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Exercise to Combat Rheumatoid Arthritis Pain and Fatigue

May 03, 2019


Here is a link to the Facebook LIVE replay of this discussion.

You Will Learn  

  • What is rheumatoid arthritis?
  • What causes rheumatoid arthritis?
  • What are the risk factors for rheumatoid arthritis?
  • What is the connection between osteoporosis and rheumatoid arthritis?
  • What exercise is best to improve rheumatoid arthritis pain and fatigue


What is Rheumatoid Arthritis?  

Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body.  


Symptoms of Rheumatoid Arthritis  

Early rheumatoid arthritis tends to affect your smaller joints first — particularly the large knuckle joints in your hands and feet. Common symptoms include joint swelling, tenderness, and joint stiffness occurring in the same joints on both sides of your body. As the disease progresses, symptoms often spread to other joints like the wrists, knees, ankles, elbows, hips and shoulders.  

Fatigue, mild fever, and depression often occur before joint problems by weeks or months. Fatigue is one of the biggest complaints of someone with RA.  

Some people who suffer from severe or advanced rheumatoid arthritis can experience symptoms that don’t involve the joints. Over time, the inflammation caused from RA may damage your heart, lungs, eyes, skin, kidneys, blood vessels, and nerves.  


What is a Flare Up?  

Symptom flare ups are common in RA. This is when your joint swelling and pain, along with systemic symptoms like depression and fatigue get worse.  

Flares can be either predictable or unpredictable. Overexertion, poor sleep, stress or an infection like the flu can all set off RA symptoms. Predictable flare ups will usually resolve with time.  

Flares can also be unpredictable with no apparent preceding cause. If your symptoms don’t go away with your usual tactics your medication may need to be adjusted.  

Over time, these flare ups damage your joints, causing them to deform and shift out of place. When this happens your function starts to be affected. Everyday tasks like self-hygiene, cooking, and cleaning becomes more difficult. If the joints in your feet become affected you may find it harder to walk and be active, and notice your balance is getting worse.  

Clearly RA can have long-term physical, mental, emotional, and financial effects. That is why preventative care is so important. There are certain things you can do to prevent your risk for developing RA, and if you already have RA there are some things you can do to improve your symptoms.  


What Causes Rheumatoid Arthritis?  

Doctors don’t know what triggers RA. There appears to be a genetic link, although is is not well understood.  

Unlike osteoarthritis that is caused from wear and tear on the joints, RA is caused by inflammation of the tissue surrounding your joints. This tissue becomes inflamed and thickened, fluid builds up and joints erode and degrade.3  


Risk Factors for Rheumatoid Arthritis  

Factors that may increase your risk of rheumatoid arthritis include:3  

  • Age: RA can begin at any age, but the likelihood increases with age. The onset of RA is highest among adults in their sixties.
  • Sex: New cases of RA are about three times higher in women than men.
  • Genetics/inherited traits: People born with specific genes are more likely to develop RA. These genes, called HLA (human leukocyte antigen) class II genotypes, can also make your arthritis worse. The risk of RA may be highest when people with these genes are exposed to environmental factors like smoking or when a person is obese.
  • Smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
  • Environmental exposures like secondhand-smoke, silica and asbestosis. 
  • Obesity: Being obese can increase the risk of developing RA. Studies examining the role of obesity also found that the more overweight a person was, the higher his or her risk of developing RA became. You can check to see if you are in the overweight or obese category HERE. 
  • Hormonal changes: Women who have RA often state that pregnancy will improve their symptoms, perhaps due to increased estrogen levels. Whereas women are often diagnosed with RA during menopause when their estrogen levels are dropping. Hormone replacement therapy is usually not recommended because it tends to increase the risk of cardiovascular disease, and RA already increases this risk.  


The Link Between Rheumatoid Arthritis and Osteoporosis  

People with rheumatoid arthritis are at increased risk for osteoporosis for many reasons. Below are the main reasons why:  

  • Glucocorticoid medications often prescribed for the treatment of rheumatoid arthritis can trigger significant bone loss. 
  • Pain, fatigue, and loss of joint function caused by the disease can result in inactivity, further increasing osteoporosis risk. 
  • Bone loss in rheumatoid arthritis may occur as a direct result of the disease. 
  • Osteoporosis and RA share risk factors such as female sex, older age, menopause, and low lean body mass.  


Barriers to Exercise with Rheumatoid Arthritis  

In general, exercise is vital for overall physical health and mental wellness. It can increase energy levels, improve strength and flexibility, reduce depression symptoms, and reduce your risk of heart disease. It can also help fight the weight gain and insomnia that often accompany menopause.  

While many people with RA know the benefits of physical activity, research shows many people with RA are sedentary, or not physically active. This is in large part due to their pain, fatigue. Research shows that encouragement from health professionals as well as friends and family were identified as important to physical activity.  

Education about the benefits of regular physical activity should be provided to individuals with RA, their family members, exercise instructors, and other health professionals.4  

I think another reason why people with RA may not be as physically active is because like any other new condition, it can be scary to start exercising, especially if you haven’t before. They may be fearful that exercise will make their symptoms worse and research shows that is not the case. The right kinds of exercise can actually greatly improve pain perception, fatigue, and joint stiffness.


Exercise Recommendations for Rheumatoid Arthritis  

I like to think of this topic in 2 different sections: general exercise for overall health and wellbeing and joint-specific exercises to improve strength and range of motion at the affected joints. If you have RA, you will get benefit from both forms of exercise.  

It is important to note that while aquatic exercise is great for RA flexibility and motion, it is not considered weight-bearing so does not have the protective effect against osteoporosis so shouldn’t be the only exercise prescribed for someone with RA.  



Physical and Occupational Therapy to Improve Motion and Reduce Pain for Rheumatoid Arthritis  

While general physical activity is important, it is also very important to keep your individual joints healthy and mobile. Walking, cycling, and swimming don’t do a lot to help the specific joints that are often affected with RA in a way that truly preserves range of motion.  

I think this is really where physical therapy and occupational therapy can shine. A therapist can perform a full assessment of your range of motion and strength deficits and prescribe certain exercises and strengthening equipment to preserve your function.  

Many clinics will have additional pain relief options like paraffin wax bath to reach the small joints that a traditional heat pack won’t touch.  

If you really want to get the most bang for your buck, find someone who specializes in your problem area. Seeing that many people with RA struggle with hand stiffness, THIS website will help you find a certified hand specialist. THIS website will help you find a PT if you are having trouble with other joints or your balance.  

There are many youtube videos with general range of motion or strengthening exercises for hand stiffness. HERE is an example of one.  


Bottom Line

There are a few modifiable risk factors for RA. Smoking and obesity being the two that are most in your control. Exercise is an important part of RA treatment and is often underutilized by people who have RA because they aren’t sure what is safe, or they are too tired or in too much pain to participate in exercise.  


Action Items  

  • If you are smoking, make a plan to quit. Seek help from your doctor as there are some medications that can make quitting easier. 
  • If you have never been to physical or occupational therapy to learn targeting stretches for your rheumatoid arthritis, go to THIS website to find a hand specialist. 



1. Cooney, J. K., Law, R. J., Matschke, V., Lemmey, A. B., Moore, J. P., Ahmad, Y., ... & Thom, J. M. (2011). Benefits of exercise in rheumatoid arthritis. Journal of aging research, 2011.

2. Kim, S. Y., Schneeweiss, S., Liu, J., Daniel, G. W., Chang, C. L., Garneau, K., & Solomon, D. H. (2010). Risk of osteoporotic fracture in a large population-based cohort of patients with rheumatoid arthritis. Arthritis research & therapy, 12(4), R154.

3. Mayo Clinic Staff. Rheumatoid Arthritis. Mayo Clinic Blog. March 1, 2019. Accessed May 2, 2019. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648.

4. Van Zanten, J. J. V., Rouse, P. C., Hale, E. D., Ntoumanis, N., Metsios, G. S., Duda, J. L., & Kitas, G. D. (2015). Perceived barriers, facilitators and benefits for regular physical activity and exercise in patients with rheumatoid arthritis: a review of the literature. Sports medicine, 45(10), 1401-1412.  

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