Arthritis and exercise

Arthritis is a general term that refers to many different conditions that affect the muscles, bones and joints. The accurate term for this group of conditions is 'musculoskeletal conditions,' as they affect the muscles, bones and joints.

Your musculoskeletal system

To understand how arthritis and other musculoskeletal conditions work, it’s helpful to know a little about the muscles, bones and joints that make up your musculoskeletal system.

A joint is a structure that allows movement at the meeting point of 2 bones. Cartilage is a firm cushion that covers the ends of the 2 bones, absorbing shock and enabling the bones to glide smoothly over each other. The joint is wrapped inside a tough capsule filled with synovial fluid. This fluid lubricates the cartilage and other structures in the joint and keeps them moving smoothly.

Ligaments hold the joint together by joining one bone to another. Your muscles are attached to the bones by tendons. As your muscles contract, they pull on the bones to make the joint move.

Arthritis and other musculoskeletal conditions affect the normal functioning of the joints, muscles, bones and surrounding structures. The way this happens will depend on the condition you have.

Arthritis can cause pain, stiffness and often inflammation in one or more joints or muscles. Regular exercise can reduce some of the symptoms of arthritis, and improve your joint mobility and strength.

The benefits of exercise for arthritis

Regular exercise has many health benefits for people with arthritis. Exercise can:

• aid joint lubrication and nourishment
• ease your joint pain and stiffness
• improve flexibility
• build muscular strength
• improve your balance
• help you sleep better
• improve posture
• improve or maintain the density of your bones
• improve overall health and fitness
• lower stress levels
• improve your mood
• help you maintain a healthy body weight.

Types of exercise for arthritis

There are many different forms of exercise to choose from. The type that is best for you will depend on your personal preference, the severity of your symptoms and whether or not you have other musculoskeletal conditions or health issues.

If you aren’t sure which exercises are suitable for you, be guided by your doctor or other health professional, such as a physiotherapist or exercise physiologist.

Aim to do some form of exercise every day. The exercises you choose should ideally help with:

• flexibility – stretching and range of movement exercises help maintain or improve the flexibility of your joints and nearby muscles. They will help keep your joints moving properly and ease joint stiffness
• strength – to build muscle strength, provide stability to your joints and improve your ability to perform daily tasks
• overall fitness – exercise that gets you moving and increases your heart rate (such as walking, swimming and cycling) will help improve the health of your heart and lungs (cardiovascular system) and can also help with endurance, weight loss and prevention of other health problems (such as diabetes). This type of exercise is also called aerobic exercise, cardiovascular exercise or 'cardio'.

Many types of exercise can help with flexibility, strength and overall fitness at the same time, including:

• swimming or water exercise classes
• tai chi
• walking or Nordic walking (walking with Nordic poles)
• chair exercises
• low-impact aerobics
• strength training
• dancing.

The exercise you choose should be something you enjoy and you’re committed to doing. Consider exercising with friends, or in a group or a team environment if you find it difficult to get motivated.

Sometimes it can be difficult to exercise due to pain. An inflamed, hot or painful joint needs rest, but too little exercise can cause muscle weakness, pain and stiffness. It’s important to find the right balance of rest and exercise.

If you’re not sure what the right balance is for you, talk with your doctor, physiotherapist or exercise physiologist for some advice.

Arthritis and water exercise

Warm water exercise is particularly helpful if you have arthritis or another musculoskeletal condition, because your body is supported and the resistance provided by moving through water builds muscle strength and endurance.

Water exercise involves exercising in a pool, usually heated, and may also be called 'hydrotherapy'. There are several ways you can exercise in water. The most suitable type of water exercise for you depends on a number of factors such as:

• the type of arthritis you have
• how your arthritis affects you
• your fitness level
• your confidence in the water
• your personal preferences and interests.

The types of water exercise available include:

• Hydrotherapy – a type of exercise therapy offered by physiotherapists as one-on-one sessions for individuals, or in small groups. Exercises are specific to your condition, injury or situation.
• Gentle water exercise classes – some fitness or recreation centres offer gentle water exercise programs suitable for older adults or people with health. conditions such as arthritis. All participants follow the same general exercises in a fun, group environment.
• Swimming laps at your local pool can also help.

Starting a water exercise program

Venues that may run warm water exercise classes include:

• recreation centres
• fitness centres
• public swimming pools
• retirement villages.

Things you can do before you choose a class include:

• Talk with your doctor, physiotherapist or exercise physiologist about the class and whether it’s right for you.
• Contact the various fitness and recreation centres in your local area to find out what sort of warm water classes are on offer. Ask them about the qualifications of the person running the classes.
• Check out the venue to see if it’s suitable for you. For example, is the pool easy to access? Are the change rooms accessible and comfortable? Is the venue close enough for you to go to regularly?
• Before choosing a class, make sure it’s appropriate to your level of fitness and ability.
• If you like, watch a class or two from the sidelines before joining.

Another option is to use the pool facilities and a water exercise program that has been designed for you by a physiotherapist or exercise physiologist and exercise on your own. You could do this instead of, or as well as, joining a class.

There are many different options available so that you can exercise in water and get the associated health benefits.

Pool safety

Once at the pool, safety suggestions include:

• warm up – a good way to do this is to swim gently or go for a walk through the water. Be guided by your instructor or by the exercise program that has been designed for you
• if you feel light-headed, sick or dizzy at any stage, get out of the water
• take care when moving in wet areas around the pool, including in change rooms, to avoid slipping and falls
• perform each movement as gracefully and smoothly as you can
• keep the body part you are exercising under the water, this may require you to squat or bob down at times.

Arthritis and tai chi

There is good evidence to support the effectiveness of tai chi for people with arthritis and other musculoskeletal conditions. There are many styles of tai chi and most are suitable for people with arthritis.

The benefits of tai chi include:

• it can be practised by people of all ages and fitness levels
• it promotes correct body posture and balance
• it’s a low impact exercise
• it can help relieve joint pain and stiffness
• it integrates the body and mind
• it uses gentle and circular movements
• it’s relaxing and enjoyable.

You can learn tai chi from books and DVDs, but most people find it easier to learn from a qualified instructor. Books and DVDs are useful to help you practice between classes.

Before starting a tai chi class:

• Talk with your doctor about whether tai chi is suitable for you.
• Make sure your instructor is qualified, and takes special care of people with arthritis. Musculoskeletal Australia can help you find suitable instructors.

General exercise cautions and suggestions

Your doctor or exercise professional can give you exercise advice that is specific to you and your particular condition and situation.

Here are some general suggestions on exercising safely:

• See your doctor before starting any new exercise program. If you have had a joint replaced, find out from your surgeon or health professional which movements you should limit or avoid.
• Pre-exercise screening is used to identify people with medical conditions that may put them at a higher risk of experiencing a health problem during physical activity. It‘s a filter or ‘safety net’ to help decide if the potential benefits of exercise outweigh the risks for you. Print a copy of the adult pre-exercise screening tool from AUSactive, and discuss it with your doctor or exercise professional.
• Don’t exercise a painful, inflamed or hot joint. Instead, gently move the joint through its range of movement to help reduce stiffness and improve circulation.
• Start gently and increase the intensity of your exercise program gradually over weeks or months.
• Warm up thoroughly beforehand. Cool down after exercise with gentle, sustained movements.
• Pay attention to good technique and try to move smoothly. Don’t force a joint beyond a comfortable range of movement.
• Don’t try to do too much too soon. If you feel out of breath, slow down.
• If your joint feels particularly painful afterwards (for longer than two hours after an exercise session), reduce the intensity of your next exercise session.
• If an activity causes you pain or increases your pain beyond what is normal, then stop this activity.
• Drink plenty of fluids during and after exercising.
• Wear appropriate clothing and footwear when exercising.
• Increase incidental activity in your life. For example, walk to nearby shops instead of driving.

Where to get help

• Your GP (doctor)
• Physiotherapist
• Exercise physiologist
• Community health centre
• Local fitness or aquatic centre
• Musculoskeletal Australia