensity of exercise and avoid resistance exercise involving affected joints

Many people need to rest during the day; long naps should be avoided to preserve nighttime sleep

Rheumatoid arthritis — RA is a chronic inflammatory condition that can affect many tissues throughout the body. The joints are usually most severely affected. The number and type of joints affected by RA can vary widely, although joints on both sides of the body are usually involved. (See "Patient education: Rheumatoid arthritis symptoms and diagnosis (Beyond the Basics)" and "Patient education: Rheumatoid arthritis treatment (Beyond the Basics)", section on 'Exercise' and "Patient education: Rheumatoid arthritis treatment (Beyond the Basics)", section on 'Physical and occupational therapy'.)

Morning stiffness related to RA often improves after performing stretching exercises, taking a warm shower, and/or using warm-up exercises. Performing flexibility exercises before sleeping can reduce morning stiffness (picture 1 and picture 2 and picture 3 and picture 4).

Avoid extreme neck movements and do not put pressure on the back of the neck. Yoga positions that stress the neck such as the plough, headstand, and shoulder stand should be avoided. A safe stretch for the neck is shown here (picture 1).

Avoid overstretching or applying too much force over malaligned joints, especially knees and fingers (most common for people with RA). Modify “all-fours” exercises (positioning on hands and knees) by using towel rolls or yoga blocks to avoid overstretching the wrists.

Be sure to include hand and wrist exercises in your daily routine (picture 5 and picture 6). After doing dishes or after showering is a good time to do these exercises because hands are warmer and more flexible. Include hand exercises that strengthen all the muscle groups of the hand to increase grip strength and decrease hand pain.

Take part in low-impact aerobics to increase your walking endurance and ability to participate in daily activities, to decrease pain, and to help lessen fatigue and depression.

Resistance training combined with aerobic exercise significantly improves fatigue in people with RA. If you are unsure how to safely perform resistance exercises, consult with a physical therapist.

Ankylosing spondylitis — AS is a chronic, inflammatory disease that primarily affects the back, neck, and sometimes hips and shoulders. The most common symptoms of AS are pain and stiffness of the low back and hips. Pain, stiffness, and limited mobility in other joints also occur in some patients. (See "Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics)".)

Flexibility exercises for the neck, back, shoulders, and hips are especially important to maintain range of motion (picture 1 and picture 2 and picture 3 and picture 4).

Be sure to include breathing exercises in your exercise program; this helps to improve mobility and chest expansion.

Take a deep breath, allowing the chest to expand as much as possible

Hold the breath for a count of three

Exhale slowly through the mouth; rest for a count of three

Muscle strengthening for the extensor muscles of the back and hips is needed to maintain erect posture (picture 7 and picture 8).

Pay attention to keeping the neck aligned with the trunk to minimize pain during activity.

Swimming is an excellent form of exercise if you are feeling stiff. A snorkel and mask can allow you to swim without turning your head to breathe.

Ongoing regular exercise is required to maintain the gains that you make.

Systemic lupus erythematosus — Systemic lupus erythematosus (SLE) is an autoimmune chronic inflammatory disease that affects various organs of the body. Joint symptoms occur in almost all patients and are often the earliest sign of SLE. The arthritis tends to occur in different parts of the body and does not usually affect both sides of the body the same way. Only a few joints are affected at any time. (See "Patient education: Systemic lupus erythematosus (Beyond the Basics)".)

Fatigue, shortness of breath, and pain with a deep breath (pleurisy) are common in people with SLE.

People with SLE who exercise regularly actually experience less fatigue.

Pace yourself and break up exercise sessions into short sessions.

Begin with breathing exercises and pay attention to breathing during exercise.

Take a deep breath, allowing the chest to expand as much as possible

Hold the breath for a count of three

Exhale slowly through the mouth; rest for a count of three

Protect the joints during exercise. (See 'Protect the joints' above.)

If you start to have pain in your hip or groin, check with your clinician. These can be signs that the head (top) of the femur is not receiving adequate blood flow, which can quickly destroy the joint and can potentially require joint replacement surgery.

Performing stretching or flexibility exercises at night may help to reduce morning stiffness (picture 1 and picture 2 and picture 3 and picture 4).

Osteoarthritis — Osteoarthritis (OA) occurs as a result of a gradual loss of cartilage from the joints. OA can affect almost any joint, although it is most commonly seen in the hands, knees, hips, and spine. Common symptoms include pain, stiffness, some loss of joint motion, and changes in the shape of affected joints. (See "Patient education: Osteoarthritis symptoms and diagnosis (Beyond the Basics)".)

Cartilage, which is worn down with OA, needs motion to help the joints stay healthy. People with OA generally benefit from a general exercise program that promotes healthy cartilage.

Painful joints should be moved through a full range of motion every day to maintain flexibility and slow deterioration of cartilage. For example, if the knees are affected, bend and extend the knees as far as comfortably possible several times per day.

If you have knee OA, knee-strengthening exercises can reduce pain and make it easier to walk, get up and down from a chair, and climb stairs (picture 8 and picture 9). Muscle strength training for people with OA can help maintain and even increase muscle mass as you age. Be sure to keep the joints in line by avoiding twisting motions or moving at an angle. You can do strengthening exercises even if your OA is severe; they can help you to function better with less pain and with an improved quality of life. Some people with knee OA find that doing tai chi helps.

Tai chi has been shown to improve balance for many types of arthritis. Along with other forms of traditional Chinese exercise, tai chi has also been shown to be beneficial in improving pain, stiffness, and physical function for people with knee OA.

Exercise helps decrease pain and prevent disability in people with OA.

Aerobic exercise also helps to prevent depression in people with OA.

Hip-strengthening exercises are especially helpful for reducing pain and improving function in knee OA, although they are unlikely to slow the progression of the arthritis.

Low-impact activities (biking, swimming, tai chi) are recommended when knees, hips, and spine are affected.

Higher activity levels promote better function. People with OA benefit from being as active as they are can be.

Knee braces or other supports (eg, a Neoprene sleeve) may be helpful if there is pain while walking.

Knee braces can be somewhat helpful for people who have active arthritis, significant joint instability, malaligned knees (bow-legged), or knees that "give out" as a result of arthritis. With a clinician's referral, an orthotist can provide an appropriate brace for these conditions and can provide instructions for wearing the brace correctly.

Fibromyalgia — The most common signs and symptoms of fibromyalgia are fatigue; tender points around the shoulders, back, hips, and knees; and generalized aching and stiffness. Joints do not become swollen as a result of fibromyalgia alone. (See "Patient education: Fibromyalgia (Beyond the Basics)".)

Exercise, especially endurance exercises and gentle strengthening, is key to managing this condition. In addition to low-impact aerobic exercises such as fast walking or biking, other options include water therapy, tai chi, chair yoga, or gentle yoga.

Avoid very prolonged or vigorous exercise, as this may worsen symptoms.

When supervised by professionals, people with fibromyalgia benefit from moderate resistance training. Resistance exercises help to reduce the number of tender points.

Being physically fit seems to help lower pain levels, and helps people with fibromyalgia feel more confident that they can do things.

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Physical activity for people with arthritis (The Basics)
Patient education: Osteoarthritis (The Basics)
Patient education: Exercise and movement (The Basics)
Patient education: Psoriatic arthritis in adults (The Basics)
Patient education: Psoriatic arthritis in children (The Basics)
Patient education: Exercise and movement as you get older (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Exercise (Beyond the Basics)
Patient education: Psoriatic arthritis (Beyond the Basics)
Patient education: Rheumatoid arthritis symptoms and diagnosis (Beyond the Basics)
Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics)
Patient education: Systemic lupus erythematosus (Beyond the Basics)
Patient education: Osteoarthritis symptoms and diagnosis (Beyond the Basics)
Patient education: Fibromyalgia (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Nonpharmacologic therapies for patients with rheumatoid arthritis
Overview of joint protection
The benefits and risks of aerobic exercise
Systemic lupus erythematosus in adults: Overview of the management and prognosis
Treatment of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults

The following organizations also provide reliable health information.

National Library of Medicine

(medlineplus.gov/healthtopics.html)

National Institute of Arthritis and Musculoskeletal and Skin Disease

(www.niams.nih.gov)

American College of Rheumatology

(www.rheumatology.org)

Arthritis Foundation

(www.arthritis.org)

Spondylitis Association

Phone: 1-800-777-8189

(spondylitis.org)

Centers for Disease Control and Prevention

(www.cdc.gov/arthritis/)

Lupus Foundation of America

(www.lupus.org)

[1-15]

  1. O'Dwyer T, O'Shea F, Wilson F. Exercise therapy for spondyloarthritis: a systematic review. Rheumatol Int 2014; 34:887.
  2. Pettersson S, Boström C, Eriksson K, et al. Lifestyle habits and fatigue among people with systemic lupus erythematosus and matched population controls. Lupus 2015; 24:955.
  3. Dunlop DD, Song J, Semanik PA, et al. Physical activity levels and functional performance in the osteoarthritis initiative: a graded relationship. Arthritis Rheum 2011; 63:127.
  4. Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 2015; 1:CD004376.
  5. Bennell KL, Hunt MA, Wrigley TV, et al. Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Osteoarthritis Cartilage 2010; 18:621.
  6. Busch AJ, Webber SC, Richards RS, et al. Resistance exercise training for fibromyalgia. Cochrane Database Syst Rev 2013; :CD010884.
  7. Soriano-Maldonado A, Ruiz JR, Aparicio VA, et al. Association of Physical Fitness With Pain in Women With Fibromyalgia: The al-Ándalus Project. Arthritis Care Res (Hoboken) 2015; 67:1561.
  8. Kelley GA, Kelley KS, Hootman JM. Effects of exercise on depression in adults with arthritis: a systematic review with meta-analysis of randomized controlled trials. Arthritis Res Ther 2015; 17:21.
  9. Huston P, McFarlane B. Health benefits of tai chi: What is the evidence? Can Fam Physician 2016; 62:881.
  10. Fangtham M, Kasturi S, Bannuru RR, et al. Non-pharmacologic therapies for systemic lupus erythematosus. Lupus 2019; 28:703.
  11. Santos EJF, Duarte C, Marques A, et al. Effectiveness of non-pharmacological and non-surgical interventions for rheumatoid arthritis: an umbrella review. JBI Database System Rev Implement Rep 2019; 17:1494.
  12. Metsios GS, Moe RH, van der Esch M, et al. The effects of exercise on cardiovascular disease risk factors and cardiovascular physiology in rheumatoid arthritis. Rheumatol Int 2020; 40:347.
  13. Thomsen T, Esbensen BA, Hetland ML, Aadahl M. Motivational Counseling and Text Message Reminders: For Reduction of Daily Sitting Time and Promotion of Everyday Physical Activity in People with Rheumatoid Arthritis. Rheum Dis Clin North Am 2019; 45:231.
  14. Balasukumaran T, Olivier B, Ntsiea MV. The effectiveness of backward walking as a treatment for people with gait impairments: a systematic review and meta-analysis. Clin Rehabil 2019; 33:171.
  15. Plumb Vilardaga JC, Kelleher SA, Diachina A, et al. Linking physical activity to personal values: feasibility and acceptability randomized pilot of a behavioral intervention for older adults with osteoarthritis pain. Pilot Feasibility Stud 2022; 8:164.
Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms. 2024© UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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