WebMD Health - Rheumatoid Arthritis

Jan 31, 2011 10:00 PM

An Exercise Plan to Help Your Body Handle Real Life With RA

When Melinda Winner was diagnosed with rheumatoid arthritis (RA), she was overwhelmed by depression.

"I laid around the house eating," says Winner, now the author of A Complete Guide to Living with Arthritis. "The more I laid, the more depressed I became, and the bigger I became, and with the weight and lack of movement came more pain."

In a little over a year, Winner gained 100 pounds, weight she kept on for the next three years. Then one day, her 3-year-old kept begging her to get down on the floor and play cars. "I knew if I got down there, getting back up was not an option," she says. "As I sat there having a huge pity party, I knew it was move or die. That very day I began to walk very slowly. Maybe it was only 50 feet that first day, but I was determined to change my life, and every day I walked a few steps farther."

As she got stronger, Winner, who couldn't afford a gym membership or YMCA pass, devised her own exercise program that involved everything from water exercises in the bathtub to home resistance training. "The more I move, the better I feel," she says.

As Winner discovered, if you have RA, exercise isn't just about looking good in a cocktail dress or taking off baby weight. It can reduce your pain and help you function better as you do all the million tasks your household requires each day. Plus, it can just plain make you feel better, which is invaluable when a chronic disease like RA is dragging you down. Exercise can also help reduce your risk of osteoporosis, which is a big issue for women with RA, especially if you're taking steroids to fight inflammation.

Keri Cawthorne is a personal trainer so when she developed RA a year ago, fitness was already an enormous part of her life. But she found that she had to modify her routine because arthritis can make some moves challenging.

Functional Fitness for RA

"I'm focused a lot on functional fitness," Cawthorne says. That means exercise that strengthens the body to do real-life work in real-life ways, rather than just lifting certain weights on the machines you use at the gym. Functional exercise uses multiple muscles at once, helping them work together in harmony. Balance is at the heart of functional fitness.

"I'm fairly fit, but I've had to go back to the basics, such as balancing on one foot and then the other," Cawthorne says. "I also have to watch my form and make sure that if I'm using a weight, my wrists are in line and I'm using the right muscle groups and not just powering through a move."

Cawthorne also does toe exercises to keep her feet limber, because they cramp up often. "I'll sit on the couch and put a towel down on the floor, and pull my toes in to scrunch the towel in and out and get the synovial [joint] fluid moving around in there," she says.

Winner has a similar trick for her hands. Each night, as she watches TV, she holds a bowl of uncooked rice on her lap and moves her fingers through the rice as if playing a piano. "This helps keep my hands, fingers, and wrists limber, as well as helping with swelling and pain," she says.

To strengthen her legs, Winner began with chair exercises. Using a pair of ankle weights she found at a yard sale, she would do leg lifts and circles several times a day. She also did these moves in the tub, with the aid of a rubber bath mat to help prevent slips. "The water made me lighter, as well as helped with the pain," she says. "I then moved on to lifting myself up repeatedly by placing my arms on wet washrags on the sides of the tub."

Ellen Shmueli was diagnosed with RA when she was 28. A certified fitness trainer who creates exercise programs for people with RA and other mobility issues, she recommends starting slowly.

"Work at your own pace, and then maybe try to get just a touch beyond what you think you can do," she says. "When I started exercising, I couldn't lift my left arm past a 45-degree angle. Once I could, I made sure I could keep doing it." Some other moves she recommends:

  • For shoulders: Bring your arms up to the front or to the side, and try to get them over your head so you can point to the sky.
  • For arms: Bend your elbow and raise your palm to your shoulder, then lower your hand.
  • For hips: Stand with a wall to your right. Place your hand on the wall for balance and lift your left foot off the floor. Move your leg up and to the front. Lower and then raise it to the side. Lower it and then raise it to the back. Then switch sides.For knees: Sit on a chair. Lift one foot off the ground and begin to straighten your leg until you can feel it in your knee. Hold it a few seconds, then relax.
  • For back: Do "cat stretches." Get on the ground on all fours. Arch and round your back like an angry cat. Then release your back, letting it sag down. If you can't get on your hands and knees, stand holding the back of a chair and round your back. Then release, bringing your chest and stomach forward .

For more of a challenge, weights can be added to many of these moves. Ask your doctor whether you should use weights.

A Family Affair

Even though she's a personal trainer, Cawthorne doesn't work at being active alone. She and her family make moving a family activity.

"We'll take our dogs out hiking, with my daughter riding her mountain bike and my husband and I walking through the woods," Cawthorne says. "You don't have to go on a big expedition. Slow things down and take time to snap pictures and relax."

Involving your family in your exercise program not only makes it more fun, but it helps partners and kids take part in staying healthy instead of feeling like they have to sit by and watch you struggle with your disease.

You can even involve your kids in your resistance training. One trick Winner recommends: sit on the bed, or on a pad on the floor if you can. Have your child or spouse sit across from you, and place the bottom of your feet flat against the bottom of his feet, sole to sole. Push against his feet as much as you can without causing pain. You can do the same thing with your hands, and also with your back -- for this one, sit back to back and hold your stomach taut while pushing against your partner.

Fitness instructor Shmueli practices balancing with her sons, now 13 and 8. "We'll see who can stand on one foot the longest," she says. "Balance is so important; when you have a strong core, it helps everything. Or I'll lie on the floor and they'll stand over me and try to push my legs down as I try to bring them back up."

Experts agree: the more you move, the better you'll feel. That doesn't mean you shouldn't take a break, though. "There are days when the pain is so severe, exercise is out of the question," Winner says. "On those days, if I'm lying in bed, I'll just move my legs, feet, arms, hands, neck, and fingers, so I don't get stiff. But the important thing is to find your personal balance between rest and exercise. Talk with your doctor or physical therapist about a program and goal you would like to reach. No matter how big or small your goal is, it is important to have one."

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