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Fitness for Fatigue

We’ve all heard it over and over (and over and over) again: it’s so important for people living with rheumatoid arthritis (RA) to exercise. Physical fitness can be extremely useful in managing many of the symptoms that come with RA, including fatigue, stiffness, and pain.

But does anyone else think this advice is easier to hear than actually follow?

And have you ever had a doctor give you this guidance but fail to offer practical suggestions for how on earth you’re really supposed to make it happen?

A recent session at the 2017 American College of Rheumatology Annual Meeting focused on this topic for an audience of healthcare professionals, exploring the real impact of fatigue on patient’s lives and offering practical suggestions to help doctors promote fitness realistically.

Daniel Clauw, director of the Chronic Pain and Fatigue Research Center at the University of Michigan, explained that fatigue is very common in patients with RA. He also pointed out that residual fatigue is still possible, even after successful treatment of other RA symptoms with a biologic medication. But even though fatigue is often as functionally limiting as joint pain, Dr. Clauw cited a study (F Wolfe, T Pincus. A&R 1999) showing that only about 10% of rheumatologists even evaluate fatigue in their care of RA patients!

What is the exact cause of fatigue in RA?

Rheumatologists may disregard fatigue more often than they should because it can be really complicated to determine exactly why it is happening in each patient. Is it caused by RA inflammation? Depression or anxiety? Sleep issues? Diet? Underlying medical conditions? A side effect from medications? Hormones? Fatigue can also be a very difficult symptom for doctors to address because the word doesn’t necessarily mean the same thing to every patient.

When it comes to treating fatigue, other than properly treating any underlying medical conditions, Dr. Clauw concluded that research shows the most effective treatment for fatigue is exercise. Based on this conclusion, David Williams, Associate Director Dr. Clauw’s research center, offered strategies for rheumatologist to help enable their patients to realistically improve their level of fitness.

Strategies for combating fatigue with exercise

Dr. Williams first encouraged the healthcare professionals in the audience to consider the myriad barriers that RA patients have in attempting to increase their level of physical activity: joint and muscle pain, lack of energy, lack of time, family or work obligations, lack of motivation, dislike of physical activities, and more. He argued that without helping the patient figure out how to address these barriers, a recommendation to exercise more could be both futile and frustrating. With this in mind, Dr. Williams emphasized the importance of doctors initiating patient-centric conversations that focus not only on the merits of exercise but also help patients engage in problem solving to address the specific barriers they face.

As for practical advice about how to get started on a better exercise routine, Dr. Williams gave the example of using a step counter (such as a pedometer or Fitbit) as a helpful starting place for patients to get feedback on their level of activity. Getting exercise “credit” for activities you already do every day can help with overall motivation. He also suggested brainstorming ways to incorporate more activity into a regular daily routine, such as parking slightly farther away or taking the stairs instead of the elevator.

For patients who are really struggling with exercise, Dr. Williams focused on the importance of “pleasant activity scheduling.” The idea behind this technique is for patients to start not by focusing on exercise but by actively scheduling activities that they truly enjoy – whether those activities are active or not. Once patients get into the habit of altering their schedule in a way that feels doable, it may make it more likely that they can find time to schedule additional physical activity in the future.

Do you struggle with exercise even though you know it can be an important management tool for life with RA? When it comes to doctors recommending exercise, what has your experience been like? Has the conversation been patient-centric, with your doctor helping you address the barriers you face? Or, if not, have you tried any of Dr. Williams’ suggestions yourself?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • 1kmn917
    2 years ago

    This is a subject near and dear to my heart as a yoga teacher and RA patient. Use it or lose it applies to all of us but those with RA may need to use it differently. Get your exercise but in a way that’s appropriate for you. Happy moving everyone!

  • Merry
    2 years ago

    I am 57. I was diagnosed at 55, after a very big flare. I had been experiencing joint pain and fatigue for years. Since I was so tired I gained weight. Every time I started an exercise program I just made me more tired. In light of my diagnosis this now makes sense.

    When my Rheum told me the cure for the fatigue was exercise I thought she was crazy. What good was exercise? It just makes me more tired….My idea of exercise had to change. Any movement is better than sitting. Walking around the block was too much;
    walk to to corner and back. I got a yoga mat and started with all the easy poses, gentle twists and bends. Then I did what a the young ones do “youTube”. I found quite a bit of easy movement, just add “for seniors” when searching. I found Tai chi for Better Balance, and a chair Zumba….

    The key for is finding how much is enough. Dealing with RA I have learned that too much of a good thing is truly too much.

  • Monica Y. Sengupta moderator
    2 years ago

    My question is “how do I exercise when I can’t exercise??” similar to “how do I get into my pill bottles that take down a flare while in flare??”.

    I am so happy you found an exercise regime that works for you, Merry! It’s definitely a fine line between what we can take and cannot.

    I personally rock-climb. It is gentle on the joints and keeps every part of my body active. However, I can easily overdo it long before I realize the signs…and end up in flare!

    Thank you so much for sharing and all the best!
    ~Monica ( Team Member)

  • LindaE
    2 years ago

    I am 68 also and diagnosis with ra less than a year ago. I have struggled with meds, brain fog and severe pain. In addition, I am gaining weight — can’t do much and loosing hair.

    This does not make for a happy mood. I am luck in that I have a very supportive husband and we have sat down and tried to figure out ways for me to get more active. I garden, do house work, etc., but that did not seem very active to me.

    I talked to my ra doc about this and he told me to start very slow, but set a goal and keep at it. Do something for 4 or 5 minutes for several days and then move it up 1 minute.

    So I started slow — doing 5 minutes on my exercise bike (the kind that the handle bars move). It has taken a couple of weeks, but I am up to 10 minutes a day 5 or 6 times a week. We also have started a great video — yoga for seniors and do 20 minutes of the 40 minute workout 5 times a week.

    I am starting to see some results — not in weight, but in mood and energy level. We do our exercise in the morning, which is usually my best time of day.

    So, my doctor was supportive and gave me a place to start, which really helped!!!

  • Monica Y. Sengupta moderator
    2 years ago

    LindaE, thank you so much for sharing your story. I am actually going to use your doctor’s advice as well. Before my symptoms presented I was extremely active. Even now, 7 years after my diagnosis I sometimes find it hard to take it slow with my exercise since I’m used to training hard!

    I definitely need the reminder to start slow and build up from there. Thank you!

    All the best, Monica ( Team Member)

  • Heartsong
    2 years ago

    My doctors seem to think that exercise means joining a class or exercise studio. I finally said that I have a choice between class or exercise studio or quality of life. If I do a “workout” or yoga class, I have no energy for anything else and it’s the “else” part of my life that gives quality to my life – friends, family, hobbies.

    I go for walks as I can. I garden in spring or summer. I window shop in the mall. I can measure these out per my energy level and take into consideration the recovery time. Furthermore, I’m getting older – 68!

    Yes, I have fatigue. Of course I have fatigue. It’s not a moral failing. It’s inflammation!

  • Lawrence 'rick' Phillips moderator
    2 years ago

    I tried a step counter (fail), I tired jogging (double fail), but what I love is riding my bicycle. I love it so much I cannot really do other forms routinely. I can walk some, but since I lean forward so much (AS), I feel I am moving forward toward the ground at the rate of a bowling pin going down, continuously.

    Which sort of makes it feel like I am constantly riding downhill, even when I am going uphill.

  • SydneyH
    2 years ago

    I have a step counter and it has been enlightened in terms of how much walking I do at work, when shopping, and arts and crafts festivals, and then how little I do at home. It has been helpful. When the step count is low, I find myself trying to do things that work in more steps.

    I love my doctors but I have found it hard to communicate with my doctors about the level of fatigue I have day to day. On work days, I don’t have much more to give since I work long hours. By the time the weekend rolls around, I’m trying to recover from the work week. It feels like a vicious cycle that is hard to break through, but exercise does help with the fatigue. I just haven’t found a good routine.

  • Richard Faust moderator
    2 years ago

    Thanks for writing Sydney. You bring up great point about the difficulty many patients have talking to their doctor about fatigue and exercise. I’m surprised the doctor leading this conference session did not recommend or discuss physical therapy. Physical therapists have the experience dealing with these issues and evaluating patients for exercises that can fit their abilities. My wife, Kelly Mack (A contributor here), has had severe RA since she was 2 years old and has used a motorized wheelchair since her late teens. A step counter, while possibly great for some, would be of little use for her. In this article Kelly writes about returning to physical therapy for a “refresher” (on the doctor’s recommendation): She could get evaluated and get recommendations to fit her abilities, schedule, and overall lifestyle. The PT even recommended a stepper that she can use from her chair (it wasn’t even terribly expensive). Sometimes doctors need to realize when other professionals may be able to offer better insight and work on a team approach to better overall care. Best, Richard ( Team)

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