Exercise and Arthritis

About these exercises

Exercise tips

These exercises can help keep your joints moving. Follow these tips to get the most benefit.

1. Do these once or twice per day.
2. Do each exercise 3 to 10 times.
3. Move slowly. Do not bounce.
4. Breathe while you exercise. Count out loud.
5. Begin exercises slowly doing each exercise a few times only and gradually build up to more.
6. Try to achieve full range of motion by moving until you feel a slight stretch, but don't force a movement.
7. Don't try to help others do their exercises by moving their arms or legs.
8. STOP exercising if you have severe pain. Deep joint pain and sharp pain in particular should be avoided. Some muscle fatigue or tiredness are expected with an exercise program particularly at first.

If you have arthritis, you should try to move your joints through their full range of motion every day. Daily activities such as housework, climbing stairs, dressing, bathing, cooking, lifting or bending DO NOT usually move your joints through their full range of motion. They should NOT replace the therapeutic exercises your therapist recommends for you.

Instructions for viewing movies

Below are some range-of-motion exercises for people with arthritis. Although these exercises were selected for their safety and effectiveness, the UW Department of Ortheopedics is not responsible for any injuries resulting from these exercises.

Some of these exercises are illustrated with movies.

Range of motion exercises

Neck

Breathe with the movements, breathing out when your head moves down, breathing in when it moves up. Don't let your shoulders or torso (upper body) sway to the side. Don't do movements that your doctors or therapists have advised against.

1. Turn your head slowly to the right then to the left. Repeat two to four times.
2. Tilt your head toward one shoulder then toward the other shoulder. Repeat two to four times.

Arms

1. Sit upright arms supported on your lap palms upward. Bend your fingers inward towards your palm then unbend.
2. Next as your fingers bend inward flex your wrist. Keep fingers relaxed. Do not clench fist.
3. Bend your arm at the elbow bringing fingertips towards shoulder. Keep fingers relaxed. Do not clench fist.
4. Maintaining this position bring elbow up and then draw imaginary circles in space with your elbow.
5. Now unfold your arm at the elbow and reach towards the ceiling.
6. Slowly fold your arm down to rest your hand in your lap as in the initial position. Repeat two times unfolding to shoulder reaching to ceiling returning to lap.

Fingers

• Massage each hand one at a time. Take your time; go in between each finger. Enjoy this one!


• Open and close fingers slowly.

Chest and torso

• Sit in a chair. With hands on your waist tilt to the right, return to center, then tilt to the left and return to center. Exhale as the movement goes down; inhale as the movement comes up. Don't allow your torso (upper body) to tilt forward. Don't try to hold your head up; instead let it relax to the side.

Legs

• Rock and roll: Sit straight in your chair with your hands on your hips. Gently rock your hips from side to side.
• Note that the hip joint in particular seems sensitive to flare-ups when pushing too far into a painful range of motion so don’t push past the point of pain.
  
  

Click to play Ankle range of motion Click to play Gastroc stretch Click to play Soleus stretch

Click to play Pelvic tilt Click to play Hip lift Click to play Lower back rotation Click to play Double leg pull Click to play Single leg pull Click to play Push Click to play Back press Click to play Back release Click to play Arm reach

Click to play Elbow bending Click to play Elbow straightening Click to play Turning palm up Click to play Turning palm down Click to play Stretch for tennis elbow

Click to play Table top Click to play Finger curls Click to play Finger tip touch Click to play Finger spread

Click to play Hamstring stretch Click to play Hip flexor stretch

Click to play   Getting the arm up overhead while lying down Click to play   Getting the arm up overhead while sitting Click to play   Getting the arm up overhead with a pulley Click to play   Getting the arm up to rotate while lying down Click to play   Getting the arm to rotate while standing Click to play   Getting the arm up the back Click to play   Getting the arm across the body

Click to play   Thumb slide Click to play   In and out Click to play   Thumb roll

Click to play   Wrist flexion and extension Click to play   Moving the wrist side to side

About these exercises

Common exercises

Two common strengthening exercises for people with arthritis are:

• Isometric: In these exercises you tighten your muscles but don't move your joints (see figure 1). This helps build your muscles without moving painful joints.
• Isotonic: In these exercises you strengthen muscles by moving your joints (see figure 2). For example when you press your knee toward the floor you are doing an isotonic exercise to strengthen your thigh muscle.

Do these exercises daily or every other day. On days when you have more joint pain and swelling, you can adapt your program by leaving out or decreasing the strengthening exercises. Ask your therapist or doctor about ways to do this.

Specific strengthening exercises can be done for different joints. These should ONLY be done if they are comfortable. If you have questions about whether you should be doing these exercises contact your physician.

Instructions for viewing movies

Below are some strengthening exercises for people with arthritis. Although these exercises were selected for their safety and effectiveness, the UW Department of Ortheopedics is not responsible for any injuries resulting from these exercises.

Some of these exercises are illustrated with movies.

Strengthening exercises

Back

• Pelvic tilt (see figure 3)


• Back erector (see figure 4)


• Angry cat stretch (see figure 5)


• Double knee pull (see figure 6)


• Half sit-up (see figure 7)


• Hip kicker (see figure 8)

Chest and torso

• To strengthen the muscles of the chest: Place your hands in front of your chest palms together elbows at sides. Press your palms together holding for a count of five. Keep breathing.


• To tone the abdominal muscles: Place one hand over your stomach. Inhale then exhale tightening your abdominal muscles while pressing your lower back against a chair. Hold for up to a count of five. Inhale or breathe normally relaxing your abdominal muscles. (The hand is there to feel the movement.)

Legs

• Knee lift: Sit in a chair. Slowly lift one knee at a time keeping the knee bent. Alternate left/right. Let your hands rest by your sides; "hold" with the abdominal muscles rather than with your hands on the chair. Don't let your knees roll inward.


• Leg extension: Sit in a chair. Slowly extend or straighten each leg then bring it back to resting. Alternate left and right legs.
• Thigh firmer: Sit on the edge of a chair with your legs stretched out in front and heels resting on the floor. Tighten the muscle that runs across the front of the knee by lifting your toes toward your head. Push the back of the knee down towards the floor so you also feel a stretch at the back of your ankle.

Click to play   Calf strengthening I Click to play   Calf strengthening II Click to play   Posterior tibial strength Click to play   Toe flexor strength Click to play   Peroneal Strength Weights Click to play   Peroneal Strength Tubing

Click to play   Quad sets Click to play   Straight leg raises Click to play   Short arcs Click to play   Wall sits Click to play   Mini squats Click to play   Hamstring strengthening

Click to play   Shoulder shrug Click to play   Table push ups Click to play Balance Click to play   Stiff arm pull Click to play Flies Click to play   Two hand catch Click to play   Rhomboids Click to play   Internal Rotation Isometrics Click to play   Internal Rotation Tubing Click to play Internal Rotation Free weight Click to play External Rotation Free weight Click to play   External Rotation Isometrics Click to play   Supine Press Two hands Click to play Supine Press One hand Click to play   Supine Inclined press Click to play   Supine Sitting press

Fitness exercises for arthritis

Some of the best fitness exercises for people with arthritis are walking water exercise and bicycling.

Walking

Walking is better than running for people with arthritis because it doesn't put as much stress on your joints. It doesn't require any special skill and it doesn't cost a lot. You can walk almost any time and anywhere. If you have severe hip knee ankle or foot problems talk to your doctor: walking may not be for you...but even in that case there are other choices - see water exercise and bicycling below.

Water exercise

Swimming and exercise in water are especially good for stiff sore joints. Warm water helps relax your muscles and decrease pain. The water should be between 83 and 90 degrees. Water helps support your body while you move your joints through their full range of motion. With the water holding you up there is less stress on your hips knees and spine. You can do warm-water exercises while standing in shoulder-height water or while sitting in shallow water. In deeper water use an inflatable tube life vest or ski belt to keep you afloat while you move your arms and legs. Many public pools (as well as private fitness clubs) conduct water exercise and/or water aerobics programs for arthritis patients.

Exercise in the water – whether swimming water aerobics water walking or water jogging – is particularly handy for patients with arthritis of the legs (hips knees ankles feet) for whom a walking program is painful.

For more information about arthritis of particular joints see our articles on hip arthritis knee arthritis and shoulder arthritis. For more information about joint replacements for arthritic joints see our articles about hip replacement minimally-invasive knee replacement and shoulder replacement.

Bicycling

Bicycling especially on an indoor stationary bicycle is a good way to improve your fitness without putting too much stress on your hips knees and feet. Adjust the seat height so your knee is as straight as possible when the pedal is at the lowest point. The recommended cadence (number of pedal strokes per minute you can count each time your right foot reaches the lowest point as "one") is about 60 per minute. Add resistance only after you have warmed up for five minutes. Don't add so much resistance that you have trouble pedaling.

Gradually build up your fitness exercises to 20 to 30 minutes per day at least three times per week. Fitness exercises should be only one part of your total exercise program. DO NOT substitute fitness exercises for the therapeutic exercises your health professionals recommend.

Communicate with your doctor

Talk with your doctor or therapist to decide what types of exercises are best for you. Your decision will be based on what type of arthritis you have which joints are affected what you like to do where you live and other factors.

If you find a program on your own and you have serious joint problems show a copy of the exercises to your doctor or therapist. They may suggest ways to modify the exercises to protect your joints or may suggest other exercises to add to the program.

When to exercise

In general it is best to exercise:

• at a specific time and place
• when you have the least pain and stiffness
• when you are not tired
• when your arthritis medication is having the most effect

Here are a few more tips about exercise times:

• Try exercising at different times of day until you decide what is best for you.
• Exercise on a regular basis: try to do range of motion exercises daily and your other exercises every other day. If you miss several days you may need to start again at a lower level. If you must miss a day just pick up again where you left off.
• Don't do strenuous exercises just after you eat or just before you go to bed. Wait at least two hours after a meal. Do gentle range-of-motion exercises in the evening. This helps reduce morning stiffness for some people.

Before exercising

Massage the stiff or sore areas or apply heat and/or cold treatments to the area. Heat relaxes your joints and muscles and helps relieve pain. Cold also reduces pain for some people. Here are some ways you can apply heat or cold:

• Take a warm (not hot) shower before you exercise.
• Apply a heating pad or hot pack to the sore area.
• Sit in a warm whirlpool.
• Wrap a bag of ice or frozen vegetables in a towel and place it on the sore area.

In general use warmth before exercise and ice afterwards.

Be sure to apply the heat correctly! Mild heat will give you results. It should feel soothing and comfortable not hot. Apply it for about 20 minutes at a time. Use cold for 10 to 15 minutes at a time.

Warm up first. Do gentle range-of-motion and strengthening exercises at least 10 to 15 minutes before more vigorous exercise. Begin your activity at a slow pace and gradually work to a faster pace. This helps avoid injuries.

Wear comfortable clothes and shoes. Your clothes should be loose and in layers so you can adapt to changes in temperature and activity. Your shoes should provide good support and the soles should be made from non-slip shock-absorbent material. Shock-absorbent insoles can also make your shoes more comfortable.

During exercise

Don't hurry. Exercise at a comfortable steady pace and give your muscles time to relax between each repetition. For range-of-motion and flexibility it is better to do each exercise slowly and completely rather than to do many repetitions at a fast pace. You can gradually increase the number of repetitions as you get into shape.

Breathe while you exercise. Don't hold your breath. Counting out loud during the exercise will help you breathe deeply and regularly.

Move swollen painful joints gently. Ask your doctor or therapist how to adapt your regular exercises on days when your joints are more painful and swollen than usual.

After exercising

Cool down for five to 10 minutes after exercising. This helps you cool off lets your heart beat slow down and helps your muscles relax. To cool down simply do your exercise activity at a slower pace such as walking slowly. Also try gentle stretching to avoid stiff or sore muscles the next day.

At first it may be hard to start moving your stiff sore joints. Keeping your goals and the benefits of exercise in mind will help you during this time. Try to gently move your joints by yourself. If you need help ask a therapist who is trained to help people with arthritis. The therapist can also train your friends or family members to help you.

If you're having a flare

Exercises that seem easy one day may be too much on days when your joints are more painful and swollen. When this happens cut back on the number of exercises or take a day off. Gradually add more when you can. If you notice a big change in what you are able to do talk to your doctor or therapist about it.

Do not attempt fitness exercises when your joints are swollen and painful. If just one or two joints are swollen or painful you can adapt your exercises to put less stress on those joints. For example if your knee flares up switch to exercises in water instead of walking.

Know when to stop

Stop exercising right away if:

• you have chest tightness or pain or severe shortness of breath
• if you feel dizzy faint or sick to your stomach

If these symptoms continue contact your doctor.

Stop exercising if you have muscle pain or a cramp. Gently rub and stretch the muscle. When the pain is gone continue exercising with slow easy movements.

Know your body's signals. During the first few weeks you may notice that your heart beats faster you breathe faster and your muscles feel tense when you exercise. You may feel more tired at night but awake feeling refreshed in the morning. These are normal reactions to exercise that mean your body is adapting and getting into shape.

Don't do too much: you'll know you have done too much if you have joint or muscle pain that continues for two hours after exercising or if your pain or fatigue is worse the next day. Next time decrease the number of times you do each exercise or do them more gently. If this doesn't help ask your therapist about changing the exercise. A good general rule to remember is to stop exercising if you start having sharp pain or more pain than usual. Pain is your warning signal.

Keeping up with your program

It's important to keep a positive attitude about arthritis and your exercise program.

It will help to remember that exercise can help reduce the pain and enable you to keep up with most of your daily activities. But also remember there will be days when you won't feel like doing as much. On these days do a little less exercise.

The keys to keeping up with your program are:

• make exercise a regular part of your day
• listen to your body's signals--know when to cut back or stop your exercise

Overcoming excuses to avoid exercise

Yet we all can find many reasons not to exercise. Here are some problems and ways to overcome them.

"I don't have enough time." Exercise at the same time every day or follow an exercise schedule. Several short periods are just as good as one long period. Think of your exercise time as special time for yourself. Use this time to think about other creative goals for yourself.

"It's boring." Do exercises you enjoy. Listen to your favorite music while exercising. Exercise with friends or family. If you walk or bicycle go to the park or another pleasant area.

"The weather's bad." If you usually exercise with a group and can't get to your class do your exercises at home. If you swim or walk have a "back-up" plan for indoor exercises when the weather is bad. For example walk around a shopping mall if it's too cold or hot to walk outside.

"My arthritis is acting up." If you are having a flare don't skip your exercises entirely. Just cut back on the number of times you do each exercise. There will be days when you can't do as much but don't give up. You can get back to your regular program when the flare dies down.

"I don't like to exercise alone." Ask friends or family to exercise with you. Or join an exercise class or club.

"It hurts." It's normal to have some pain or soreness at first. Always remember to warm up beforehand and to cool down afterwards to help relax your muscles and reduce the pain. Also remember that exercising to build strong muscles and joints will reduce the pain of arthritis.

"I'm out of shape. It will take too long to see results." Set short-term realistic goals for yourself every three to four weeks. For example if you want to walk one mile start by walking one block. Or if you want to do ten repetitions of an exercise start with three. Keep a record of your exercise or report your progress to a friend or family member. Think of rewards you can give yourself when you reach your goal.

"I lose interest and forget about it." If you're having trouble sticking to your program think about the things that can affect your attitude. Why did you want to start the program? Are these reasons still important? Keep a record of what you do. List what you plan to do each week. Post the list where you'll see it often. At the end of each day check off the exercises you did.

"It's too much work." Maybe you're being too serious about your exercise program. Maybe you're trying to do too much. Relax! Enjoy the good feelings while you exercise and afterward. Join an exercise group. Exercising for fun is the best way to keep it up.

Exercise and arthritis

Exercise keeps you fit and healthy.

If you have arthritis exercise helps keep your joints and muscles strong your bones and joint tissues healthy and gives you more energy to keep up with daily activities.

Your doctor or other health professionals can help you design a fitness program that meets your individual needs.

To get the most benefit from your program remember these tips:

• Make exercise a part of your daily routine.
• Do all types of exercises (range-of-motion strengthening and fitness)
• Know when to stop or cut back on your exercises.
• Have fun!

Credits

Some of this material may also be available in an Arthritis Foundation brochure.

Adapted from the pamphlet originally prepared for the Arthritis Foundation by Victoria Gall PT MEd and Marian Minor PT Ph.D. This material is protected by copyright.