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What
Is Arthritis?
Should People With Arthritis
Exercise?
How Does Exercise Fit Into a
Treatment Plan for People
With Arthritis?
What Types of Exercise Are
Most Suitable for Someone
With Arthritis?
How Does a Person With
Arthritis Start an Exercise
Program?
What Are Some Pain Relief
Methods for People With
Arthritis?
How Often Should People With
Arthritis Exercise?
What Type of Strengthening
Program Is Best?
Are There Different
Exercises for People With
Different Types of
Arthritis?
How Much Exercise Is Too
Much?
Should Someone With
Rheumatoid Arthritis
Continue To Exercise During
a General Flare?
How About During a Local
Joint Flare?
Are Researchers Studying
Arthritis and Exercise?
Where Can People Find More
Information on Arthritis and
Exercise?
This booklet 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?
There are over 100 forms of
arthritis and other
rheumatic diseases. These
diseases may cause pain,
stiffness, and swelling in
joints and other supporting
structures of the body such
as muscles, tendons,
ligaments, and bones. Some
forms can also affect other
parts of the body, including
various internal organs.
Many people use the word
"arthritis" to
refer to all rheumatic
diseases. However, the word
literally means joint
inflammation; that is,
swelling, redness, heat, and
pain caused by tissue injury
or disease in the joint. The
many different kinds of
arthritis comprise just a
portion of the rheumatic
diseases. Some rheumatic
diseases are described as
connective tissue diseases
because they affect the
body's connective
tissue--the supporting
framework of the body and
its internal organs. Others
are known as autoimmune
diseases because they are
caused by a problem in which
the immune system harms the
body's own healthy tissues.
Examples of some rheumatic
diseases are:
Osteoarthritis
Rheumatoid arthritis
Fibromyalgia
Systemic lupus erythematosus
Scleroderma
Juvenile rheumatoid
arthritis
Ankylosing spondylitis
Gout
In this booklet, the term
arthritis will be used as a
general term to refer to
arthritis and other
rheumatic diseases.
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, cardiac fitness,
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
(e.g., dance) help maintain
normal joint movement and
relieve stiffness. This type
of exercise helps maintain
or increase flexibility.
Strengthening exercises
(e.g., weight training) help
keep or increase muscle
strength. Strong muscles
help support and protect
joints affected by
arthritis.
Aerobic or endurance
exercises (e.g., bicycle
riding) 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.
Most health clubs and
community centers offer
exercise programs for people
with physical limitations.
How Does a Person With
Arthritis Start an Exercise
Program?
People with arthritis should
discuss exercise options
with their doctors and other
health care providers. 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.
Step Up to Exercise: How
To Get Started
Discuss
exercise plans with your
doctor.
Start with supervision from
a physical therapist or
qualified athletic trainer.
Apply heat to sore joints
(optional; many people with
arthritis start their
exercise program this way).
Stretch and warm up with
range-of-motion exercises.
Start strengthening
exercises slowly with small
weights (a 1- or 2-pound
weight can make a big
difference).
Progress slowly.
Use cold packs after
exercising (optional; many
people with arthritis
complete their exercise
routine this way).
Add aerobic exercise.
Consider appropriate
recreational exercise (after
doing range-of-motion,
strengthening, and aerobic
exercise). Fewer injuries to
joints affected by arthritis
occur during recreational
exercise if it is preceded
by range-of-motion,
strengthening, and aerobic
exercise that gets your body
in the best condition
possible.
Ease off if joints become
painful, inflamed, or red,
and work with your doctor to
find the cause and eliminate
it.
Choose the exercise program
you enjoy most and make it a
habit.
What Are Some Pain Relief
Methods for People With
Arthritis?
There are known methods to
help 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. In TENS, an electrical
shock is transmitted through
electrodes placed on the
skin's surface. 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.
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
should be done 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.
According to the American
College of Rheumatology, 20-
to 30-minute exercise
routines can be performed in
increments of 10 minutes
over the course of a day.
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
small free 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 their exercise plans
with a doctor. Doctors who
treat people with arthritis
include rheumatologists,
orthopaedic surgeons,
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 strenuous. 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
strenuous 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 during general or
joint flares.
Are Researchers Studying
Arthritis and Exercise?
Researchers are looking at
the effects of exercise and
sports on the development of
musculoskeletal
disabilities, including
arthritis. They have found
that people who do moderate,
regular running have low, if
any, risk of developing
osteoarthritis. However,
studies show that people who
participate in sports with
high-intensity, direct joint
impact are at risk for the
disease. Examples are
football and soccer. Sports
involving repeated joint
impact and twisting (such as
baseball and soccer) also
increase osteoarthritis
risk. Early diagnosis and
effective treatment of
sports injuries and complete
rehabilitation should
decrease the risk of
osteoarthritis from these
injuries.
Researchers also are looking
at the effects of muscle
strength on the development
of osteoarthritis. Studies
show, for example, that
strengthening the quadriceps
muscles can reduce knee pain
and disability associated
with osteoarthritis. One
study shows that a
relatively small increase in
strength (20-25 percent) can
lead to a 20-30 percent
decrease in the chance of
developing knee
osteoarthritis. Other
researchers continue to look
for and find benefits from
exercise to patients with
rheumatoid arthritis,
spondyloarthropathies,
systemic lupus erythematosus,
and fibromyalgia. They are
also studying the benefits
of short- and long-term
exercise in older
populations.
Where Can People Find
More Information on
Arthritis and Exercise?
National Institute of
Arthritis and
Musculoskeletal and
Skin Diseases Information
Clearinghouse
National Institutes of
Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or
877-22-NIAMS (226-4267)
(free of charge)
TTY: 301-565-2966
Fax: 301-718-6366
http://www.niams.nih.gov/
NIAMS provides information
about various forms of
arthritis and rheumatic
disease and bone, muscle,
and skin diseases. It
distributes patient and
professional education
materials and refers people
to other sources of
information. Additional
information and updates can
also be found on the NIAMS
Web site.
American Academy of
Orthopaedic Surgeons
P.O. Box 2058
Des Plaines, IL 60017
Phone: 800-824-BONE (2663)
(free of charge)
www.aaos.org
The academy provides
education and practice
management services for
orthopaedic surgeons and
allied health professionals.
It also serves as an
advocate for improved
patient care and informs the
public about the science of
orthopaedics. The
orthopaedist's scope of
practice includes disorders
of the body's bones, joints,
ligaments, muscles, and
tendons. For a single copy
of an AAOS brochure, send a
self-addressed stamped
envelope to the address
above or visit the AAOS Web
site.
American College of
Rheumatology
1800 Century Place, Suite
250
Atlanta, GA 30345
Phone: 404-633-3777
Fax: 404-633-1870
www.rheumatology.org
This association provides
referrals to doctors and
health professionals who
work on arthritis, rheumatic
diseases, and related
conditions. The association
also provides educational
materials and guidelines.
American Physical Therapy
Association
1111 North Fairfax Street
Alexandria, VA 22314-1488
Phone: 703-684-2782 or
800-999-2782, ext. 3395
(free of charge)
www.apta.org
The association is a
national professional
organization representing
physical therapists, allied
personnel, and students. Its
objectives are to improve
research, public
understanding, and education
in the physical therapies.
Arthritis Foundation
1330 West Peachtree Street
Atlanta, GA 30309
Phone: 404-872-7100 or
800-283-7800 (free of
charge) or
call your local chapter
(listed in the telephone
directory)
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 an
aquatic exercise program
held in swimming pools. The
foundation also can provide
physician and clinic
referrals.
Lupus Foundation of America,
Inc. (LFA)
2000 L Street, N.W., Suite
710
Washington, DC 20036
Phone: 202-349-1155
Toll Free: (800)558-0121
Fax: 202-349-1156
E-mail: lupusinfo@lupus.org
www.lupus.org
This is the main voluntary
organization devoted to
lupus. It also provides
information on arthritis and
exercise.
SLE Foundation
149 Madison Avenue, Suite
205
New York, NY 10016
Phone: 212-685-4118
www.lupusny.org
This foundation supports and
encourages medical research
to find the cause and cure
of lupus and improve its
diagnosis and treatment. It
also provides information on
arthritis and exercise.
National Fibromyalgia
Partnership, Inc.
P.O. Box 160
Linden, VA 22642-0160
Phone: 866-725-4404 (free of
charge)
Fax: 866-666-2727
E-mail: mail@fmpartnership.org
www.fmpartnership.org
This organization devoted to
fibromyalgia provides
information on arthritis and
exercise.
Spondylitis Association of
America (SAA)
P.O. Box 5872
Sherman Oaks, CA 91413
Phone: 800-777-8189 (free of
charge)
E-mail: info@spondylitis.org
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.
Acknowledgments
The NIAMS gratefully
acknowledges the assistance
of Susana A. Serrate-Sztein,
M.D., and James S. Panagis,
M.D., M.P.H., NIAMS, NIH;
Jeanne Hicks, M.D., and
Naomi Lynn Gerber, M.D.,
both of the Rehabilitation
Medicine Department, NIH;
and Stanley R. Pillemer,
M.D., National Institute of
Dental and Craniofacial
Research, NIH, in the
preparation and review of
this booklet.
The mission of the National
Institute of Arthritis and
Musculoskeletal and Skin
Diseases (NIAMS), a part of
the National Institutes of
Health (NIH), is to support
research into the causes,
treatment, and prevention of
arthritis and
musculoskeletal and skin
diseases, the training of
basic and clinical
scientists to carry out this
research, and the
dissemination of information
on research progress in
these diseases. The National
Institute of Arthritis and
Musculoskeletal and Skin
Diseases Information
Clearinghouse is a public
service sponsored by the
NIAMS that provides health
information and information
sources. Additional
information can be found on
the NIAMS Web site at http://www.niams.nih.gov/.
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