The advice has changed
When you are diagnosed with rheumatoid arthritis, the last thing on your mind is probably joining a gym and starting to exercise.
But there are some genuinely good things to be said about exercise when you have arthritis. Working the muscles around a joint helps support and protect that joint. Exercise can improve flexibility and endurance, give you more energy, and help you manage your weight — which matters a great deal when a condition makes moving harder.
This article covers what RA is, and what a sensible exercise program looks like when you have it.
What rheumatoid arthritis actually is
Rheumatoid arthritis is an autoimmune condition. For reasons we still don’t fully understand, the immune system attacks the synovium — the thin lining of the joint — as though it were a threat.
That lining becomes inflamed and thickened. The joint swells, gets warm and stiff, and hurts. Over time, if the inflammation isn’t controlled, it can erode the cartilage and the bone underneath.
That last part is why RA is taken so seriously and treated so early. It isn’t wear and tear. It’s an active process, and modern medication is very good at slowing it down.
What else we know
It’s around two to three times more common in women than men, and often begins between the ages of 30 and 60 — though it can start earlier.
RA usually starts in the smaller joints. Hands and feet are commonly affected first, generally on both sides of the body. Early symptoms can include fatigue, loss of appetite, a low-grade fever, and aching or stiff joints before any obvious swelling appears.
The frustrating part is that we still don’t know what triggers the immune system to turn on the joint in the first place.
Where treatment sits
There is no cure for rheumatoid arthritis. The goal of treatment is to reduce joint inflammation and pain, keep the joints working, and prevent damage and deformity.
Medication does the heavy lifting there, and it has improved enormously since I first wrote this article. That side of things belongs entirely with your rheumatologist — it is not a trainer’s territory and I’m not going to pretend otherwise.
What sits alongside it is how you move and how you live. That part I can help with.
Why exercise is now recommended
In the past, people with RA were advised to keep exercise to a minimum. The thinking was intuitive: the joints are inflamed, so rest them.
That has been comprehensively overturned.
A Cochrane review of dynamic exercise programs in rheumatoid arthritis found they improve aerobic capacity and muscle strength, without detrimental effects on disease activity or pain (Hurkmans et al., 2009).
The European guidelines now go further and recommend physical activity as part of standard care for people with inflammatory arthritis (EULAR recommendations).
Building a program around RA
A good program focuses on functional training — exercises that make everyday activities easier. Getting off a chair. Carrying shopping. Opening a jar. Managing stairs.
Flexibility and joint range of motion belong in there as key components, not afterthoughts.
Here’s what I keep in mind when programming for someone with RA:
- Start with low intensity and short duration in the early phase
- Choose low-impact exercise to protect the joints
- Go easy on stair climbing, contact sports, prolonged single-leg standing and stop-start movements
- Reduce load or intensity if pain or swelling appears or persists
- Avoid overstretching and pushing into hypermobility — stretches should be comfortable and pain-free
- Choose shoes and insoles with good shock absorption
- Keep the head supported where you can during exercise
- Avoid long maximal isometric holds, which push blood pressure up
- Always warm up before you start
On flare days
This is the part that isn’t in the textbook list.
When a joint is actively flaring — hot, swollen, genuinely angry — that is not the day to load it. Work around it. Train something else, keep the affected joint gently moving through its range, and come back to loading it when the flare settles.
The aim is a program that survives contact with a fluctuating condition, rather than one that only works on good weeks.
Aim for a body that handles your everyday life, not one that handles a barbell.
With RA, function is the goal and everything else is a bonus. That reframe takes the pressure off enormously.
What about diet?
There is currently no good evidence that any particular food or diet causes, cures or slows rheumatoid arthritis.
That is not to say diet doesn’t matter. A good diet has many positive effects on your health, and it becomes more important when your ability to exercise drops — it’s not unusual to gain weight simply because you’re moving less, and extra weight is not what sore joints need.
Some people find that certain foods seem to coincide with their symptoms. Those foods differ from person to person, and it’s hard to generalise. If you want to explore that, do it properly with a dietitian rather than cutting out food groups on a hunch.
Where to start
Talk to your rheumatologist or GP first, and get their view on what’s appropriate for you right now.
Once you have that, the work is unglamorous and effective: start smaller than you think you should, build slowly, keep the joints moving, and adjust around the flares instead of stopping altogether.
- Exercise
- rheumatoid arthritis
- arthritis
- personal training
