Questions and Answers About Arthritis and Exercise

National Institute of Arthritis and Musculoskeletal and Skin Diseases

This fact sheet answers general questions about arthritis and exercise. The amount and form of exercise recommended for each individual will vary depending on which joints are involved, the amount of inflammation, how stable the joints are, and whether a joint replacement procedure has been done. A skilled physician who is knowledgeable about the medical and rehabilitation needs of people with arthritis, working with a physical therapist also familiar with the needs of people with arthritis, can design an exercise plan for each patient.

What Is Arthritis?

Arthritis is a general term that refers to many rheumatic diseases that can cause pain, stiffness, and swelling in joints and other connective tissues. These diseases can affect supporting structures such as muscles, tendons, and ligaments and may also affect other parts of the body. Some common types of arthritis are osteoarthritis, rheumatoid arthritis,systemic lupus erythematosus,gout,juvenile rheumatoid arthritis,ankylosing spondylitis, and psoriatic arthritis.Osteoarthritis is the most common.

Should People With Arthritis Exercise?

Yes. Studies have shown that exercise helps people with arthritis in many ways. Exercise reduces joint pain and stiffness and increases flexibility, muscle strength, 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 help maintain normal joint movement and relieve stiffness. This type of exercise helps maintain or increase flexibility.

• Strengthening exercises help keep or increase muscle strength. Strong muscles help support and protect joints affected by arthritis.

• Aerobic or endurance exercises 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. 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?

There are known methods to 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 to 20 minutes three times a day to relieve symptoms. A health professional can use short waves,microwaves, and ultrasound to deliver deep heat to noninflamed 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 to stop pain and reduce swelling when used for 10 to 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. 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 and also sells relaxation tapes. 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 Often Should People With Arthritis Exercise?

• Range-of-motion exercises can be done daily and should be done at least every other day.

• Strengthening exercises also can be done daily and should be done at least every other day unless you have severe pain or swelling in your joints.

• Endurance exercises should be done for 20 to 30 minutes three times a week unless you have severe pain or swelling in your joints.

What Type of Strengthening Program Is Best?

This varies depending on personal preference, the type of arthritis involved, and how active the inflammation is. Strengthening one’s muscles can help take the burden off painful joints. Strength training can be done with smallfree weights, exercise machines, isometrics, elastic bands, and resistive water exercises. Correct positioning is critical, because if done incorrectly, strengthening exercises can cause muscle tears, more pain, and more joint swelling.

Are There Different Exercises for People With Different Types of Arthritis?

There are many types of arthritis. Experienced doctors, physical therapists, and occupational therapists can recommend exercises that are particularly helpful for a specific type of arthritis. Doctors and therapists also know specific exercises for particularly painful joints. There may be exercises that are off-limits for people with a particular type of arthritis or when joints are swollen and inflamed. People with arthritis should discuss theirexercise plans with a doctor. Doctors who treat people with arthritis include rheumatologists, general practitioners, family doctors, internists, and rehabilitation specialists (physiatrists).

How Much Exercise Is Too Much?

Most experts agree that if exercise causes pain that lasts for more than 1 hour, it is too much. 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 too much exercise:

• Unusual or persistent fatigue

• Increased weakness

• Decreased range of motion

• Increased joint swelling

• Continuing pain (pain that lasts more than 1 hour after exercising)

Should Someone With Rheumatoid Arthritis Continue To Exercise During a General Flare? How About During a Local Joint Flare?

It is appropriate to put joints gently through their full range of motion once a day, with periods of rest, during acute systemic flares or local joint flares. Patients can talk to their doctor about how much rest is best duringgeneral or joint flares.

Are Researchers Studying Exercise and Arthritis?

Researchers are comparing the development of musculoskeletal disabilities, including arthritis, in long-distance runners and nonrunners. Preliminary results show that running does not increase the likelihood of developing osteoarthritis.

Researchers also are looking at the effects of muscle strength on the development of osteoarthritis. Other researchers continue to look for and find benefits from exercise to patients with rheumatoid arthritis, spondyloarthropathies, systemic lupus erythematosus, and polymyositis.

Where Can People Find More Information on Arthritis and Exercise?

• Arthritis Foundation
  1330 West Peachtree Street
  Atlanta, GA 30309
  404/872-7100 or call your local chapter (listed in the telephone directory)
  800/283-7800
  World Wide Web address: http://www.arthritis.org

This is the major voluntary organization devoted to arthritis. The Foundation publishes a free pamphlet on exercise and arthritis and a monthly magazine for members that provides up-to-date information on all forms of arthritis. Local chapters organize exercise programs for people who have arthritis, including People with Arthritis Can Exercise (PACE) and an aquatic exercise program held in swimming pools. The Foundation also can provide physician and clinic referrals.

• PACE Catalog Center
  Arthritis Foundation
  P.O. Box 9020
  Pittsfield, MA 01202-9945
  800/PACE-236 (722-3236)

This center sells PACE exercise videotapes at two levels, basic and advanced. Each videotape is approximately 30 minutes long and includes a warm-up section, a gentle or moderate exercise routine, and a rhythmic movement sequence to help improve endurance. The videotapes are available for $19.50 per tape, plus shipping charges.

• Spondylitis Association of America (SAA)
  P.O. Box 5872
  Sherman Oaks, CA 91413
  818/981-1616
  800/777-8189
  World Wide Web address: http://www.spondylitis.org

This nonprofit, voluntary organization helps people who have ankylosing spondylitis and related conditions. SAA sells books, posters, videotapes, and audiotapes about exercises for people who have arthritis of the spine.

• American College of Rheumatology/Association of Rheumatology Health Professionals
  60 Executive Park South, Suite 150
  Atlanta, GA 30329
  404/633-3777
  Fax: 404/633-1870
  World Wide Web address: http://www.rheumatology.org

This association provides referrals to physical therapists who have experience designing exercise programs for people with arthritis. The organization also provides exercise guidelines developed by the American College of Rheumatology.

Acknowledgments

The NIAMS gratefully acknowledges the assistance of Jeanne Hicks, M.D., and Naomi Lynn Gerber, M.D., both of the Rehabilitation Medicine Department, and Stanley R. Pillemer, M.D., Office of the Director, NIAMS, at the National Institutes of Health, in the preparation and review of this fact sheet.

The National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse (NAMSIC) is a public service sponsored by the NIAMS that provides health information and information sources. The NIAMS, a part of the National Institutes of Health (NIH), leads the Federal medical research effort in arthritis and musculoskeletal and skin diseases. The NIAMS sponsors research and research training throughout the United States as well as on the NIH campus in Bethesda, MD, and disseminates health and research information.

KEY WORDS

Aerobic exercise:

Exercise that requires continuous, rhythmic motion of large muscle groups such as the quadriceps. Swimming, running, and walking are examples of aerobic exercise. Aerobic exercise also improves the ability to perform activities of daily living.

Ankylosing spondylitis:

See spondyloarthropathies.

Arthritis:

The term arthritis literally means joint inflammation, but it also is used to refer to more than 100 rheumatic diseases. These diseases can cause pain, stiffness, and swelling in joints and may also affect other parts of the body.

Atrophy:

Decrease in size or wasting away of a body part or tissue. When muscles are not used, they atrophy (get smaller and weaker).

Biofeedback:

A way to enhance a body signal so that one is aware of something that usually occurs at a level below consciousness. An electronic device provides information about a body function (such as heart rate) so that the person using biofeedback can learn to control that function. Biofeedback can help people with arthritis learn to relax their muscles. In this case, an electronic device amplifies the sound of a muscle contracting, so the arthritis patient knows that the muscle is not relaxed.

Body mechanics:

Correct positioning of the body for a given task, such as lifting a heavy object or typing.

Cardiovascular:

Involving the heart and the circulatory system.

Cartilage:

A tough, stretchy tissue that covers the ends of bones to form a low-friction, shock-absorbing surface for joints.

Collagen:

A fibrous protein that is one of the main building blocks of skin, tendon, bone, cartilage, and other connective tissues.

Connective tissue:

The supporting framework of the body and the internal organs- -including bone, cartilage, and ligaments.

Degenerative joint disease:

See osteoarthritis (OA).

Endorphin:

A substance produced in the brain or nervous system that stops pain naturally.

Endurance:

The ability to continue a given task.

Exercise:

Movement of the body designed to improve its physical condition. The goals of an arthritis exercise program are to improve physical conditioning, muscle strength, flexibility, well-being, and function.

Fibromyalgia:

A chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points.

Fibrous capsule:

A tough wrapping of tendons and ligaments that surrounds the joint.

Flare:

A period of time in which disease symptoms reappear or become worse.

Flexibility:

Ability to bend various joints and move freely.

Gout:

A type of arthritis caused by the reaction of the body to needle-like crystals of uric acid that accumulate in joint spaces. This reaction causes inflammation, swelling, and pain in the affected joint, most commonly the big toe.

Hydrotherapy:

Therapy that takes place in the water.

Inflammation:

A typical reaction of tissues to injury or disease. It is marked by four signs: swelling, redness, heat, and pain.

Internist:

A doctor who specializes in internal medicine (not requiring surgery).

Isometrics:

Isometric exercises are exercises that cause a muscle to contract and do work while joints do not move, for example, pushing against a wall.

Joint:

The place where two bones meet. Most joints are composed of cartilage, joint space, fibrous capsule, synovium, and ligaments.

Joint space:

The area enclosed within the fibrous capsule and synovium.

Juvenile rheumatoid arthritis:

A chronic arthritis of childhood that causes pain, stiffness, swelling, and loss of function in the joints and may also affect other parts of the body.

Ligaments:

Stretchy bands of cordlike tissue that connect bone to bone.

Manipulation:

Trained professionals such as chiropractors or osteopaths use their hands to help restore normal movement to stiff joints.

Microwaves:

Microwave therapy is a type of deep heat therapy. The electromagnetic waves pass between electrodes placed on the patient’s skin. This creates heat that increases blood flow and relieves muscle and joint pain.

Mobilization therapies:

A group of treatments that include traction, massage, and manipulation. When used by a trained professional, these methods can help control pain and increase joint and muscle motion.

Muscle:

Tissue that can contract, producing movement or force. There are three types of muscle: striated muscle, attached to bones; smooth muscle, found in such tissues as the stomach and blood vessels; and cardiac muscle, which forms the walls of the heart. For striated muscle to function at its ideal level, the joint and surrounding structures must be in good condition.

Nonsteroidal anti- inflammatory drugs (NSAIDs):

A group of medications, including aspirin, ibuprofen, and related drugs, used to reduce inflammation that causes joint pain, stiffness, and swelling.

Osteoarthritis:

OA (also know as degenerative joint disease) primarily affects cartilage within the joints, causing it to fray, wear, ulcerate, and in extreme cases, to wear away entirely, leaving a bone-on-bone joint. At the edges of the joint, bony spurs may form. OA can cause joint pain, loss of function, reduced joint motion, and deformity. Disability results most often from disease in the spine and in the weight-bearing joints (knees and hips).

Polymyositis:

A rheumatic disease that causes weakness and inflammation of muscles.

Physiatrist:

A doctor who specializes in the diagnosis and management of injuries and diseases causing pain, loss of function, and disability. Treatment plans often include the use of exercise, massage, heat, electricity (TENS), relaxation techniques, splints and braces, and local injections to relieve pain.

Psoriatic arthritis:

Joint inflammation that occurs in about 5 to 10 percent of people with psoriasis (a common skin disorder).

Range of motion (ROM):

The ability of a joint to go through all its normal movements. Range-of-motion exercises help increase or maintain flexibility and movement in muscles, tendons, ligaments, and joints.

Relaxation therapy:

People with arthritis use relaxation to release the tension in their muscles, which relieves pain.

Rehabilitation specialist:

Seephysiatrist.

Rheumatoid arthritis:

An often chronic systemic disease that causes inflammatory changes in the synovium, or joint lining, that result in pain, stiffness, swelling, and loss of function in the joints. The disease can also affect other parts of the body.

Rheumatologist:

A doctor who specializes in diagnosing and treating disorders that affect the joints, muscles, tendons, ligaments, and bones.

Short waves:

These deliver deep heat to relieve pain. (Short waves are not used much currently because of problems in people with pacemakers.)

Spondyloarthropathies:

A group of rheumatic diseases that affect the spine, such as Reiter’s syndrome and ankylosing spondylitis.

Strengthening exercises:

Exercises that build stronger muscles, for example, exercises that require movement against a force (weight lifting or isometric exercises).

Synovial fluid:

Fluid released into movable joints by surrounding membranes. This fluid lubricates the joint and reduces friction.

Synovium:

A thin membrane that lines a joint and releases a fluid that allows the joint to move easily.

Systemic lupus erythematosus:

Lupus is a type of immune system disorder known as an autoimmune disease, which causes the body to harm its own healthy cells and tissues. This leads to inflammation and damage of various body tissues. Lupus can affect many parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain.

Tendons:

Tough, fibrous cords of tissue that connect muscle to bone.

TENS (transcutaneous electrical nerve stimulation):

Passes electricity to nerve cells through electrodes placed on the patient’s skin. TENS is used to relieve pain.

Traction:

Gentle, steady pulling along the length of body structure, for example, the spine or neck.

Transcutaneous:

Through the skin.

Ultrasound:

Sound waves that provide deep heat to relieve pain.