Friday, April 2, 2010

To Exercise Or Not To Exercise

I've been trying to figure out desperately whether or not I should be exercising and how much and what exactly I should/should not be doing. I have RA in multiple joints and am on Enbrel/Methotrexate but have pain/aches many days. However, from what I can tell, other than maybe my little left toes, I don't seem to have inflammation anymore.

Back when I was first diagnosed in January, my rheumatologist said exercise was OK as long as it didn't hurt. Using that definition, exercise is pretty much out right now for the most part (and I have to admit, other than that brief question/answer, I haven't discussed it with her since then).

But there's a lot of controversy on the subject.

Many sites on the internet that I can find recommend gentle stretching exercises or yoga. This WebMD link mentions that when regular exercise are painful for joints, you can try isometric exercises. But for someone like me, who has many joints that are painful most of the time, that means cardio exercise that actually gets your heart rate up is pretty hard to achieve. And that's exactly the sort of workout I need right now. I've been having trouble sleeping, and from past experience I know that cardio workouts will help with that and also help me feel better mentally.

Swimming is also recommended for those with RA, but that means getting to a pool and, for me, time is of the essence. When you're as tired as I am already, the thought of getting up at some ungodly hour to drive to a pool is not appealing, to say the least. Not when the gym I belong to is right across the street and offers readily accessible exercise options...

On a recent Rheumatoid Arthritis Warrior post on exercise, DadwithRA commented that he thought that the arthritis community in North America takes a more conservative viewpoint toward exercise than they do in the Netherlands.

I've been doing research trying to track down some scientific data to try to explain the difference in tack taken re exercise between the two communities. Here's a link that outlines a study undertaken by a doctor at Leiden University in the Netherlands that I found very interesting.

And here's another more detailed study.

I've been trying to find more links, but, most of the Dutch ones are, well obviously, in Dutch! If I find more in English, I'll add them to this post.

It seems to me odd that there should be two such differing viewpoints. Then again, maybe not. Half the time (and that's just a turn of phrase, not a scientific measure!) doctors can't even decide if someone has RA. So why should it surprise me that they can't agree on whether or not exercise is good or not for someone who has RA? And "active" RA is another thing, and how you define that "active" RA is yet another...So you see the problems that arise.

All I know is, I feel like crap from the RA anyway. Now I'm really feeling like crap mentally, too, and the lack of sleep from that is wearing on me. So, as much as I'm really a lazybones and am not that into exercise and never have been, I love the way it makes me feel, I love feeling fit and strong, and I'm going to do my damnedest to get to the gym and workout as much as I can (without straining my sad, unworked, sorry-ass muscles!) over the next two weeks while I'm off work.

I'll report back and let you know how it goes and how I feel! Consider it my own personal little RA study!


  1. At the end of the first study you linked to, there was a recommendation that patients should work with a physical therapist in order to make sure they're doing the best, safest level of exercise they can for their particular circumstances. This seems like very sound advice to me.

    I was a little surprised that they called fears of exercise-induced joint damage, etc. "baseless." Of course, they were working with a group of people with "moderate" disease, a term that is subject to great debate.

    I believe that exercise can be wonderful for rheama, but one has to be pragmatic about it. I don't know about you, but when my joints are flaring, exercising them is so exceedingly painful that it feels, literally, like torture. I've been advised by my PT that while vigorous exercise is good for me overall, and good for my rheuma overall, it's NOT good to force painful, inflamed joints to move. Even if doing so does no extra damage (and I have to question this, since rheuma actually loosens joints and makes them unstable), it hurts like a ... well, you know. And that's NOT good for mental health at all.

    In the end, I think you just have to listen to your own body, Laurie. Exercise the joints you CAN exercise without causing yourself even more pain, and be gentle with the ones that are flared. Consult a PT. I think that's your best route. And in the meantime, those isometrics can be very beneficial over time, even if they don't give you the workout you're longing for right now.

    I hope your rheuma will give you a break from pain and allow you to get some good, uninterrupted sleep soon. Sending warmth and comfort and hugs your way, and thinking of you ...


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  3. Hey Wren,

    Thanks for taking the time to repost your comment after the Blogger meltdown!

    I just came back from the gym and all went well. Of course, today my joints feel good, except my left foot, and the workout (20 minutes of cardio, then strength + stretching) was a good one. We'll see how other workouts go over the next couple of weeks.

    Exercising properly is of the utmost importance, and I've always believed that. That's why when I started strength training (well before RA hit), I hired a personal trainer (not an option for everyone, though, I realize).

    Consulting a physiotherapist is undoubtedly a good idea and something I will do once I can coordinate a session with one and my personal trainer. Luckily, my personal trainer – as I've mentioned in a previous post – is incredibly well educated, and I've worked with her for some years and, as a result, I know quite good form. There is definitely a right way to do things – you can so hurt yourself if you do something the wrong way, and with RA, I can only imagine that risk is increased.

    I don't, however, in any of this, claim to be an expert, and I am all for consulting experts!

    That said, I'm going with the Dutch RAPIT idea of exercise for now to see what happens. I will consult with my expert rheumatologist when I see her next month and get her thoughts on the RAPIT program, among other things. I will also keep you and everyone else up on how things are going in my mini-me study!

    Take care and keep well and give Finny a big pat for me!

    :) L

  4. Sounds like a good plan. I read the RAPIT study you referred to; it looks excellent. You GO, girl, and consider Finny well-patted. :o)

  5. I think exercise is a must. For me it feels like I am loosening up the joints (in a good way) and making them more liquid. Don't know if that makes sense but it is how it feels. I find the elliptical is a great cardio work out as long as you don't set the tension too high. I also ride a bike year round inside and out. Weight training helps support the weak joints. After 23 years dealing with RA I can honestly say that working out has made a tremendous difference in my mental outlook. Not sure what I would do without it.
    Some days are a chore and often I have to adjust my workouts depending on pain level but I try to do something most days. And yes the pool is a good alternative when joints are really squaking. Kind of boring and not my favorite but it is something.
    All of that being said, work at your own pace and take cues from your joints. Good luck.

  6. Good to hear it Laurie. Its not easy, but I believe it is definitely a benefits to us. I love working out and am just getting back on a consistent routine after the later part of last year into this year. You're right, a good workout makes your whole body feel good. I can't do what I once could, but I still do what I'm comfortable with. I have tried to find exercises for RA patients and have not had much success. So, I walk every day, do weights 3 times a week and either a bicycle or elliptical 3 times a week. I'll be watching for your update on exercise.

  7. Any day that I feel up to it, I try to work out. I feel it gives me strength and balance for the days I can't and need to have a strong body to pull me up. Some days I have to modify a lot.