What is Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of undetermined etiology involving primarily the synovial membranes and articular structures of multiple joints. The disease is often progressive and results in pain, stiffness, and swelling of joints. In late stages deformity and ankylosis develop.
Effects on the exercise response
Persons with joint involvement tend to be less active (cardiovascular and musculoskeletal) than those who are unaffected.
Pain stiffness, bio mechanical inefficiency, and gait abnormalities can increase the metabolic cost of physical activity by as much as 50%.
Joint range of motion may be restricted by stiffness, swelling, pain, bony changes, fibrosis and ankylosis.
Inability to perform rapid, repetitive movements affects exercise performance in terms of walking speed and bicycle revolutions per minute.
Site and severity of joint involvement determine exercise mode for aerobic and strength tests.
Deconditioned and poorly supported joints are at high risk for injury from high-impact or poorly controlled movement.
Pain lasting longer than 2 hours after exercise indicates the activity was too strenuous.
Any pain beyond temporary muscle soreness should be respected and reported.
Fatigue is a side affect of RA. Clients with extreme fatigue at the beginning of the exercise session should not exercise that day.
Pain tends to be worse in the morning. Plan the timing of the client’s exercises accordingly.
Recommendations for exercise program
Select low-impact activities
Avoid stair climbing, jogging and running in persons in whom the hip or knee is involved with the arthritic condition.
Condition muscles prior to more vigorous activity.
Include flexibility and joint range of motion as key exercise components.
Avoid over stretching and hypermobility.
Reduce load on joint (exercise in pool, use the bike or row machine).
Select shoes or insoles for maximum shock absorption for maximum shock absorption during weight bearing activities.
Use low intensity and duration during initial phase of programming.
Arthritis Exercise Programming
MODESGOALSINTENSITY/FREQUENCY/ DURATIONTIME TO GOAL
Large muscle activities (e.g., walking, cycling, rowing, swimming, water aerobics, dance)Increase VO2max, peak work and endurance.• 60-80% peak HR or 40-60%
• RPE 11-163-5days/week
• 5 minutes/session building to 30 minutes/session
• Emphasize progression of duration over intensity4-6 months
Circuit training with free weights, weight machines, isometric exercises, or elastic bands
Increase maximal voluntary contraction (MVC), peak torque, or power• Use pain tolerance to set %MVC
• 2-3 repetitions initially, build to 10-12
• 2-3 days/week
Stretching• Increase/maintain pain free range of motion
• Decrease stiffness1-2 sessions/day
Neuromuscluar Any appropriateImprove gait, balance
Activity specific exercises
• Increase/maintain daily living activities
• Return to work
• Improve quality of life