How to Exercise With Arthritis
Weight Training 101
Getting started lifting weights can be tough – especially when coping with arthritis and are unsure of which exercises are the best and safest for your joints. How much weight should you use? How many times should you lift it? We compiled a list of weight training basics to answer your questions.
How long and how often? Two or three weekly 20- to 30-minute, weight-training sessions are sufficient to start reaping noticeable benefits within four to 12 weeks, such as improved energy and muscle tone. Within six months, most people increase their strength 40 percent or more. Give your body at least one recovery day between sessions (although some people may need more, especially in the beginning).
How much weight? Start with a pair of light dumbbell hand weights (2 to 3 pounds for women and 5 to 8 pounds for men). If you can’t do 12 repetitions (or reps are the number of times you do the exercise) the weight is too heavy. If your muscles don’t feel tired after 12 reps, it’s too light. Adjustable weights that can be strapped to wrists or ankles may be convenient if you have arthritis in your hands. You can also use home or gym weight machines, or resistance bands.
How many reps and sets? For general toning and strength, the American College of Rheumatology and American Council on Exercise recommend completing one set of eight to 12 reps, working the muscle to the point of fatigue by the last few reps of each set.
What kind of exercises? Work all major muscle groups, starting with the larger muscles. Always include exercises for opposing muscles: for example, work the biceps and triceps of your arms, and the quadriceps and hamstrings of your thighs. Avoid above-the-shoulder exercises if you have arthritis in your upper body, and talk to your doctor before using leg press machines if you have arthritis in your knees or hips.
How to do it. Lift slowly and smoothly, counting four counts up and four counts down. Avoid locking (fully straightening) knees or elbows, which stresses joints. Deliberately exhale when lifting, and inhale when lowering.
A New Way to StretchSimple stretches help improve flexibility and can also ease joint pain. | By Linda Melone
Stretching as a warm-up prior to exercise may be a practice you learned back in grade school gym class. Today, experts debate its effectiveness. The truth? “Stretching is helpful,” says Amy Ashmore, PhD, an exercise physiologist with the American Council on Exercise. Stretching particularly benefits those with arthritis by lubricating joints and enhancing and maintaining range-of-motion.
Keep these basics in mind:
Avoid stretching a cold muscle
Only perform "static stretching” (stretch and hold) after a five to 10 minute warm-up, says Ashmore. A warmed-up muscle can stretch longer and endure more, says Duane Knudson, PhD,professor and chair of the department of health, physical education and recreation at Texas State University.
Use dynamic or “active” stretching as a warm-up
Dynamic stretches mimic movements used in the sport or activity. Dynamic warm-ups prepare the body for activity by helping to increase blood flow and muscle temperature.
If you're preparing to play tennis, for example, you’ll want to practice side and front lunges as part of your warm-up – movements you'll use to reach for the ball.
If you're walking, you’ll want to start off at a slow pace and gradually pick up speed.
"Light, gentle rhythmic movements work best for the average person," says Ashmore. "Go through a shallow range of motion (i.e. a half-squat vs. a full squat) until you're thoroughly warmed up."
Even professional football players use dynamic warm-ups before a game. "You'll see players high-kicking down the field and going through a full range of motion instead of partner stretching for 10 minutes like they used to do," says Knudson.
Of course, you should always consult your physician or physical therapist before trying new stretches.
Stretch at the end of your workout
"Stretching at the end of the cool-down phase, after exercise when your muscles are still warm, helps to maintain long-term flexibility benefits," Knudson says.
Working Out Through Pain Learn when to keep moving through exercise pain and when to stop.| By Camille Noe Pagán
Exercise is crucial if you have arthritis. But knowing just how much activity to do when you’re hurting can be tricky. After all, research has shown that moderate activity can help prevent the progression of arthritis and improve overall function. But while mild muscle soreness after a workout is normal, sharp pain during or immediately after can signal injury. And sometimes simply the fear of pain can keep you from wanting to do any kind of exercise at all. Here’s how to determine when it’s OK to work through exercise pain – and when it’s not.
If you have mild to moderate pain in a specific joint area before you work out: Some mild pain or discomfort is typical when you first start to move, but after a few minutes you’ll usually start to feel better, says A. Lynn Millar, PhD, a professor of physical therapy at Winston Salem State University in Winston-Salem, N.C. “Our joints and muscles get nutrition through movement,” she explains. “Once you start to move around a little you’ll improve the lubrication and circulation around that joint.” Start with some gentle, active range of motion movements and if that feels OK, progress to some low-impact activity like walking, she advises.
If you have moderate to severe pain in a specific joint area before you work out: Focus on a different area for a day or two. If your knees hurt, decrease the intensity. If the pain becomes worse, then stop the lower body moves and work your upper body instead. “Continuing to put pressure on a joint when it’s especially sore could contribute to joint damage, so it’s best to ease up for a while,” says physical therapist Richard Kassler, supervisor at the Orthopaedic and Sports Therapy Center at New York University Hospital for Joint Diseases, in New York City.
If you have moderate to severe joint pain during exercise: Stop immediately. “Most people with arthritis can work through mild pain safely. But if you’re experiencing a lot of pain while you exercise, even if you’re not doing a particularly joint-taxing workout, it may be a sign that you have inflammation in the joint, or even joint damage that requires treatment,” says Kassler.
If you consistently have joint pain (not muscle pain) after exercise: Switch to a workout that puts less pressure on your joints. “If you need an elaborate brace or have to pop ibuprofen constantly, it’s a pretty good sign that your activity is too hard on your joints,” says rheumatologist James O’Dell, MD, president of the American College of Rheumatology Research and Education Foundation, in Atlanta. Swimming, water aerobics and biking are all good options for people with joint pain.
If you occasionally have moderate to severe joint pain the day after you work out: Cut back on the intensity of your workout. “If you’re really sore the next day, you probably were exercising too hard or too long,” says Dr. O’Dell. He suggests taking a day off, then doing a shorter, less strenuous workout. If your pain still doesn’t let up, switch to a less intense form of exercise, such as trading your elliptical workout for water aerobics.
Avoiding Common Workout MistakesExercise smarter – and safer – to help you get more out of your workouts and maximize your results. | By Lissa Poirot
You’ve finally made the commitment to exercise. But if you aren’t exercising correctly, you could be doing your body more harm than good. And according to the American Council on Exercise (ACE), there are some top fitness mistakes that people – regardless of age or physical ability – tend to make repeatedly. Each one can cause stress and injury to the body. To get the most from your fitness program and keep your joints strong and injury-free, be sure to avoid these exercise mistakes.
The mistake: You skip the warm-up. It’s important for raising body temperature and increasing blood flow to loosen the muscles. When you don’t properly warm up, you risk injury and stiffer joints the day after, says Jessie Jones, PhD, professor of kinesiology and health promotion, California State University-Fullerton. A simple warm-up: March in place for five minutes.
The mistake: You never stretch. Stretching gives muscles a full range of motion. “Flexibility is key in preparing for aerobic activity, particularly when dealing with joint stiffness,” says Cedric Bryant, chief science officer for ACE. The best stretch? Hamstring stretches. “When a hamstring is tight, it can cause misalignment in the pelvis and knees,” Bryant says.
The mistake: You forget to cool down. A proper cool-down, which includes deep breathing and long stretches, will get your heart rate, breathing and blood pressure safely back to normal while improving flexibility.
The mistake: You head straight for the heaviest dumbbells. Weight training increases energy and stamina, but be careful not to overdo it. “Lifting too much too soon is just going to damage the tissue,” Jones says. When weight training, you should feel fatigue by the 12th or 15th repetition, be it a 1-pound or 100-pound weight. Once that becomes easy, add more weight.
The mistake: You’re excessively huffing and puffing. A workout that’s too intense can put you in an anaerobic state, which means you aren't getting enough oxygen into your system. That causes joint and tissue pain, says Jones. How do you know if you’re getting the right combination of aerobic activity and oxygen? Find your target heart rate (subtract your age from 220), then shoot for 40 to 70 percent of that rate. “Research has shown that you can improve pain levels and weight loss in an aerobic capacity anywhere after 40 percent,” adds Jones.
The mistake: You go too easy. In order to lose weight, build muscle and maintain energy levels, a good workout means breaking a small sweat and working out at 40 to 70 percent of your target heart rate. However, there is a fine line for people with arthritis. “You have to work out within your pain level. If you’re hurting a lot over the next couple of days after a workout, you need to change the intensity,” Jones says.
The mistake: You don’t hydrate. Working out means your body needs extra water to cool off and keep blood circulating. If you’re dehydrated, you aren’t doing either. Water is especially important for older people, says Bryant, “because as we age, our thirst mechanism becomes less active, and we already tend to be less hydrated.” Drink plenty of water prior to exercise, get another 6 to 8 ounces for every 15 minutes of exercise and then follow the workout with more water to replenish what was lost.
The mistake: You eat for exercise. Unless you are training for a marathon, you do not need extra calories before working out. Eating less than two hours before a workout means blood flow is concentrating on digestion instead of on keeping muscles warm and bringing oxygen to your body. The result could be cramps and nausea.
The mistake: You’re a “leaner.” It’s easy to lean over and rest on the armrests when using stationary equipment, such as a stair climber, but Jones suggests resisting the temptation. Leaning may feel easier, but she explains, “You’re not using good posture, and that will only exacerbate joint pain.”
The mistake: You’re not focused on form. Make sure you’re using the proper form when doing a move by looking at yourself in a mirror or asking a trainer to evaluate your positioning. This is a big one, says Jones, “Because exercise is bone on bone for a person with rheumatoid arthritis (RA) or osteoarthritis (OA), there is a greater chance of injury. A lot of people use the wrong posture and hyperextend their joints.”
The mistake: You’re a little too tough. “Pushing through pain is not the thing to do. If your joints are hot or swollen, exercise can increase the damage,” Jones says. And it can cause too much pain. But remember, arthritis pain and pain from a strenuous workout are not the same. A little soreness a day or two after a workout is OK, more than that is not.
Exercise: How Much Is Enough?Get the answers to your questions about beginning an exercise program. By Bryan D. Vargo
Exercise is good for arthritis. This much you know. Regular physical activity keeps your joints lubricated, which makes movement easier; it produces endorphins, which contribute to your overall sense of well-being and help control pain; it improves your overall health and even helps you sleep easier at night.
But folks who are just starting out on a fitness plan may have a few questions. How often do I exercise? How intensely? For how long? What types of workouts are best for my type of arthritis?
If those questions sound familiar to you, use these F.I.T.T. guidelines, part of the U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans. Short for Frequency, Intensity, Time and Type, they can help provide a framework for your regular fitness program.
Frequency: Daily exercise is best, but its benefits are cumulative. Short sessions throughout the day or week can add up to big health benefits. Try three 10-minute walks in a day instead of one 30-minute workout.
Intensity: Start slow and easy, with the goal of working up to moderate or vigorous. Use the talk test to measure intensity. If you can talk but not sing, you’re exercising at moderate intensity. If you're able to say only a few words before you need to pause for a breath, you’re exercising at vigorous intensity.
Time: Choose any of these options:
1. 150 minutes of moderate-intensity aerobic exercise per week, which equals 30 minutes of exercise five days a week.
2. OR 75 minutes of vigorous-intensity aerobic exercise per week.
3. OR an equivalent combination of moderate and vigorous exercise.
Also, perform muscle strengthening exercises at least two days per week. Adding balance exercises to the mix is also a good idea.
Type: Aim for a combination of these three activities:
1. Low-impact aerobic exercise such as brisk walking, biking, swimming, water aerobics, gardening, group exercise classes and dancing.
2. Muscle-strengthening exercises such as calisthenics, isometrics, weight training and using resistance bands.
3. Balance exercises such as yoga and tai chi.
Source: Physical Activity Guidelines for Americans, U.S. Department of Health and Human Services.
Lower Body Exercises: Dos and Don'tsLearn how to keep your hips, knees, ankles and feet limber and strong. | By Joe Mullich
Exercise is great when it comes to reducing pain and improving range of motion, but what’s best for your joints – particularly those in your lower extremities? Marjorie Albohm, a certified athletic trainer and director of orthopaedic research at Orthopaedics Indianapolis, suggests the following lower body exercises that work best – and even help improve the affected area – as well as some activities to avoid.
Remember to wear well-fitting, supportive shoes for all exercise, except pool work and yoga in some cases. As always, check with your doctor or physical therapist before starting a fitness regimen, and stop any action or movement that brings pain. If you feel joint – not muscle – soreness that lasts more than two hours after your workout, your regimen needs adjusting.
Most of the following lower body exercises can be modified for tender joints.
Do: Walk in the shallow end of the pool, on land or on a treadmill (keep it flat – no incline); swim laps using gentle kicks; ride a bike in easy gears or cycle on a stationary bicycle; perform some yoga poses; upper-body strengthening exercises and isometric exercises to strengthen the hip without moving the joint.
Don’t: Running; “abduction” exercises, which move the leg away from the body and can include some Pilates and yoga poses; squats with heavy weights. Wall squats or squats with just the bar and no weights across your shoulders are OK.
Do: Swim laps using gentle kicks; walk in the shallow end of the pool, on land (rubberized asphalt tracks are best) or on a flat treadmill; tai chi; perform upper-body and quadriceps-strengthening exercises (without weights); ride a bike in easy gears or cycle on a stationary bicycle.
Don’t: Running; squats with heavy weights; some yoga poses and sports such as basketball or racquetball that involve jumping and quick changes of direction; high-impact exercise where both feet leave the ground at the same time, like jumping jacks or rope.
Ankles and Feet
Do: Swim laps with gentle kicks; ride a bike in easy gears or cycle on a stationary bicycle; walk in the shallow end of the pool; yoga; walk in supportive shoes, limiting speed as needed, on land (on a rubberized asphalt track, if available) or a flat treadmill; most land exercise moves and upper-body and quadriceps-strengthening exercises.
Don’t: High-impact activities that involve jumping (jumping rope, some aerobics classes); walking on uneven surfaces (gravel, hiking trails and some sidewalks), walking for long distances without rest or lower body stretching breaks and sports like basketball or tennis that involve quick changes of direction.
Be sure to ask your doctor or physical therapist about the best lower body stretching moves.
How Hard Should You Work Out?Are you working out at the right intensity? These easy tests can help you make the most of any activity. | By Mary Anne Dunkin
You already know that regular strength and cardiovascular exercises can boost your overall health and improve your flexibility, joint function and your mood. But if you’re not sure how hard you should be working out to get the most benefit and least risk of injury, take these self-assessment tests.
The Talk Test
Experts have long recommended the “talk test” for a cardio workout: If you can talk but not sing during an activity, you’re probably working at moderate intensity – enough to improve fitness, but not to the point of risking injury.
If you are very physically fit, you may need to train at a higher intensity – where talking is difficult – to improve athletic performance, according to a study published in the Journal of Sports Science. But for most people the talk test works just fine, says Carl Foster, PhD, director of the Human Performance Laboratory at the University of Wisconsin-La Crosse.
“For the non-athlete, there is almost no time when you would not want to be talking comfortably,” says Foster. Plus, moderately intense exercise is more efficient than strenuous exercise at burning fat, and because it is more pleasant, you are more likely to stick with it long-term, he adds.
The Strength Test
For strength training exercises complete each exercise with light weights. Go slowly, using a “two-up, four down” count for each repetition. Then ask yourself these questions.
1. Were you able to complete two sets of 10 repetitions in good form?
Yes. Good, keep it up.
No. Reduce the weight to an amount that you can lift 10 times in good form; rest for one or two minutes, then do a second set.
2. After completing 10 repetitions, do you need to rest because the weight is too heavy to complete more repetitions in good form?
Yes. You’re working at the proper intensity. Don’t increase the weight.
No. If you can do only a few more repetitions (not another set of 10 without a break), then at your next workout you should do the first set of repetitions with your current weight and your second set with the next weight up. For example, if you're currently using 1-pound dumbbells, use 2- or 3-pound dumbbells for your second set.
But if you could have done all 20 repetitions without a break, use heavier dumbbells for both sets of repetitions at your next session,
The Two-Hour Pain Rule
If you have more joint pain two hours after exercising than before you started, you’ve overdone it. Ease up at your next workout.
Tracking Your Heart Rate
The American Heart Association recommends monitoring your heart rate when participating in any fitness program – even one as simple as walking – to make sure you aren’t overdoing it. Some tips to keep you on target:
• First, calculate your approximate maximum heart rate by subtracting your age from 220. Then multiply that number by .50 and by .75. That will give you a target heart rate range of 50 percent to 75 percent of maximum heart rate. For example: If you are 66 years old, your approximate maximum heart rate is 154 (220-66 = 154). Fifty percent of that number is 77; 75 percent is about 115. So your target heart rate range during exercise would be 77 to 115 beats per minute. You can find this number by wearing a heart rate monitor, or simply by checking your pulse for 10 seconds and multiple by six.
• When you start a program, aim for 50 percent of your target heart rate. If you have been walking for some time, try to reach 75 percent. It can help to combine both heart rate and talk test – so if you’re able to say a few words or short phrases (“I’m doing great!”) you’re probably in a moderate zone; if you can only say one or two words at a time, you may be going too hard and need to back off. On the other hand, if you can easily hold a detailed conversation, you may want to increase intensity a bit.
Developing a Well-rounded WorkoutA mix of cardio, strength-training and stretching exercises will give you a full-body workout.
Your primary care physician recommends walking to get your weight down. Your physical therapist has you using weights to strengthen the muscles around certain joints. Your rheumatologist says stretching can increase your range of motion. They’re not contradicting each other – a balanced program of aerobic conditioning, strengthening and stretching can greatly help to reduce arthritis pain and improve your overall fitness and health. Consider these fundamental facts:
Aerobic workouts require a high level of endurance. You should be able to exert yourself without becoming winded. The lungs take in more oxygen, the heart pumps more blood to spread that oxygen throughout your body, and the body converts the oxygen into energy more efficiently. Getting your heart pumping may make you sweat, but the effort will reward you with improved metabolism, better mood, more energy, increased stamina, and, as studies show, decreased inflammation, which can help minimize arthritis symptoms.
What to do: Aquatic exercise, cycling, swimming, walking.
What not to do: High-impact aerobics or running without your doctor’s approval.
Strength training makes your joints more stable. Strong muscles help keep bones positioned properly, and building muscle through weight-bearing exercise increases bone density, decreasing your risk for osteoporosis and fractures.
What to do: Lift light dumbbells or soup cans; use resistance bands or tubing; stand in a pool and push against water; or try Pilates. Do slow, controlled movements, concentrating on proper form.
What not to do: Do not overtrain by lifting too much weight or performing too many repetitions or sets of exercises. Do not jerk weighted items quickly.
The “use it or lose it” mantra definitely applies to muscle flexibility. To decrease daily joint stiffness and maintain or improve range of motion in joints, you need to stretch. To minimize muscle soreness after training with weights, squeeze in a few stretches between sets. Stretching muscles while they are warm reduces injury.
What to do: Yoga and tai chi are good flexibility workouts, but be sure to also do basic hamstring, shoulder, neck and back stretches. Simply reaching for the sky and your toes is beneficial.
What not to do: Don’t bounce when you hold a stretch or forget to stretch after a warm-up or finishing a workout.
Set Realistic Goals
Just starting a program? Build your exercise routine slowly in five to 10-minute blocks of time, working up to 30 minutes total. Exercise time is cumulative so you don’t need to worry about doing it all at once. Three 10-minute sessions throughout the day are as effective as one 30-minute session. Already active? If you are regularly getting 30 minutes of physical activity on most days of the week, start adding time to existing workouts gradually. Add anywhere from two to 10 minutes at a time. As you become comfortable with your longer routine, continue to add minutes to build endurance, strength and flexibility.
How to Start an Exercise ProgramDon’t let arthritis stop you from reaping the rewards of lifelong fitness. | By Camille Noe Pagán
Even with your arthritis, it’s entirely possible to make the leap from couch potato to avid exerciser – and well worth the effort.
A 2008 study from the University of North Carolina at Chapel Hill found that sedentary individuals with arthritis (both rheumatoid arthritis and osteoarthritis) who exercised twice a week for an hour experienced significant declines in pain and fatigue and improved their ability to manage their arthritis. In addition, a 2006 study in the Canadian Medical Association Journal concluded that exercise markedly lowered the risk of a number of health problems, including heart disease, cancer, obesity, diabetes, depression and osteoporosis.
Don’t let inexperience, inertia, weight, or arthritis hold you back. “Contrary to popular belief, there is never an age, skill level or stage of arthritis so bad that you can't do something constructive for your mobility,” says Vonda Wright, MD, assistant professor of orthopaedic surgery at the University of Pittsburgh Center for Sports Medicine and author of Fitness After 40 (AMACOM, 2009).
Doreen M. Stiskal, PhD, chair of the department of physical therapy at Seton Hall University in New Jersey, agrees. “Most people with arthritis don’t exercise because they’re in pain – not realizing that exercise is a powerful and effective pain reliever. It eases inflammation, improves energy and promotes the flow of feel-good, pain-relieving chemicals like endorphins.”
And if extra weight is a concern, take heart: For obese people, being physically active is key to not only helping you lose extra pounds, it will also reduce pain and boost your overall health.
So what are you waiting for? Here’s your comprehensive guide on how to start – and stick with – an exercise program:
Before you lace up your sneakers, follow these steps to make sure you safely jump-start your new routine.
Check in with your doctor. Let your rheumatologist and general practitioner know that you’re going to start exercising. She may advise against specific activities because of your medical history, says Cedric Bryant, PhD, chief science officer of the American Council on Exercise in San Diego.
“Ask your doctor for specific suggestions, including how long and hard you should exercise,” says Bryant. Your doctor may be able to refer you to exercise programs in your area. “If she’s unable to do so, seek the help of a physical therapist or certified professional trainer who has extensive experience working with people with arthritis.”
Set Modest Goals to Start. Even once you know you’re ready to make a change, there’s still one unanswered question: How do I get started? The best advice: Start small. “It’s great to have big dreams, like losing 100 pounds, but it’s more important to set small, attainable goals at first. Otherwise, you may get discouraged,” says Rick Van Haveren, PhD, a sports psychologist in Atlanta.
Thirty minutes of exercise still counts if you break it into three 10-minute increments throughout a day. If you’re not quite bold enough to stroll into a gym and start working out, consider taking that first step at home. Try an exercise DVD, such as the Arthritis Foundation’s "Take Control with Exercise," to help boost your confidence in getting active.
And don’t be afraid to aim for shorter-term successes, like always using the stairs instead of using the elevator at the office or walking for 30 minutes straight without stopping. These are all equally important achievements and each deserves recognition.
Find your courage. Embarking on a fitness program can be a challenge for anyone, but especially for people who know making that first move will likely be somewhat daunting. Don’t let fear prevent you from taking action to reduce pain and improve function. You may have to dig deep for the courage to get started, but you know you’ll feel better once you do. Think back to other challenges you’ve faced and how you rose to them. Are there any people you admire who have faced a similar challenge? How can you learn from them and challenge yourself as they did?
Know What to Wear. Perhaps the most important thing you’ll need is a supportive but comfortable pair of shoes – and good fit is paramount. Visit a running or walking store to get properly fitted. A good walking or running shoes will serve your needs for most aerobic and strength-training workouts. It’s OK to walk in a running shoe, but best not to run in walking shoes. When shoe shopping, wear the socks you plan to wear during workouts and try the shoes for at least 10 minutes in the store.
Loose-fitting clothing such as t-shirts, cotton shorts, sweatpants and sweatshirts are fine to start out. But if you think you’ll be sweating or working on gym equipment, form-fitting, perspiration-wicking attire will keep you dry and is less likely to get caught on the equipment’s moving parts. If you’re self-conscious about your weight, wear clothing that you feel comfortable in. Plus-size workout clothing and swimsuits are available at department stores or discount stores such as Wal-Mart and online.
If you plan to get your workout rolling on a bike, go to a bicycle shop and get help selecting a bike that fits you and your riding style. A helmet, gel-padded gloves and a comfy seat also will deter injury.
Get Set …
Now that you’re ready to get going, set a plan you can stick with. Here are some strategies that will help bring out your inner exercise enthusiast.
Don’t go it alone. If you find exercise tedious or lonely, you’re less likely to stick with it. “Ask a friend or significant other to join you. Exercise feels less like exercise when it’s a social event,” says Bryant. You're also more likely to stick with your commitment – to exercise and to your partner. If you have an active dog, take it for a stroll. Look into group walks or arthritis exercise classes – activities that make working out more of a fun social event and less of a chore.
Reward yourself. Research shows that when people are rewarded for "good behavior" – including exercise – they feel better about it and are more likely to repeat it. “Instead of rewarding yourself with food, do something that builds on your new healthy habits. For example, book a massage or a pedicure, [or go] window shopping at the mall with a friend,” says Stiskal.
Commit to the cause. Make physical activity a non-negotiable part of your day. “Schedule it in your calendar as you would a doctor’s appointment, and do everything you can to stick to your plan,” says Van Haveren. “It’s all too easy to fall off the fitness wagon when you start skipping workouts. I recommend trying to exercise for at least 10 minutes, even on bad days.
Pick the right time. “You’ll enjoy your workout more if you don’t do it when your symptoms are at their worst,” says Bryant. “For example, if you’re most stiff when you wake up, then exercise after work. Or if you’re exhausted at the end of the day, work out in the morning.”
Shop around. Does the very idea of a gym make you break out into a cold sweat? You aren’t alone. But if you think all gyms are filled with nothing but toned and thin people, think again. Take a tour or accept a trial membership at a variety of gyms in your area. You may find several that suit you. Explore specialized health clubs such as Curves, a chain of gyms for women. At Curves, women of all sizes, ages and fitness levels perform circuit training with instruction from a coach.
Certain forms of exercise are particularly effective for individuals with arthritis. Here are five you may want to consider.
Walking. There’s a reason it’s America’s favorite workout: “It’s safe for almost everyone, even those with severe arthritis. The only equipment it requires is a pair of comfortable, supportive shoes; and it involves zero training," says Dr. Wright.
Where and when you walk are also important considerations. If walking a hilly route is too strenuous stick with level ground. Try an indoor mall or gym with a flat track so you can walk safely and comfortably. Explore large churches, YMCAs or community centers in your area that may have indoor tracks good for walking in any weather.
To get the most from your walking workout, consider the Arthritis Foundation's Walk With Ease program. It helps you develop a walking plan suited for your needs, helps you stay motivated and teaches you to exercise safely. You can do it in a group with a trained instructor, or on your own with guidance from a book that provides instructions, checklists, progress charts and other helpful information. Because it’s an evidence-based program, it’s safe and effective for people with arthritis.
Water workouts. “Swimming or water aerobics are especially great for people who are heavier or who have advanced arthritis,” says C. Thomas Vangsness Jr., MD, chief of sports medicine at the Los Angeles County University & Southern California Medical Center. “If you can find a heated pool, all the better – warm water almost instantly relieves painful joints."
Stationary or recumbent cycling. “Both recumbent and stationary bikes allow you to get your heart rate up, but they put very little pressure on the hip and knee joints,” says Dr. Vangsness. A recumbent bike is a safer choice if your balance is iffy or if you’re overweight, new to exercise or exercising post-knee surgery. An upright bike allows you to spin faster and is best reserved for an injury-free, experienced exerciser.
Yoga and tai chi. “Tai chi and yoga improve flexibility and balance – two areas which individuals with arthritis often struggle with – and both are gentle on joints, too,” says Stiskal. Check your local community and fitness centers for yoga and tai chi classes, or you can exercise on your own time with guidance from a Tai Chi DVD based on Sun Style Tai Chi available from the Arthritis Foundation.
Resistance training. Resistance training is an absolute must for people with arthritis, says Stiskal. Contrary to popular belief, weights are an excellent choice: “The key to using them safely is to have proper form and to lift the correct amount of weight for your strength level. If you’re not sure, ask a physical therapist or personal trainer to teach you,” she advises. Rubber resistance bands and strengthening equipment at the gym are good ways to build lean muscle mass. “Strong muscles absorb the shock that would otherwise affect your joints. It’s like the difference between walking barefoot on a cold floor and wearing warm, padded slippers,” says Stiskal.
High-intensity Exercise and Rheumatoid ArthritisStrength and cardio training can boost mood and energy. By Lissa Poirot
For people with rheumatoid arthritis (RA), exercise – namely high-intensity exercise, such as running or jogging – was considered a no-no for many years. But studies suggest it may be OK – even beneficial – to kick it up a notch.
“My research shows that people who participated in high-intensity exercise, such as sports, jogging or strength training, at least twice a week, improved in daily functioning and mood,” says Zuzana de Jong-Strakova, MD, PhD, rheumatologist and researcher at Leiden University Medical Center in the Netherlands.
Her research also found that high-intensity exercise did not speed up the rate of joint damage. In fact, for the minority of patients who did experience rapid progression of damage, the culprit was more aggressive disease activity. “There is a group of patients who have progressive damage, whatever they do,” says Dr. de Jong-Strakova.
Ready to ramp it up? The first thing you should do is talk to your doctor. After that, use common sense, says Dallas rheumatologist Scott Zashin, MD. Here are a few tips to get you going.
Evaluate the location of affected joints. “If you have no damage to the weight-bearing joints, there would be no reason you couldn’t participate in high-intensity exercise, such as aerobics or jogging,” Dr. Zashin says. “If you have damage in the lower extremities, then no jogging or hard aerobics. If it’s in the upper extremities, exercise that involves these joints, such as boxing and heavy weight lifting, could pose a problem.”
Exercise slowly at first. Stephanie Siegrist, MD, an orthopaedic surgeon in private practice in Rochester, N.Y., says the key to sticking with high-intensity workouts is knowing when to pick up the pace. “Start with a basic level of fitness that incorporates strength, endurance and flexibility, such as walking, and then work your way up. When it becomes easy, then it’s OK to kick it up a notch to see how your body responds,” she says.
Listen to your joints. “Adjust your workout to accommodate your body,” Dr. Siegrist says. “If you take a spinning class and it hurts when standing on the pedals, sit – but keep pedaling. By modifying your activities, you can do the things you want to do.”
Upper Body Exercises: Dos and Don'tsWork your upper body safely and efficiently with these tips. | By Joe Mullich
Exercise is a must for keeping joints in good shape, but when a particular joint is affected by arthritis, you need to make some changes to your routine. Marjorie Albohm, a certified athletic trainer and director of orthopaedic research at Orthopaedics Indianapolis, has a few suggestions on activities that work best for keeping the joints in your upper body healthy. What’s more, she also has advice about upper body exercises you should avoid.
Always check with your doctor or physical therapist before starting a fitness regimen, and if a movement causes pain, stop. If you feel joint – not muscle – soreness that lasts more than two hours after your workout, your regimen needs adjusting.
Do: Walk on a level surface or in the shallow end of the pool; swim laps using the backstroke, the sidestroke or a snorkel for freestyle swimming; ride a bike that doesn't require you to bend over too far (try a mountain bike on level ground or a recumbent bike); yoga and Pilates; leg- and core-strengthening exercises; use elliptical machines.
Don’t: Sports such as golf or tennis that involve arching and twisting your back; high-impact activities that involve running and jumping; toe touches; straight-leg sit-ups; double leg lifts; lifting weights above your waist.
Do: Walk on a treadmill or in the shallow end of the pool; ride a mountain bike that keeps you upright, or cycle on a stationary bike or recumbent cycle; use elliptical machines; lower-body strengthening exercises; yoga and Pilates poses that stretch the upper body; standing wall push-ups; warm-water exercises; shoulder shrugs.
Don’t: Overhead serves in tennis or volleyball; golf; rowing or canoeing; swimming the backstroke or freestyle; lifting weights above your shoulders; some yoga poses, such as the Downward Facing Dog, that support weight on the hands, arms and shoulders.
Do: Walk on a treadmill or in the shallow end of the pool; ride a bike, or cycle on a stationary bike or recumbent cycle; swim, using the backstroke; use elliptical machines; do flexibility neck exercises (such as head turns and tilts); yoga and Pilates; tai chi; warm-water exercises.
Don’t: Overhead serves in tennis or volleyball; bikes with racing handlebars; any abdominal exercises with hands behind the head; ski machines; lifting weights above your shoulders; swimming freestyle or using the breaststroke; diving.