Condition guide
Rheumatoid arthritis is an inflammatory condition in which the immune system attacks the joints; it mostly brings pain, swelling and morning stiffness in the small joints of the hands and feet. The mainstay of treatment is the medication prescribed by your rheumatologist; exercise complements it. In trials, exercise programmes were not found to be harmful; they improved muscle strength, stamina and hand function.
In rheumatoid arthritis the immune system attacks the lining of the joints; the joint swells, hurts and can be damaged over time. It usually appears in both hands or both feet at once, symmetrically. More than half of those affected are over 55.
The disease does not go away completely, but early diagnosis and treatment can reduce symptoms, slow the disease and prevent lasting disability. That is why joint swelling and morning stiffness that have lasted for weeks should be assessed by a rheumatologist without delay.
For many years it was thought that inflamed joints should be rested. The Cochrane review of eight trials showed the opposite: programmes combining aerobic and muscle-strengthening exercise increased stamina and muscle strength and reduced pain a little, and no harmful effects were seen in any trial. EULAR, the European rheumatology association, also recommends that physical activity should be an integral part of standard care in rheumatoid arthritis.
Exercise aimed at the hands works too. In the SARAH trial of 490 patients whose drug treatment had been unchanged for at least three months, a tailored stretching and strengthening programme added to usual care improved hand function more after one year (7.9 points versus 3.6 points out of 100). No serious adverse events related to the programme were recorded.
Exercise does not replace drug treatment; it complements it. During a flare-up, reduce the intensity but do not stop moving altogether: move a swollen, warm joint within its pain-free range without forcing it, and once the flare-up settles, bring the programme gradually back to its previous level.
Exercises at home
Do the exercises within your pain-free range, without forcing. Increased pain that lasts a long time after exercise shows that you should do less next time. Skip the resistance exercises while your joints are swollen and warm.
Hold your hand upright with the fingers straight. In turn make a hook, a full fist and a straight fist; hold each for a few seconds, then open your fingers again. This helps to keep the finger joints moving; do it within your pain-free range, without forcing.
5–10 reps, once or twice a dayHold a soft ball or a rolled-up towel in your hand. Squeeze with a force that does not increase your pain, hold for 3–5 seconds and let go. If your joints are swollen and warm, skip this exercise that day.
10 reps, once a dayHold your arm out in front of you with the palm facing up. With your other hand, gently draw your fingers down and back; feel a mild stretch along the inside of your forearm. Do not force it.
20 seconds, 3 repsRest your forearm on a table with the palm facing down. Hold a half-litre water bottle in your hand. Lift your wrist up, then lower it slowly over 3–4 seconds. If it feels easy, increase the weight little by little.
8–10 reps, 2 setsSit towards the front of a sturdy chair. Breathe out as you stand up and breathe in as you slowly sit down. Use your hands for support if needed; as it gets easier, cross your arms over your chest.
8–10 reps, 2 setsWalk on level ground at a pace at which you can talk but not sing. Start slowly for the first few minutes and then speed up; slow down for the last few minutes. Increase the time little by little from week to week.
Start with 10 minutes; aim for 30 minutes a dayIf you have a marked deformity of the hand joints or have had hand surgery recently, consult your rheumatologist or hand therapist before starting the exercises.
Video
From the YouTube channels of North Bristol NHS Trust in England and the Hospital for Special Surgery in New York.
A hand exercise video prepared by the hospital.
An information video on the place of exercise in inflammatory arthritis.
The research does not show that. In the review of eight trials, no harmful effects were seen with any of the exercise programmes; muscle strength and stamina increased. It is enough to adjust the programme to the phase of your disease.
Reduce the intensity, but do not stop moving altogether. Do not work swollen, warm joints against resistance; move them gently within the pain-free range and take more rest breaks. If the flare-up lasts a long time or is more severe than usual, let your rheumatologist know.
In the SARAH trial of 490 patients, a tailored hand exercise programme added to usual care improved hand function more after one year, and no serious adverse events related to the programme were recorded. The researchers judged it a worthwhile, low-cost addition to drug treatment.
Osteoarthritis has to do with wear of the joint cartilage; it usually causes pain that increases with movement and morning stiffness that is short-lived. Rheumatoid arthritis is an inflammatory disease driven by the immune system; the joints swell, morning stiffness lasts a long time and both sides are usually affected at once. A doctor tells them apart by examination and blood tests.
See a doctor without delay if you have any of the following:
Sources
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