Exercise & Rehabilitation

RATE

If you have RA, getting regular exercise is an important key to maintaining the strength and flexibility that will help you continue to function at your best. Because RA can cause erosion of cartilage in the joints, maintaining muscular strength is particularly important because it provides the extra support that damaged joints need to be stable. Beyond its benefits for joint health, a regular exercise program provides a range of other benefits, from improving your mood to helping you prevent other health problems, including obesity and cardiovascular disease.1

 

Benefits of exercise: evidence speaks for itself

The benefit of exercise for patients with RA has been demonstrated in a variety of well-controlled studies These studies have shown that regular exercise, including aerobic activity, strength training, and exercises to improve range of motion, provide a number of benefits. These include improvements in strength, physical functioning, and joint stability, decreases in disease activity, increases in bone mineral density, and improvements in pain control and overall quality of life.2-4 Additionally, weight training has been shown to be useful in preventing bone loss (osteoporosis) related to glucocorticoid treatment.1

 

Many exercise options

There are a broad variety of activities you can engage in as part of a regular exercise program, from yoga and Tai Chi to swimming, walking, running, and biking. Because of the way RA affects the joints, some types of exercise may be more appropriate for you than others. Ask your doctor, nurse, or physical or occupational therapist for advice and instruction about what types of exercise you should engage in. Members of your RA healthcare team, especially your physical therapist, can work with you to develop an exercise program tailored to meet your physical needs and limitations.

 

Your rehabilitation team

For patients who have experienced joint or bone damage or who are struggling with other symptoms associated with RA, rehabilitation plays an important role in the management of the disease. Your rehabilitation team may include a physical therapist (PT) and/or an occupational therapist (OT). These are health specialist who are trained to work with you to help you feel your best and function effectively at work and at home by providing education and treatment to address your symptoms and challenges and promote general health and conditioning.
Physical and occupational therapy. Physical and occupational therapists are important members of your RA care team.

Key goals of physical therapy in RA include relief of pain, reduction of inflammation, and maintenance of joint health and function. Your PT will help you learn about the physical symptoms of RA, develop and implement an exercise program to address your symptoms, and recommend assistive devices (such as mobility aids and splints) and instruct you in their proper use. The overall goal of the interventions used by your PT is to help you adapt to physical limitations and to function independently.1

Your PT has a number of tools at his or her disposal to help achieve treatment goals. These range from application of heat, cold, or ultrasound and passive and active exercises to relaxation techniques and splinting to improve function and control pain. Additionally, your PT can refer you to other specialists, such as a podiatrist who can provide custom orthotics and supportive footwear.1 Your PT can help to design an appropriate exercise program which fits your needs.

 

Physical therapy tools in RA

Technique

< div class="clmn400 ">Benefit

Heat or cold
  • Relief of pain and stiffness
Ultrasound
  • Improve joint inflammation and swelling
Passive and active exercise
  • Improve and maintain joint range of motion
Dynamic exercise
  • Improve endurance and strength
Splinting
  • Control pain and improve joint function
  • Prevent deformity
Relaxation techniques
  • Relieve muscle spasm

 

Your OT is specially trained to provide assistance in helping you overcome your physical limitations so that you can continue to function independently and maintain quality of life. While some of the interventions used in physical therapy and occupational therapy overlap, your OT is more focused on helping you with practical strategies for accomplishing everyday tasks, both at home and at work. He or she will work with you to help you come up with methods and techniques to carry out tasks including work-related activities, dressing, bathing, preparing meals, and driving. Specific occupational therapy interventions for patients with RA include education in joint protection and self care, as well as the provision and instruction in use of assistive devices.1

Occupational therapy has been shown to very useful in helping patients with RA overcome physical challenges, allowing them to continue to lead full and productive lives. Studies have found that OT interventions can provide significant benefits for RA patients whose physical challenges interfere with their ability to function on the job. These interventions have been shown to be effective in keeping individuals with RA in the workforce.5

view references
1. Schur PH, Maini RN, Gibofsky A. Nonpharmacologic and preventive therapies of rheumatoid arthritis. In: O'Dell JR, Romain PR, eds. UptoDate. Wolters Kluwer Health. Accessed at: www.uptodate.com. 2013. 2. Häkkinen A, Sokka T, Kotaniemi A, Hannonen P. A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis. Arthritis & Rheumatism 2001;44:515-22. 3. Van den Ende CH, Vliet Vlieland TP, Munneke M, Hazes JM. Dynamic exercise therapy for treating rheumatoid arthritis. Cochrane Database Syst Rev 2008:CD000322. 4. Baillet A, Zeboulon N, Gossec L, et al. Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: Meta-analysis of randomized controlled trials. Arthritis Care & Research 2010;62:984-92. 5. Macedo AM, Oakley SP, Panayi GS, Kirkham BW. Functional and work outcomes improve in patients with rheumatoid arthritis who receive targeted, comprehensive occupational therapy. Arthritis Care Res 2009;61:1522-30.further reading
Fox B, Taylor N, Yazdany J. Arthritis for Dummies. Hoboken, NJ: Wiley Publishing, Inc; 2004.
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