For a number of years now I have given a presentation on how physiotherapy can help me self manage rheumatoid arthritis to University of British Columbia physiotherapy students. Each year I appreciate being able to speak candidly about how physiotherapy has been a crucial part of my self management with RA. I create blog posts out of these presentations so others can learn from my presentation, patients or clinicians!
Physical Activity and Rheumatoid Arthritis: How Physiotherapy Has Helped Me Move
A decade with rheumatoid arthritis has taught me something surprising: when people ask what helps most, I don’t start by talking about medications. Yes, the drugs have gotten better over the years, and they help tame this aggressive disease. But that’s not the whole story.
The real game-changer? Exercise or Physical Activity. Research shows that regular movement actually makes our medications work better. This matters a lot to someone like me who’s cycled through more than a dozen different drugs for RA alone, not counting the medications for everything else that often comes along with RA.
Living with RA means dealing with unwanted guests – in my case, that’s osteoarthritis, fibromyalgia, anxiety, depression, ADHD, premenstrual dysphoric disorder (PMDD), and high blood pressure. Each one makes exercise harder, yet each improves with the right movement. The tricky part is knowing when to push and when to rest. Physiotherapists have been invaluable in helping me navigate this balance.
Further reading: 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis
Finding the right help Is Critical for self managing rheumatoid arthritis
Since 2018, I’ve served on Arthritis Research Canada’s patient advisory board, participating in studies that have transformed how I manage my rheumatoid arthritis and connected me to clinicians who really understood arthritis. Finding the right guidance hasn’t always been easy though, and I am privileged to live so close to Arthritis Research Canada and The Mary Pack Arthritis Clinic. Not everyone is so lucky to have this type of care and information within 20 minutes of where they live.
I’ve worked with various personal trainers and physiotherapists, but many lacked the specific knowledge needed for someone with severe seropositive RA. They couldn’t offer tailored advice for exercising through fatigue or managing inflammatory arthritis’s unique challenges. Looking back, I can see their hesitation when discussing my condition – a clear sign they needed more specialized training.
What’s made the real difference? Working with physiotherapists and kinesiologists who specifically study arthritis. Their deep understanding of RA has been invaluable and taught me more about my condition, not just how to navigate it. My advice to other patients is ask your rheumatologist to recommend physiotherapists who specialize in inflammatory arthritis. In my experience, they’re just as crucial to your care as your rheumatologist.
At one point I was seeing a pain specialist who was doing myofascial release and lidocaine injections in my back. I got minimal relief from these and actually dropped seeing the pain specialist when I met my new physiotherapist who I found more helpful for my pain. One of the treatments he does that has significantly helped me is Dry Needling. He also has a deeper understanding of rheumatic diseases as he works in a hospital and has advanced training through the Mary Pack Arthritis Program. Another reason I chose to go to him instead is because he is significantly closer to my home, less than a five minute walk, where the pain specialist took me 40 minutes to get to. When you live with fairly severe chronic fatigue, how far your treatments are from you really does matter. He was also the first and only clinician of mine to ever address how brain fog affects me.
Important Questions I’ve Asked My Physiotherapists
I have been going to physiotherapists for about 9 years now into my diagnosis, these would be some of the most important questions I have asked my physiotherapists or topics they have addressed to me.
- What are the best exercises to do to improve my posture?
- What exercises can help me reduce pain?
- What should I look for in footwear to help with avoiding pain?
- Is it safe to exercise in a flare? How can I exercise in a flare without causing pain and irritating my joints?
- What pain should I be looking out for and what pain should I expect?
- How can you help me memorize my exercises with cognitive dysfunction?
- How do I exercise with fatigue?
- What exercises should I avoid?
- How can I protect my joints with exercise?
- What time of day is the best time to exercise?
- What counts as physical activity?
- What are some signs I am over doing it with my physical activity?
My Personal Barriers to Physical Activity
Exercising and being physically active with rheumatoid arthritis (RA) presents unique challenges. Physical barriers include fatigue, pain, medication timing, surgeries, infections, depression, anxiety, mobility issues, hand pain and strength, cognitive dysfunction, and “painsomnia” (pain-related insomnia). Additionally, time constraints, balancing activities (especially as a single mother who recently went back to work after years of being on disability from RA), safe exercise practices, suitable equipment, weather, environment, costs, and location also pose challenges.
For me, depression and fatigue are my biggest barriers. Both are common in those with inflammatory arthritis. Fatigue saps my energy, making everyday tasks like showering, dishes, laundry, and meal prep physically and emotionally draining. It feels like a heavy weight. Depression further reduces the joy in simple activities, turning them into massive chores. It impacts my confidence and motivation to exercise. The combination of the two is even more difficult to navigate than chronic pain.
Further reading:
What Happens When I Exercise vs What Happens When I Don’t Exercise
How I feel when I am physically active compared to how I feel when I am not physically active is definitely something to keep me motivated to stay physically active. This is what I experience and my concerns:
| When I Am Not Physically Active | When I Am Physically Active |
|---|---|
| -Increase in stiffness and pain -Handle less in a day -Balance and posture worsen -Require more naps in the day and an increase in fatigue -Fragmented sleep with an early bedtime -Putting myself at risk for serious comorbidities -Decline in my mental health -Weight gain – especially depending on what medications I am on like prednisone |
-Improvement with sleep -Increased stamina and ability to do more in a day -Balance improves -Pain Reduction – Reduces inflammation and joint stiffness -Corrects Posture -Mental Health and Cognitive Health improve -Reduces comorbidity risks – Especially cardiovascular disease, the leading cause of death of people with RA -Assists in maintaining a healthy weight and takes a load off the joints -Medications work more effectively -Prevents sarcopenia – Muscle loss and strength that is common in people with RA |
Finding My Stride Through Trial and Error: Mistakes I Made Exercising With Rheumatoid Arthritis
Living with rheumatoid arthritis means accepting that consistency isn’t always possible because of how bumpy this chronic disease is. More often than I like, my disease forces me to start over. What matters is getting back up, not dwelling on setbacks I often experience. Life with chronic disease throws inevitable hurdles my way – surgeries, infusions and medication disruptions, infections, injuries, trauma, mental health, even my menstrual cycle can throw me off immensely. I feel like I am constantly having to pick myself back up.
Mistakes I Made
Finding the wrong influence – Trying to exercise like someone without rheumatoid arthritis and taking advice from people who don’t know much of anything about rheumatoid arthritis and would suggest me high impact exercises best suited for a body builder. Navigating unsolicited bad advice with chronic disease is another chapter of the difficulties we have to go through.
The elliptical became my safe space. I’d push through 30-60 minute sessions, following them with peaceful sauna time. It helped – I lost weight and built some strength. But the weight room? That was my personal house of horrors. I couldn’t bring myself to step inside. Instead, I turned to YouTube fitness videos, which turned out to be a mixed blessing. These perky influencers had no idea what it meant to exercise with inflamed wrists or unstable ankles. They were selling dreams to healthy people, not solutions for someone with RA. My confidence hit rock bottom during a supposedly “all-abilities” exercise class. On a gray, exhausting day, I struggled through 45 minutes without breaks while older participants breezed through the routine. When the instructor called me out for falling behind, I wanted to disappear. Public exercise became my new fear. Looking back, my biggest mistake wasn’t just avoiding strength training – it was trying to exercise like someone without chronic illness. I pushed too hard on the elliptical, ignored my body’s signals, and chased some idealized version of fitness I’d seen on social media. I had no real routine, no concrete goals, just a desperate desire to feel “normal.” It took me years to realize that my path to fitness needed to be as unique as my condition.
What Helps Me Be Physically Active With Rheumatoid Arthritis
| Advice | Equipment I Use or Own |
|---|---|
| –Do a little bit each day until I gain more strength – Important to track this progress. I use a fitbit and OPERAS – an app designed to monitor physical activity and symptoms of RA by Dr. Linda Li. -When starting a new medication it is important to give my medications time to start working. If my medications are not working I go slow and light. -Focus on healthy eating along with my workouts with a goal to avoid sugar and junk food that slows me down -Allow myself to rest -Found credible resources and education for exercising with arthritis -Exercise for how I am doing that day. -Having visuals to turn to. I suggest video for those new to exercise and pictures for those who are more familiar with exercise – this helps so much with brain fog. -Having my workout routine neatly organized without distractions (in the order I am do do them, it’s overwhelming going back and forth between a huge list). -Social support – research, support groups |
-Treadmill with handrails (own) -Elliptical (gym) -Step -Loop resistance bands -Resistance bands with handles and a door anchor -2 lbs, 5lbs, 8 lbs, 10 lbs, 15lbs dumb bells – Having multiple weights for good days, bad days and in between days or different joints with varying strength and ability -10 lbs and 15lbs kettlebells -20 lbs plate -2 lbs Cuff weights -Nordic Walking Poles by Urban Poles -Yoga mat –Supportive footwear and comfortable clothing to exercise in. When it comes to footwear I have had the most luck with shoes that are available in wide width and half size up. Sweat makes clothing stick, which can be uncomfortable with arthritic joints, so I wear looser clothing or light fabrics. For sports bras, one’s that are a light fabric or front opening are beneficial. |
Mixing up activities helps too – hiking, swimming, or biking outdoors, especially during warmer months. Timing is everything. I’ve learned to weave movement into my day rather than forcing myself into rigid workout schedules. Sometimes that means breaking exercise into smaller chunks on high-fatigue days, or counting household tasks like mowing the lawn as my workout. Morning exercises work best for me – by evening, I turn into what I call an “arthritic pumpkin,” particularly in winter.
Knowing when not to exercise is just as crucial as knowing when to move. I always follow my healthcare providers’ instructions after procedures or treatments. Being immunocompromised means I often need longer recovery periods than suggested. After my recent surgery, even though I was cleared at 12 weeks, my body needed more time. The warning signs of overdoing it are clear: burning joint pain with jelly-like swelling, excessive fatigue, and brain fog that can hit anywhere from 2 to 48 hours later.
If I need more than a few hours to recover from a workout, that’s my body telling me I’ve pushed too hard. Starting (or restarting) isn’t easy. On bad days, even a shower can be exhausting. That first week back to exercise is particularly challenging – the fatigue hits hard, but it usually improves as my body adapts. I’ve learned to use prolonged fatigue (more than 3 days) as a warning sign of potential issues – whether it’s an infection, approaching menstrual cycle, or medications wearing off. If it persists beyond three weeks, it’s time to check in with my rheumatologist.
What physical activity is to me today
After all the trial and error, consulting with healthcare professionals, participating in exercise research studies, talking with other patients, and learning to listen to my body I have learned to be confident and comfortable with exercise. Here are some tips that have really helped me exercise easier with RA:
Exercise and Physical Activity – The key differences
Warm up is important
I make a point to stretch before I exercise, this can help alleviate stiffness that makes moving difficult if I don’t warm up properly.
Doing a 10 minute warm up on my treadmill before strength training to loosen the muscles which makes strength training easier and less painful. I’ve learned this is important to activate our muscles to prevent more pain.
A warm up is also a great way to tell how I am feeling that day. On the days where I really struggle with my warm up I can tell I need to focus on rest and I’ll go slow, only doing one set of the exercises I feel comfortable with. I do make a point to try and keep moving on the bad days but very gently. On bad days I’ll do range of motion and stretching at home, or go to the pool and move around in the water.
Exercise for how I feel that day
If my warm up was easy and I feel like I want more, I know this is a good day and will do my best to accomplish my exercise routine that day.
I make a point to plan my exercise when medication is most effective. I currently take my biologic in the evening before bed but I do take an anti-inflammatory with my breakfast before I exercise. I also take my daily supplements with my breakfast. I do find this helps with reducing pain and fatigue.I have had trouble with vitamin deficiencies before, iron, copper and vitamin D in particular which make exercise difficult. Vitamins and supplements need to be talked about with healthcare professionals before taking them though. For guidance on what supplements are best for me and safe to take I consult with my rheumatologist, pharmacist and registered dietitian. Everyone is different.
Which muscles to focus on first
I start with the core or shoulders when strength training. Something Kinesilogist and professor at UBC Dr. Jasmin Ma taught me was that it is important when living with RA to engage the smaller muscles first to better support joints for when activating the larger muscles as it works like a wake up call for them. This also provides more stability when performing exercise.
Intensity
Some tips that really helped me understand and prevent pain that comes with exercise.
A little discomfort is ok. Muscle pain is fine, joint pain is not. I actually crave that muscle soreness that exercise creates. Watching how I feel after 2 hours, 12 hours, 24 hours and up to 48 hours can tell me when I have done too much. If I experience discomfort in my joints or more than usual muscle soreness, I know to reduce my intensity.
The Exercises I Am Comfortable Doing and Find Relief From
On a good day I will aim for 3 sets of 10-15 reps of each exercise.
Not so good days – Extremely fatigued or inflamed days – Sometimes I will just focus on rest and range of motion exercises, maybe some light strength training 1 set of as many as I can do and feel comfortable doing, a walk around my neighborhood or a swim and sauna session.
| Core | Push | Pull | Hinge | Squat |
|---|---|---|---|---|
| Bird Dog Plank Dead Bug Flutter Kicks Russian Twists Superman |
Chest Press Shoulder Press Arnold Press Side Raises Front raises |
Seated Row Lat Pulldown Reverse Fly |
Romanian Deadlift Glute Bridge Kettlebell Swings |
Reverse Lunge Curtsy Lunge Goblet Squats Side Lunge Squat |
Conclusion/Recommendations
As physiotherapists it is important for you to understand all the symptoms of rheumatoid arthritis and how to help us navigate them. Think outside of pain, how can you help us move easier with brain fog, fatigue, fibromyalgia, osteoarthritis, anxiety and depression.
RA is one of the most common forms of inflammatory arthritis and With arthritis being incredibly common in Canada and the world, with over 100 forms and the main cause of disability I highly recommend you continue your education and training in this field. There is always work and you can help a wide range of the population.
