Gillian White, MSc, Ph.D. (Candidate), University of Toronto, Graduate Department of Exercise Sciences

Rheumatoid Arthritis (RA)

RA is an autoimmune disorder resulting in pain, swelling, and stiffness of joints and has been previously discussed in blogs here and here. It is caused by chronic inflammation of these joints, ultimately resulting in damage, deformity, and loss of function. Although is most commonly affects the joints of the hands and feet, it can also affect larger joints in the body, as well as result in damage and dysfunction to the cardiovascular and respiratory systems. Pain, stiffness, loss of mobility, and fatigue are common symptoms of RA and are common barriers to being physically active.

People who have a genetic risk for RA but are physically active have a 35% lower likelihood of developing the disease (Di Giuseppe et al., 2015). Similarly, those who have RA but are regularly physically active have a higher psychological function, higher physical function (joint mobility, range of motion, and pain), lower symptom severity, and slower disease progression compared with those who have RA and are not physically active. A recent meta-analysis (Sharif et al., 2017) reported that people with RA should exercise at least 20 minutes per day totaling at least 1 hour per week.

Related Article: Autoimmune Illnesses: How To Move When Your Immune System Has Gone Rogue

Make Exercise A Priority

senior couple joggingThe type of exercise that is best may depend on specific symptoms. Cardiovascular illness is 1.6x higher in people with RA, therefore, people with lower cardiovascular fitness should make this a priority. Further, rheumatoid cachexia – a condition in which inflammatory processes result in muscle being replaced by fat – can take a significant toll on overall function an quality of life, and should, therefore, be addressed with progressive resistance training if it is an issue. High-intensity interval training (HIIT) has been shown to be safe and effective for people with RA and can increase muscle strength and cardiovascular fitness simultaneously. One study used a twice per week for a 10-week spin program in which participants completed 4 bouts of 4 minutes at 85%-95% of their maximum heart rate (predicted HRmax = 220-age), with 3 minutes at 70% max heart rate between bouts (Sandstad et al., 2015).

While high-intensity exercise can be beneficial for people with RA, it can sometimes exacerbate fatigue symptoms. Therefore, for people experience acute or chronic fatigue as a symptom of RA, a lower intensity aerobic exercise session may be more appropriate, such as 20 minutes of walking, swimming, or cycling. Lower intensity exercise is also easier to do when the psychological and physical barrier of fatigue is whispering excuses in your ears (for people with and without RA!). For days with high fatigue, putting your shoes on and getting out the door is the goal, and anything beyond that is a bonus!

Related Article: 90 Seconds A Day Of HIIT Might Be All You Need

Workout Plan Recommendations:

General Recommendations: >20 minutes of physical activity daily.

Best exercise: HIIT – 4×4 minutes x 85-95% HRmax with 3 minutes of rest at 70% HRmax done 2-3x/week.

Other exercises:
Aerobic – 25-35 minutes of moderate-intensity aerobic activity (55-75% HRmax) done 3-4x/week
Resistance – 25-35 minutes of resistance training with progressive loads and focus on large muscle groups (i.e. lunges, squats etc.). Start with lower weight and higher repetitions (12-15 reps) for the first 4 weeks and gradually increase to higher weight with lower repetitions (8-10 reps).

Benefits: Lower pain symptoms, improved joint function, increased cardiovascular fitness, and lower risk secondary illnesses like heart disease (RA), osteoporosis (IBD), depression (Fibromyalgia).

Cautions: When fatigue is high, lower intensity aerobic exercise may be more suitable. For IBD, if surgical resection of intestines >10cm, high-intensity exercise should be avoided.

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