Evidence based medical wellness for active people from a doc who walks the walk

Exercise safely with Rheumatoid Arthritis!


What if you had rheumatoid arthritis, and still wanted to be fit, and not surrender to the disease? What if you are an athlete with rheumatoid arthritis and you wanted not to become a couch potato? What if someone told you what you should and shouldn’t do for exercise?

Lucky you, I will do just that!

First of all the basics: people with RA can safely do all components of fitness training, including cardio-respiratory fitness or “cardio”, strength/resistance training, and stretching or myofascial release.  (Think foam rolling.)  If you feel that your doctor is not helpful in telling you what you can or can’t do, you are probably right–most rheumatologists (55%) don’t feel comfortable in advising patients about exercise.

The Plan:

Cardio-respiratory fitness or “cardio”:

First of all, you really need weight bearing exercise such as walking to stress the bones and prevent osteoporosis.  The medications used in rheumatoid arthritis (RA) are really tough on bones, and so including a weight bearing exercise is key.

Type of exercise: walking, bicycling, rowing, dance and of course, aqua (swimming/pool zumba) etc are all great! How much/how often? Minimum 30 minutes at least 5 times per week at 50-70% of maximum heart rate.  (Gives you a great excuse to go get a snazzy watch with a heart rate monitor on it!)

Strength training:

Studies have shown that free weights, weight machines and bands, when used properly are safe for those with RA and will improve strength, function and may decrease RA flares.  How often? How much? Two – three days per week, 2-3 sets with 8-10 repetitions of each exercise. Use a weight that is is 40-80% of one rep max.  (What the heck is a one rep max? This is the heaviest weight you could lift one time. So if you the most you could lift was 20 pounds 50% would be ten pound.)

So to keep, it simple, start with lighter weights, work the large muscles (legs, back, “core”, arms, shoulders.  Don’t worry about the small muscles like hands, feet, etc.) It is important to keep on increasing the weight as you are able.

When starting out you may want a physical therapist, or a really good personal trainer to help set up a program and watch your form.

Flexibility/Range of Motion:

One of the toughest parts of RA is the flares–when the disease flares up and various joints become inflamed.  Range of motion is imperative for joints–moving joints through a full range improves function through time.  Most people only use their joints to a limited degree.   Joints should be moved DAILY through a full range of motion, 2-3 times per day.  This is safe even in an acute flare. Obviously, when a joint is inflamed, pain should guide the movement, and the joint should not be forced to move past the point where pain limits the motion.  Yoga, pilates, stretching etc all can be used to improve range of motion.


Recovering from exercise is important for everyone, and especially so in those with RA.  Drinking lots of water, using foam rollers, “myofascial release” and massage will hasten recovery.

Quick n dirty:

  • Cardio 5 times per week, minimum 30 minutes each time. Do some weight bearing  form of cardio at least one of these sessions!
  • Weight training: 2-3 times per week, 8-10 reps, 2 sets.  Focus on the big muscles, work up to heavier weights.
  • Range of motion: 2-3 times DAILY.
  • Recovery: daily! Foam roll, stretch etc.
  • Having a flare? Go easy, do range of motion, some swimming and lots of foam rolling/massage if you feel it helps. And a hot tub isgreat if the temperature is less than 100 degress! And swimming in a warm water pool is awesome!

Rheumatoid Arthritis Resources:

Benefits of exercise in RA

Exercise prescription in the management of rheumatoid arthritis

My favorite tools:

Fitbit surge “watch”–has a built in heart rate monitor and lets you track exercise, heart rate, sleep etc.

Fitness point ap on my phone: lets me make up exercise routines and track them. I tried a bunch of aps and settled on this one after trying about 6.  It has to be easy or I won’t use it!

PS: dedicated to my friend Susan who fights through pain, flares and nasty drug side effects!

PS 2: Check out this blog about living with rheumatoid arthritis by a college professor.  I like the fact that he talks about his medications, doctor visits etc.



Author: PookieMD

I am a board certified internal medicine physician. I love medicine and seek to bring evidence based medicine to the fitness and wellness world.

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