Exercise has many benefits for people with rheumatoid arthritis (RA), but it can be challenging due to fatigue, pain, and joint stiffness. Exercise is a common topic among myRAteam members, who often share their experiences and tips. “I went to the local pool and did my hydrotherapy exercises,” one member said. “I felt good afterward and walked to a local pub for dinner. Just hope I haven't overdone the exercise.”

Working with physical limitations is an important aspect of exercise for people with RA. One myRAteam member explained her approach. “My trainer was amazing. At the beginning of each session, he would ask how my body was feeling,” she said. “Then he would work around any issues I was currently having.” Another member said, “I’m very limited in what I can do physically due to limited range of motion and extreme pain. I did get in the pool, which helps.”

To find out more about exercise and RA, myRAteam spoke with Dr. Iris Navarro-Millán, a rheumatologist who specializes in rheumatoid arthritis. Dr. Navarro-Millán is an assistant professor of medicine at Weill Cornell Medicine and the Hospital for Special Surgery in New York City, and her research focuses on peer coaches for self-care and cardiovascular disease in RA.

When it comes to exercise, Dr. Navarro-Millán advises people with RA to begin modestly. “Start slow,” she advised. “See how your body is doing and listen to it.”

Benefits of Exercise

Exercise can improve fitness and mobility for people with RA, and it has numerous physical health benefits, including:

• Improved cardiovascular health
• Increased strength and muscle mass
• Improved range of motion and flexibility
• Better balance, which may help prevent falls

In addition to improving physical function, research has shown that exercise can enhance quality of life and benefit mental health by reducing pain, anxiety, and depression in people with RA.

Heart Health and Exercise With RA

Cardiovascular health is especially important because people with RA have an increased risk of heart disease. Compared to the general population, people with RA have a 50 percent to 70 percent higher risk of cardiovascular illnesses. Cardiovascular disease increases the risk of life-threatening heart attacks and strokes, but studies show that exercise can help decrease inflammation and the risk of heart disease in people with RA.

Dr. Navarro-Millán is a strong advocate for improving cardiovascular health among people with RA, and notes that exercise is an important factor. “According to the American Heart Association and the American College of Cardiology, they recommend first and foremost, lifestyle changes,” she said. “Those lifestyle modifications include increasing physical activity, maintaining an adequate weight for their height, and also the consumption of a healthy diet.”

One myRAteam member described the exercising she does for cardiovascular health. “It's an instructor-led, circuit-like training that includes rowing, treadmill, or strider, and a series of floor exercises. With a heart monitor, you strive to keep your heart rate above 84 beats per minute for at least 20 minutes to get lasting benefits. The stuff I can't do because of the RA, I modify. I feel really good getting an all-over body workout in an hour.”

Exercise for Bone and Muscle Health

Weight-bearing exercises, such as low-impact aerobics, elliptical machines, stair climbing, gardening, or even walking can strengthen bones and build muscles to reduce the risk for osteoporosis. People with RA have a higher risk of osteoporosis due to certain medications, inactivity, and inflammation from the disease itself. Osteoporosis increases the risk for bone fractures.

People with RA are also prone to cachexia, a loss of muscle mass, which can increase the risk of obesity and cause a decrease in physical function. Exercise that builds muscle mass can help counter this syndrome. Improved muscle strength can also help support joints that are damaged from RA.

Finding the Right Routine for You

Both weight-bearing (also called resistance) exercises for strength training and aerobic exercises that increase the heart rate are important for people with RA. Low-impact exercises like walking, swimming, gardening, yoga, tai chi, and stationary bicycling may be a good place to start.

Dr. Navarro-Millán recommends water exercises as a good introduction to exercise. Some facilities have special water therapy pools that are well-heated and easy to get in and out of. “Water therapy does not impact your joints,” said Dr. Navarro-Millán. For people whose joints may be too sensitive for some water therapy exercises, Dr. Navarro-Millán suggests walking in the pool. “You're still getting some cardiovascular fitness,” she explained.

Water therapy is commonly discussed on myRAteam. “I do water aerobics and water Zumba,” said one member. “That's about all I can tolerate, as I cannot stand or walk for very long. It helps the stiffness. It makes me tired, but with less fatigue.” Another member wrote, “I am so thankful to have a friend who makes sure I get to the Y weekly to walk in water and do other exercises in the warm water. I love it!”

“I have been going to the YMCA three days a week and doing 90 minutes of water exercises,” a member said. “The water and exercises help me feel better and sleep better.”

Dr. Navarro-Millán said a stationary bike with moderate resistance is another way to exercise with very little impact on joints. “You don't want to do it with no resistance, because no resistance can be a little bit more stressful on the knee,” she said. “There has to be some resistance.”

Dr. Navarro-Millán also recommends that people with RA do more walking. “I would not recommend running,” she added. Walking is considered weight-bearing exercise because it moves body weight, which provides resistance. “I recommend resistance exercises, but everybody is different in that regard,” she said. “Some people can still lift weights.”

One myRAteam member explained her exercise routine. “Good day. I went to my exercise class. It is a combination of standing and chair exercises, with use of weights and a ball. I picked three-pound weights today, and oh my, did I give my arms a workout.”

Exercising at home is preferable for many people with RA. One myRAteam member said, “I like to do total body workouts, the ones that get your heart rate up. I don’t go to the gym anymore. We have a lot of workout equipment at home. I recently found some workout videos that I really like.”

Work With a Physical Therapist

While some people might like working with a personal trainer, sessions with a physical therapist may be covered partially or in full by your insurance. “You don't need to pay for an expensive personal trainer,” Dr. Navarro-Millán said. “You can ask your rheumatologist, ‘Can I get a referral for physical therapy so that I can get an exercise program that I can do at home?’” She suggested doing exercises while watching TV or during commercial breaks. “Sometimes an exercise just requires carrying cans that are a few ounces, or holding one pound of beans in your hands and getting your arms moving while holding these,” she said.

A physical therapist can evaluate your capacity for exercise, Dr. Navarro-Millán said. In that way, it is possible to safely exercise without exacerbating pain in joints. Physical therapists can also recommend appropriate ways to warm up and cool down when exercising.

Challenges With Exercise and RA

It is common for people with RA to be wary of exercise. Many worry that exercise may cause painful joints and flare-ups. However, moderate-intensity exercise does not increase disease activity in people with RA, Dr. Navarro-Millán said. “There are a few studies that have shown that with an adequate program, even with some resistance exercises, many patients with rheumatoid arthritis do not experience flares,” she said.

The key is to avoid overexertion and pushing yourself too hard. “Exercise made my pain much worse,” one myRAteam member said, which underscores the importance of medical advice if you are experiencing joint pain while exercising. Another member wrote, “I’ve been working hard to incorporate exercise into my day, every day. But it is so easy to overdo it,” she said. “I am learning to listen to my body and take rest days.”

One member described how she exercises, while taking particular care of vulnerable areas of her body. “Day two of the swim program, and although I am sore, it's good so far,” she said. “Using the noodles and the water weights help. I have lots of problems with my neck, shoulder, and chest, so the water aides help from overusing these areas.”

Dr. Navarro-Millán urges everyone with RA to start doing regular exercise that works for them. “Talk to your doctor, get an evaluation by a physical therapist, and get into action,” she said. “The worst exercise is the one that is not done.”

Talk With Others Who Understand

On myRAteam, more than 142,000 members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis.

Have you ever talked to a physical therapist about exercises you can do at home? Have you tried water therapy? Share your experience in the comments below, or start a conversation by posting on your Activities page.