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Getting to know what you don’t know about exercise and rheumatoid arthritis

The Bottom Line

  • Rheumatoid arthritis is a chronic inflammatory disease that impacts almost 20 million people around the world.  
  • Medication and exercise are key components of a treatment and management plan for rheumatoid arthritis. However, when it comes to exercise, the lack of awareness or information received on this option, fears around further damaging joints, and limitations posed by symptoms of the disease can deter people from engaging in it. 
  • Aerobic exercises and/or strength training may improve some symptoms and outcomes in people with rheumatoid arthritis.  
  • Patients and caregivers should discuss all drug and non-drug treatment options with their health care team. Personal needs, preferences, and limitations should be considered when selecting the most beneficial and safest exercises to follow.  

Fear and lack of information can hinder you from making important and potentially beneficial health-related decisions, both for yourself and/or the people you care for. But as the saying goes, “Knowledge is power.” Therefore, seeking out information to help you stay up to date on the condition that you or a loved one is working to manage, as well as the diverse treatment options available, can help to quell worries, encourage reflection on needs and preferences, and assist with making informed decisions. Take, for example, the case with rheumatoid arthritis.


Rheumatoid arthritis is a disease marked by chronic inflammation (1;2). It causes fatigue and joint pain, stiffness, and swelling; and generally worsens over time (1;3-6). Eventually, rheumatoid arthritis can lead to joints becoming deformed and damaged (3;5-6). Together, these symptoms and complications reduce physical function, increase the risk for disability, impact a person’s ability to act independently, and lower quality of life (1;3-7). Be it disease progression or function, a variety of drug and non-drug treatments that aim to alleviate, slow, or prevent symptoms and complications and improve certain aspects of health and well-being do exist (1;3;8-9). One of which is exercise (1;3).


Unfortunately, the role and significance of exercise within a rheumatoid arthritis treatment plan does not appear to be clear to patients and their caregivers (3). When we loop back to our earlier discussion of barriers, it becomes more clear why. The almost 20 million individuals with rheumatoid arthritis worldwide—including over 370 thousand Canadians—and their caregivers are no strangers to experiencing barriers like fear and lack of information (3;10-12). Here, fear relates to the fear of causing further joint damage, and lack of information is linked to not knowing enough about exercise as a treatment option (3;11-12). Combine these with symptoms and complications associated with the disease, and we have an environment that can make it easy to justify not engaging in exercise.


With the help of a recent systematic review, gaps in knowledge about different exercise options and their effects may be addressed for people with rheumatoid arthritis and their caregivers. (3). This evidence may go on to help patients, and their caregivers, come to a decision about if and how to incorporate exercise into the treatment plan.


What the research tells us

The review looked at adults with rheumatoid arthritis engaging in aerobic exercise, strength training, aerobic exercise plus strength training, aquatic exercise, or hand exercise. These folks were compared to those completing other types of exercise, mobility exercise, usual care, or on a waitlist (meaning study participants were on a list waiting to engage in exercise but not yet doing so). Evidence ranging in quality from very low to moderate suggests that exercise may help to improve some symptoms and outcomes related to rheumatoid arthritis. Let’s breakdown the results of the three exercise types that yielded benefits.


First up, we have aerobic exercise, which includes: cycling, walking on a treadmill, rowing, tai chi, and more. Overall, this form of exercise showed the potential to improve one outcome by a large amount, and that’s aerobic capacity. Aerobic capacity is an indicator of how well our body uses oxygen when we are exercising at full-intensity. It can speak to our fitness level and risk for a variety of diseases, including heart disease. Second in line, we have strength training. This type of exercise demonstrated that it may improve three symptoms and outcomes, namely pain and erythrocyte sedimentation rate by moderate amounts, and 50-foot walking time by a small amount. For those unfamiliar, erythrocyte sedimentation rate is an indicator of inflammation. Last up, we have combined aerobic exercise and strength training, which appeared to provide small improvements in fatigue and physical function.


Although more research that enhances the quality of the evidence and provides specific prescriptions around the frequency, intensity, and duration of exercise is needed, currently, exercise seems to hold some promise for people with rheumatoid arthritis (3). Patients, in collaboration with their caregivers and health care professionals, should consider needs (e.g., symptoms of concern), preferences (e.g., exercises they find enjoyable and comfortable), and safety (e.g., physical limitations, disease status, etc.) when deciding on the most appropriate exercise type(s) to incorporate into a treatment plan.

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References

  1. Mudano AS, Tugwell P, Wells GA, et al. Tai Chi for rheumatoid arthritis. Cochrane Database Syst Rev. 2019; 9:CD004849. doi: 10.1002/14651858.CD004849.pub2. 
  2. Lee DM, Weinblatt ME. Rheumatoid arthritis. Lancet. 2001; 358(9285):903-911.
  3. Hu H, Xu A, Gao C, et al. The effect of physical exercise on rheumatoid arthritis: An overview of systematic reviews and meta-analysis. J Adv Nurs. 2021; 77:506-522.
  4. Englbrecht M, Kruckow M, Araujo E, et al. The interaction of physical function and emotional well-being in rheumatoid arthritis-What is the impact on disease activity and coping? Semin Arthritis Rheum. 2013; 42(5):482-491.
  5. Odegard S, Finset A, Kvien TK, et al. Work disability in rheumatoid arthritis is predicted by physical and psychological health status: A 7-year study from the Oslo RA register. Scand J Rheumatol. 2005; 34(6):441-447.
  6. Yelin E. Work disability in rheumatic diseases. Curr Opin Rheumatol. 2007;19(2):91-96. 
  7. Cross M, Smith E, Hoy D, et al. The global burden of rheumatoid arthritis: Estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014; 73(7):1316-1322.
  8. Vliet Vlieland TP, van den Ende CH. Nonpharmacological treatment of rheumatoid arthritis. Curr Opin Rheumatol. 2011; 23(3):259-264.
  9. Azeez M, Clancy C, O'Dwyer T, et al. Benefits of exercise in patients with rheumatoid arthritis: A randomized controlled trial of a patient-specific exercise programme. Clin Rheumatol. 2020; 39(6):1783-1792.
  10. Government of Canada. Rheumatoid arthritis in Canada. [Internet] 2020. [cited July 2021]. Available at https://www.canada.ca/en/public-health/services/publications/diseases-conditions/rheumatoid-arthritis.html
  11. Veldhuijzen van Zanten JJCS, Rouse PC, Hale ED, et al. Perceived barriers, facilitators and benefits for regular physical activity and exercise in patients with rheumatoid arthritis: A review of the literature. Sports Med. 2015; 45(10):1401-1412. 
  12. Larkin L, Kennedy N, Fraser A, et al. “It might hurt, but still it’s good”: People with rheumatoid arthritis beliefs and expectations about physical activity interventions. J. Health Psychol. 2017; 22(13):1678-1690.

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of these blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations such as social distancing and frequent hand washing. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with current social distancing recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.

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