June 2014

Physical activity. The Arthritis Pain Reliever

Centers for Disease Control and Prevention

Long gone are the days when health care providers told people with arthritis to “rest their joints.” In fact, physical activity can reduce pain and improve function, mobility, mood, and quality of life for most adults with many types of arthritis including osteoarthritis, rheumatoid arthritis, fibromyalgia, and lupus. Physical activity can also help people with arthritis manage other chronic conditions such as diabetes, heart disease, and obesity. Most people with arthritis can safely participate in a self-directed physical activity program or join one of many programs available in communities across the country.

What are the benefits of physical activity for adults with arthritis?

Regular physical activity is just as important for people with arthritis or other rheumatic conditions as it is for all children and adults. Scientific studies have shown that participation in moderate-intensity, low-impact physical activity improves pain, function, mood, and quality of life without worsening symptoms or disease severity. Being physically active can also delay the onset of disability if you have arthritis. But people with arthritis may have a difficult time being physically active because of symptoms (e.g., pain, stiffness), their lack of confidence in knowing how much and what to do, and unclear expectations of when they will see benefits. Both aerobic and muscle strengthening activities are proven to work well, and both are recommended for people with arthritis.

Physical Activity Guidelines for Americans

Adults with arthritis should follow either the Active Adult or Active Older Adult Guidelines, whichever meets your personal health goals and matches your abilities. People with arthritis should also include daily flexibility exercises to maintain proper joint range of motion and do balance exercises if they are at risk of falling.

If you are younger than age 65, have normal function and no limitations in your usual activities, and do not have any other severe chronic conditions such as diabetes, heart disease, or cancer you should follow the Active Adult recommendations.

Active Adults
Recommended Amount of Activity

For Important Health Benefits

Aerobic activity per week =

  • 2 ½ hours of moderate intensity OR
  • 75 minutes of vigorous intensity OR
  • an equivalent combination* of both moderate and vigorous intensity activity; activity should be at least 10-minute episodes and preferably spread throughout the week.

AND

muscle strengthening activities at least 2 days per week

For Even Greater Benefits

Aerobic activity per week =

  • 5 hours of moderate intensity OR
  • 2 ½ hours of vigorous intensity OR
  • an equivalent combination* of both moderate and vigorous intensity activity; activity should be at least 10-minute episodes and preferably spread throughout the week.

AND

muscle strengthening activities at least 2 days per week.

* A general rule is that 1 minute of vigorous intensity activity = 2 minutes of moderate intensity activity.

If you are older than age 65, have poor function and are limited in some of your usual activities, or you have other chronic conditions besides arthritis you should follow the Active Older Adult recommendations.

Active Older Adults
Recommended Amount of Activity

For Important Health Benefits

Aerobic activity per week =

  • 2 ½ hours of moderate intensity OR
  • 75 minutes of vigorous intensity OR
  • an equivalent combination* of both moderate and vigorous intensity activity; activity should be at least 10-minute episodes and preferably spread throughout the week.

AND

muscle strengthening activities at least 2 days per week

Include activities that promote balance at least 3 days per week.

For Even Greater Benefits

Aerobic activity per week =

  • 5 hours of moderate intensity OR
  • 2 ½ hours (of vigorous intensity OR
  • an equivalent combination* of both moderate and vigorous intensity activity.

AND

muscle strengthening activities at least 2 days per week.

Include activities that promote balance at least 3 days per week.

* A general rule is that 1 minute of vigorous intensity activity = 2 minutes of moderate intensity activity.

What types of activities count?

Aerobic activities. Aerobic activity is also called "cardio," endurance, or conditioning exercise. It is any activity that makes your heart beat faster and makes you breathe a little harder than when you are sitting, standing or lying. You want to do activity that is moderate or vigorous intensity and that does not twist or "pound" your joints too much. Some people with arthritis can do vigorous activities such as running and can even tolerate some activities that are harder on the joints like basketball or tennis. You should choose the activities that are right for you and that are enjoyable. Remember, each person is different, but there are a wide variety of activities that you can do to meet the Guidelines.

Examples of Moderate and Vigorous Intensity Aerobic Activities

Moderate Intensity

Vigorous Intensity

  • Brisk Walking.
  • Bicycling.
  • Swimming.
  • Mowing the grass, heavy yard work.
  • Doubles tennis.
  • Social dancing.
  • Conditioning Machines (e.g., stair climbers, elliptical, stationary bike).
  • Tai Chi, yoga.
  • Sports (e.g., softball, baseball, volleyball).
  • Skiing, roller and ice skating.
  • Jogging/running.
  • Singles tennis.
  • Swimming.
  • Jumping rope.
  • Conditioning Machines (e.g., stair climbers, elliptical, stationary bike).
  • Sports (e.g., soccer, basketball, football, racquetball).
  • Aerobic dance or spinning classes.

Muscle strengthening activities. You should do activities that strengthen your muscles at least 2 days per week in addition to your aerobic activities. Muscle strengthening activities are especially important for people with arthritis because having strong muscles takes some of the pressure off the joints.

You can do muscle strengthening exercises in your home, at a gym, or at a community center. You should do exercises that work all the major muscle groups of the body (e.g., legs, hips, back, abdomen, chest, shoulders, and arms). You should do at least 1 set of 8–12 repetitions for each muscle group. There are many ways you can do muscle strengthening activities:

  • Lifting weights using machines, dumbbells, or weight cuffs.
  • Working with resistance bands.
  • Using your own bodyweight as resistance (e.g., push-ups, sit ups).
  • Heavy gardening (e.g., digging, shoveling).
  • Some group exercise classes.

Balance activities. Many older adults and some adults with arthritis and other chronic diseases may be prone to falling. If you are worried about falling or are at risk of falling, you should include activities that improve balance at least 3 days per week as part of your activity plan. Balance activities can be part of your aerobic or your muscle strengthening activities. Examples of activities that improve balance include the following

  • Tai Chi.
  • Backward walking, side stepping, heel and toe walking.
  • Standing on 1 foot.
  • Some group exercise classes.

Additional Recommendations for People with Arthritis

Flexibility exercises. In addition to the activities recommended above, flexibility exercises are also important. Many people with arthritis have joint stiffness that makes daily tasks such as bathing and fixing meals difficult. Doing daily flexibility exercises for all upper (e.g., neck, shoulder, elbow, wrist, and finger) and lower (e.g., low back, hip, knee, ankle, and toes) joints of the body helps maintain essential range of motion.

How much physical activity do adults with arthritis need?

If you have arthritis, you should follow either the Active Adult or Active Older Adult recommendations, whichever meets your personal health goals and matches your abilities. You should do this activity in addition to your usual daily activity. You may notice that the recommended amount and type of activity are the same for the Active Adult and Active Older Adult except for the additional recommendation to include activities that promote balance.

Balance is important. Have you fallen in the past? Do you have trouble walking? If so, you may be at high risk of falling. Activities that improve or maintain balance should be included in your physical activity plan. Examples of activities that have been proven to help balance include walking backwards, standing on one leg, and Tai Chi. Some exercise classes offered in many local communities include exercises that are good for balance.

Avoid inactivity. Any physical activity is better than none. If you cannot do 150 minutes of moderate intensity activity every week, it is important to be as active as your health allows. People with arthritis often have symptoms that come and go. This may mean that one week you can do 150 minutes of moderate intensity activity and the next week you can’t. You may have to change your activity level depending on your arthritis symptoms, but try to stay as active as your symptoms allow.

Adjust the level of effort. Some activities take more effort for older adults and those with low fitness or poor function. For example, walking at a brisk pace for a 23-year-old healthy male is moderate intensity, but the same activity may be vigorous activity for a 77-year-old male with diabetes. You should adjust the level of effort during activity so that it is comfortable for you.

How hard are you working? Moderate intensity activity makes your heart beat a little faster and you breathe a little harder. You can talk easily while doing moderate intensity activity, but you may not be able to sing comfortably.

Vigorous intensity activity makes your heart beat much faster and you may not be able to talk comfortably without stopping to catch your breath.

Relative intensity can be estimated using a scale of 0 to 10 where sitting is 0 and 10 is the highest level of effort possible. Moderate intensity activity is a 5 or 6 and vigorous intensity activity is a 7 or 8. The talk test is a simple way to measure relative intensity. In general, if you're doing moderate-intensity activity you can talk, but not sing, during the activity. If you are doing vigorous-intensity activity, you will not be able to say more than a few words without pausing for a breath.


This image shows a continuum (from 0-10) to help figure out how to measure your level of effort for physical activity. On this continuum level 0 is sitting, levels 1 through 4 are labeled light intensity, level 5 and 6 are labeled moderate activity, level 7 and 8 are labeled vigorous activity, level 10 is labeled as hard as it can be.

Get advice. If you have arthritis or another chronic health condition, you should already be under the care of a doctor or other health care provider. Health care providers and certified exercise professionals can answer your questions about how much and what types of activity are right for you.

Tips for starting and maintaining a physical activity program if you have arthritis.

Safe, enjoyable physical activity is possible for most every adult with arthritis. The most important thing to remember is to find out what works best for you. At first glance, 150 minutes of activity per week sounds like a lot, but if you pay attention to the following tips you will be well on your way to getting the recommended amount of activity in no time!

Studies show that some increase in pain, stiffness, and swelling is normal when starting an activity program. If you have increased swelling or pain that does not get better with rest then talk to your health care provider. It may take 6–8 weeks for your joints to accommodate to your increased activity level, but sticking with your activity program will result in long-term pain relief.

Here is an easy way to remember these tips: Make S.M.A.R.T choices!

Start low, and go slow

Many adults with arthritis are inactive, even though their doctor may have told them being active will help their arthritis. You may want to be more active but just don’t know where to start or how much to do. You may be worried that using your joints and muscles may make your arthritis worse. The good news is that the opposite is true, physical activity will help your arthritis! The first key to starting activity safely is to start low. This may mean you can only walk 5 minutes at a time every other day. The second key is to go slow. People with arthritis may take more time for their body to adjust to a new level of activity. For example, healthy children can usually increase the amount of activity a little each week, while older adults and those with chronic conditions may take 3–4 weeks to adjust to a new activity level. You should add activity in small amounts, at least 10 minutes at a time, and allow enough time for your body to adjust to the new level before adding more activity.

Modify activity as needed.

Remember, any activity is better than none. Your arthritis symptoms, such as pain, stiffness and fatigue, may come and go and you may have good days and bad days. You may want to stop activity completely when your arthritis symptoms increase. It is important that you first try to modify your activity to stay as active as possible without making your symptoms worse. Here are some ways you can do this:

  • Decrease the number of days per week you do activity — walk on 2 days instead of 4 days.
  • Decrease the time you are active each day — walk 15 minutes each day instead of 30 minutes.
  • Change the type of activity — instead of walking, ride a bicycle or take a water exercise class.

When your symptoms have returned to normal, slowly increase your activity back to your starting level.

Activities should be "joint friendly."

People with arthritis can do many types of moderate or vigorous intensity activities, some people with arthritis can even run marathons! If you are unsure of what types of activity are best for you, a general rule is to do activities that are easy on the joints like walking, bicycling, water aerobics, or dancing. These activities have a low risk of injury and do not twist or "pound" the joints too much. It is also important to pick a variety of activities that you enjoy, this will help keep you from getting bored and make it easier to stick with your activity plan.

Recognize safe places and ways to be active.

Safety is important for starting and maintaining your activity plan. If you are currently inactive or do not have confidence in planning your own physical activity, a class designed just for people with arthritis may be a good option for you. Some people with arthritis feel safer by starting an activity program in a class with a trained instructor and get support from and gain confidence by participating with the other people with arthritis.

If you currently do some activity or feel confident that you can safely plan your own activity program, you should look for safe places to be physically active. For example, if you walk in your neighborhood or a local park make sure the sidewalks or pathways are level and free of obstructions, are well-lighted, and are separated from heavy traffic.

Talk to a health professional.

You should already be under the care of a health care professional for your arthritis, who is a good source of information about physical activity. Health care professionals and certified exercise professionals can answer your questions about how much and what types of activity match your abilities and health goals.

What should I do if I have pain when I exercise?

Some soreness or aching in joints and surrounding muscles during and after exercise is normal for people with arthritis. This is especially true in the first 4 to 6 weeks of starting an exercise program. However, most people with arthritis find if they stick with exercise they will have significant long-term pain relief. Here are some tips to help you manage pain during and after exercise:

  • Modify your exercise program by reducing the frequency (days per week) or duration (amount of time each session) until pain improves.
  • Changing the type of exercise to reduce impact on the joints – for example switch from walking to water aerobics.
  • Do proper warm-up and cool-down before and after exercise.
  • Exercise at a comfortable pace – you should be able to carry on a conversation while exercising.
  • Make sure you have good fitting, comfortable shoes.

Signs you should see your health care provider:

  • Pain is sharp, stabbing, and constant.
  • Pain that causes you to limp.
  • Pain that lasts more than 2 hours after exercise or gets worse at night.
  • Pain is not relieved by rest, medication, or hot/cold packs.
  • Large increases in swelling or your joints feel “hot” or are red.