Exercise and Arthritis

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Last updated: September 23, 2011
Edited by:

Seth S. Leopold, M.D. Seth S. Leopold, M.D.,
Professor,
UW Orthopaedics & Sports Medicine
Frederick A. Matsen III, M.D. Frederick A. Matsen III, M.D.,
Professor,
UW Orthopaedics & Sports Medicine

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Contact

If you have questions regarding the ream and run procedure, feel free to email Frederick A. Matsen III M.D. at matsen@uw.edu. If you have questions regarding hip and knee arthritis, feel free to email Seth S. Leopold M.D. at leopold@u.washington.edu.

Overview

Part of a treatment program

Bicycling can be great recreational exercise

Bicycling can be great recreational exercise

Exercise is good for almost everyone!

For many years it was thought that people with arthritis should not exercise because it would damage their joints. Now doctors know that when the arthritis is under control, people with arthritis can improve their health and fitness through exercise without hurting their joints.

Exercising for fitness is as important for people with arthritis as for anyone else. It can give you more energy, help you sleep better, control your weight, make your heart stronger, make your bones and muscles stronger, decrease depression, decrease fatigue, improve your self-esteem and sense of well-being, and give you time to socialize with friends.

If you have arthritis, you have more reasons to exercise:

  • to keep your joints from becoming too stiff
  • to keep the muscles around your joints strong
  • to keep bone and cartilage tissue strong and healthy
  • to improve your overall fitness

Along with medicines, rest and other parts of your treatment program, regular exercise can help keep your joints in working order so you can continue your daily activities. It may also help prevent further joint damage.

What happens without exercise?

If your joints hurt, you may not feel like exercising. But without exercise, your joints can become even more stiff and painful. This happens because exercise actually keeps your bones muscles and joints healthy.

Because you have arthritis, it is important to keep your muscles as strong as possible. The stronger the muscles and tissues are around your joints, the better they will be able to support and protect those joints--even those that are weak and damaged from arthritis. If you don't exercise, your muscles become smaller and weaker and your bones can become more brittle.

Many people with arthritis keep their joints in a bent position because it's more comfortable. If the joints stay in one position for too long (without movement), they can become stuck in that position. If this happens, you may even lose the use of those joints. Exercise moves these joints and helps keep them as flexible as possible.

Exercise also lifts your spirits. If you're in pain, you may feel depressed. If you feel depressed, you may not feel like exercising. And without exercise, you feel more pain and depression.

Without exercise, you can get caught in a cycle of pain depression and inactivity.

On the other hand, there are some kinds of exercise that are not ideal for patients with certain patterns of arthritis. This article will cover some general recommendations on how patients with arthritis might be able to exercise comfortably and safely.

Types of exercises

There are three main types of exercise that can be included in your exercise program: range-of-motion (flexibility), strengthening and fitness.

  • Range-of-motion exercises help reduce stiffness and keep your joints flexible.
  • Strengthening exercises help maintain or increase muscle strength.
  • Fitness exercises help increase your endurance.

These types of exercises are discussed in detail later in this article.

Health care professionals

Along with your doctor, there are two other types of health professionals who can help you plan a total fitness program. They can work with you to design a program that meets your specific needs.

Physical and occupational therapists

Physical therapists can show you special exercises to help keep your bones and muscles strong.

Occupational therapists can show you how to do certain activities in ways that will not place extra stress on your joints. They can also provide you with splints or special aids if you need them. Contact your local hospital, county medical clinic or Arthritis Foundation office for more information on how to contact these professionals.

Always check with your doctor, physical therapist or occupational therapist before starting a new exercise program or before changing your current one. They can help you determine the best exercises that meet your needs. If you have had joint replacement surgery also talk with your surgeon.

Therapeutic and recreational exercise

People with arthritis often follow a therapeutic exercise program and also take part in active leisure or recreational exercise. Therapeutic exercise is exercise recommended by your doctor physical therapist or occupational therapist. It includes specific exercises designed to meet your individual needs and achieve specific goals. Recreational exercise is done for fun and general fitness. It includes activities you can enjoy by yourself or with family and friends such as walking, bicycling, swimming and exercise classes. It is not designed specifically for you by your doctor but it is a good idea to discuss your recreational exercise plans with your doctor or therapists.

Don't work too hard

The most common risk to exercise is working your joints or muscles too much. This can happen if you exercise too long or too hard--especially when you're first beginning your exercise program.

Remember: exercise is only one part of your treatment program. Other parts of your program should include:

  • proper diagnosis by a doctor
  • using your joints wisely
  • education about arthritis
  • conserving your energy
  • medication
  • proper diet
  • rest
  • splints (for some people)
  • using heat and cold treatments

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.

Range-of-motion exercises

About these exercises

These exercises reduce stiffness and help keep your joints flexible. The "range-of-motion" is the normal amount your joints can be moved in certain directions. If your joints are very painful and swollen, move them gently through their range of motion.


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.

Ankle

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Ankle range of motion
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Gastroc stretch
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Soleus stretch

Back

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

Elbow

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Elbow bending
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Elbow straightening
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Turning palm up
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Turning palm down
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Stretch for tennis elbow

Hand

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Table top
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Finger curls
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Finger tip touch
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Finger spread

Hip

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Hamstring stretch
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Hip flexor stretch

Shoulder

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

Thumb

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Thumb slide
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In and out
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Thumb roll

Wrist

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Wrist flexion and extension
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Moving the wrist side to side

Strengthening exercises

About these exercises

These exercises help maintain or increase muscle strength. Strong muscles help keep your joints stable and more comfortable.

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 Orthopaedics 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.

Calf and Ankle

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



Knee

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

Shoulder

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Shoulder shrug
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Table push ups
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Balance
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Stiff arm pull
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Flies
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Two hand catch

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Rhomboids
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Internal Rotation
Isometrics
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Internal Rotation
Tubing
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Internal Rotation
Free weight
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External Rotation
Free weight
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External Rotation
Isometrics
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Supine Press
Two hands
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Supine Press
One hand
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Supine Inclined press
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Supine Sitting press
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Figure 1 - Isometric exercise
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Figure 2 - Isotonic exercise
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Figure 3 - Pelvic tilt
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Figure 4 - Back erector


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Figure 5 - Angry cat stretch
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Figure 6 - Double knee pull
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Figure 7 - Half sit-up
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Figure 8 - Hip kicker

About these exercises

Fitness exercise is endurance exercise. This means it helps make your heart and lungs stronger and gives you more stamina. It also helps keep your joints flexible and your muscles strong. Fitness exercise also helps you get more quality sleep, control your weight and feel better overall both mentally and physically.


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.

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.

"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.