The Problem Of Exercise and RA
I’m sitting here writing with my stationary bicycle next to me and I’m pondering my next move. Do I force my painful, swollen knees and ankles to get on and move for the next 30 minutes or do I give myself a break today? It’s never easy to answer that one. I could ask my husband his opinion, but I already know the answer. (“Heck, NO!” He’s seen me limping this morning.) I could ask my PT, who would say, “Yes, but keep the pace lower and don’t let your pain get too high.” Or I could check in with myself and find out the best answer. The answer I’m telling myself is, No, But. No, to the bike today because I know myself and I know once I start I’ll want to push. But Yes to a walk, because a bit of movement will help my sore body to loosen up. My ankle, especially, needs it today because it will quickly lock up when swollen. Last weekend I decided I would try yoga for the first time in over a year this week. I also told myself I would get into a pool this week. Neither of these things have happened, not because I don’t want to, but because my body is telling me to hold off. Often exercise goals turn into best laid plans for me, and I admit that this is partly due to the fact that I have high expectations for myself. But I wouldn’t have it any other way because my desire to do things is the thing that gets me there, and someday I will get back to yoga. Just not today, or this week.
To exercise, or not to exercise?
There are many reasons that people with RA choose not to exercise, and the facts show, as a group, we don’t exercise enough. A cross-sectional, international study in 2008 found that only 13.8 % of people with RA exercise three or more times a week.1 People feel anxious that they could be further damaging joints, self-conscious going the gym and lifting three-pound weights next to muscle heads, tired all the time, and pain is hard enough to deal with let alone joint pain and muscle pain from exercise. Doctors lament the fact that we don’t exercise more but feel unprepared to guide people on appropriate exercises to do.
I am in the 13.8% category of people who exercise regularly and have been for most of my life. I think if I didn’t live with JRA I’d be an athlete of some kind- in my fantasies I’d either be a rock climber or surfer. I have a fierce desire to exercise because I love it so much. But I still struggle with all of what our doctors call, “barriers to exercise.” If I go to the gym I try to hide in a corner, and I have to adapt almost everything I do to accommodate the joint damage I’ve suffered. It’s often not a pretty sight and I regularly have people come up to me when I’m at the pool, or on a bike, trying to be helpful, thinking they will instruct me on how to improve my form. It’s embarrassing, and I’ve yet to find the best way to respond. I’m so glad that I love to exercise because I couldn’t imagine having to push myself to do it otherwise. Simply put, RA makes exercise a lot less fun and much, much harder. It takes a Herculean effort, even for those of us that have a strong desire to do it. And when your daily life takes up all of your energy, time on the elliptical machine can make you want to cry. But like many things RA, like it or not, if you want to do well, you need to do it. So, how do I approach exercise in a healthy way, without setting myself up for failure or more suffering? Without damaging joints or going into a flare?
Here are four things I’ve done that have helped me:
Move my body every day in some way. I live by this motto, and it works because it helps me to feel like I’m moving forward even if I have to, as my PT says, “Move one step back to take two steps forward.” This week is a one-step-back week, and if I had stuck to my rigid goals, or all-or-nothing thinking, I would have felt like a failure for not getting to yoga, the pool, or the bike and possibly would have hurt my joints. Instead, I’m taking a walk. I’m moving my body, not increasing my pain, and this helps me to feel better.
Get help from physical therapy.I’m doing PT right now for my neck and he is teaching me a lot about posture, position, and movement that is helping me to understand much more about where my limits are, and to get stronger in the right way, without stressing my already stressed joints. If you want to start exercising more and need some guidance on how not to stress your joints, or appropriate exercises to do, PT is a great place to start.
I remember, it’s a marathon, not a race. Starting slow and building is the best way to not get into a flare if you haven’t been exercising for a while-slow and steady wins the race! I remember that I don’t have to work up to vigorous exercise until I’m ready, and if I never get there, I’m still moving and getting stronger which is the point.
I know when to distract and when to tune in.It’s okay to push through pain a bit, the key is to pay attention to it when you are pushing harder than usual. When I’m walking in the neighborhood, I bring along a podcast to distract me from my pain. I know I won’t be pushing my joints too hard. When I try to hike on a trail, though, I’m tuning in. If I don’t, I can overdo it and end up hurting myself. This can help me to do better at adjusting what I do. I’ve been surprised that I can push my body, and actually feel better the next day- but this is only when I’m hiking or doing things that stress my bigger joints in my low body. If I push my small joints in my hands for example, I’m risking harm and feeling it for awhile. My hands are too damaged to do anything vigorous at this point, which is why rock-climbing remains a fantasy.
Exercising with RA is not as simple as signing up for the gym, but with the right attitude, and guidance, it’s possible to be an RA exerciser. Is there anything you do to help yourself get off the couch and on the bike? How do you approach exercise?
- Sokka T, Hakkinen A, Kautiainen H, et al. Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Rheum. 2008;59(1):42–50. doi: 10.1002/art.23255.