Exercise Recommendations for Rheumatoid Arthritis

Types of Exercise

• The American College of Rheumatology conditionally recommends aerobic exercise for RA patients based on very low to low certainty evidence showing improved physical function 1
• Walking is a commonly studied and accessible form of aerobic exercise for RA patients, either on a treadmill or as supervised community-based indoor fitness walking 2
• Cycling on stationary bicycles is an effective aerobic option that reduces impact on joints for RA patients 2
• Aim for 30-60 minutes of aerobic activity, 3-7 days per week for RA patients 3
• The American College of Rheumatology conditionally recommends resistance exercise for RA patients based on very low to low certainty evidence showing improvements in both physical function and pain 1
• Options for resistance exercise include isokinetic weight machines, resistance training with elastic bands, and isometric exercises for RA patients 2
• For patients with active RA, begin with lower resistance (40-60% of one repetition maximum) with 15-20 repetitions, focusing on proper form and breathing 3
• Initially start with as few as 2-3 repetitions based on pain threshold and gradually work up to 10-12 repetitions, 2-3 days per week for RA patients 3
• The American College of Rheumatology conditionally recommends aquatic exercise for RA patients based on low certainty evidence showing improvement in physical function 1
• Aquatic exercise combines aspects of aerobic fitness and joint range of motion exercises in a low-impact environment for RA patients 2
• Aquatic exercise is particularly beneficial for patients with significant joint pain or those who have difficulty with weight-bearing exercises 2
• The American College of Rheumatology conditionally recommends mind-body exercise for RA patients based on very low to low certainty evidence showing improved physical function 4
• Mind-body exercise includes practices such as yoga, Tai Chi, and Qigong for RA patients 4
• Hand therapy exercises are conditionally recommended for RA patients with hand involvement 4

Implementation Approach

• Start with repeated short bouts of low-intensity exercise daily, progressively increasing duration for RA patients 3
• For cardiovascular exercise, begin with brief 10-minute sessions, adding 5 minutes per session until reaching 30 minutes for RA patients 3
• Exercise affected joints using a pain-free range of motion for flexibility training for RA patients 3
• Overall, exercise programs are more effective when supervised by physical therapists, sometimes in a class setting, rather than performed alone at home for RA patients 2
• Comprehensive physical therapy is conditionally recommended for RA patients 1
• Comprehensive occupational therapy is conditionally recommended for RA patients 1

Important Considerations and Cautions

• There is no uniformly accepted level of pain at which a patient should or should not exercise; a shared decision-making approach between clinician and patient is advisable for RA patients 2
• Avoid vigorous, repetitive exercises that use unstable joints and overstretching for RA patients 3
• Avoid exercising joints during disease flare-ups for RA patients 3
• Discontinue exercise if the patient experiences unusual or persistent fatigue, increased weakness, decreased range of motion, or if joint swelling or pain lasts more than one hour after exercise for RA patients 3
• Morning exercise may need to be avoided if RA-related morning stiffness is present for RA patients 3

Practical Implementation

• Exercise recommendations should focus on patient preferences and access, which are important barriers to participation for RA patients 2
• Exercise programs are more effective when combined with self-efficacy training and self-management interventions for RA patients 2