Arthritis Answers: Easing Back into Exercise

Posted on 05 March 2010

Yeah, yeah, yeah, we all know that we’re supposed to exercise…but when you have arthritis, exercise is essential, not only to protect your joints but also to prevent muscle atrophy. Still, if you have arthritis and you haven’t exercised in awhile (e.g. there was a “19” in the date), there is an art to getting back in shape…

If you are occasionally irritated by my aerobics teacher tone, here is my confession: I hate to work out. In fact, not only do I hate to work out, I will—at any given excuse—duck out of exercise the way a sinner skips Sunday school.

“I’m too busy,” is my excuse of choice and it’s true—this holiday season was more hectic than usual. At any rate, New Year’s Day came with all of its requisite guilt and I realized that I had not really exercised in nearly two months. Full of resolve, I pulled out one of my exercise tapes and some of my hand weights and set to work. Realizing that I was probably not up to my usual level, I did only half of the tape and used my lightest weights. True, I sort of glossed over the cool-down, but I got through the workout easily. In fact, I even felt a little cocky, knowing that I could have completed the entire workout, if I had wanted.

At 3 AM, I awoke in pain. At first, I thought that I had been slammed with a five-alarm flare—which was true—but it was more than that. It was my muscles. Gingerly, I made my way downstairs, taking a full minute and a half to reach the bottom. I increased the dreaded Prednisone, I iced, I heated, I rested…and still, I could barely even lift my arms, much less function like a human being.

The only thing that hurt more than my muscles (and, of course, my joints) was my pride. I couldn’t believe that such a baby workout could crip me out for three days. Then I remembered about muscle atrophy, another one of those fun components of rheumatoid arthritis. When you have RA, you must exercise, not only to keep your joints limber, keep your weight down, keep the circulation going, but also to keep your muscles from literally wasting away. True, by a certain age (which I passed, a while back) everyone has to exercise to avoid muscle atrophy. But when you have RA, the process is accelerated. It’s as if you have to exercise—not to get ahead, but just to keep up with your own body.

Realistically speaking, however, there will probably be periods of time in which you don’t or can’t exercise. If you’re getting over a flare, maybe you’re even a little gun-shy. So how do you get back into the exercise groove? Very carefully, of course…

Easing Back into Exercise
See your doctor.

Overkill? Maybe. But if it’s been awhile, it can’t hurt to get checked out by your rheumatologist. Not only can he/she check on your general well-being (blood pressure, heart, lungs, etc), he/she can best determined your level of severity and make appropriate suggestions for getting back into shape.

If you RA is extremely active, if you haven’t exercised in years or if your general health is poor, you may be referred to a physical therapist. Don’t be embarrassed! There is no shame in having a problem, only in doing nothing about it. A physical therapist is specially trained to work your weakest muscles and joints. It’s hard and even painful, but a good physical therapist can work wonders for even the wheelchair bound and can certainly help you develop a realistic exercise plan.

Underestimate your exercise level.

Let’s say that—miracles of miracles—you wake up feeling almost normal on a coincidentally gorgeous day. You blow the dust off of your walking shoes, step out into the sunshine and tell yourself, “I feel like I could walk a mile!”

Terrific! Walk half a mile.

Chances are that on a good day, you probably could walk that mile without any major problems. But your body still benefits from that half a mile and you can always build up to a mile or two or even 5. Building up, however, is the key. If you’re feeling truly impatient, look at it this way: how many miles are you going to be walking if you are knocked back with a flare? In this case, the tortoise truly does win the race.

Choose your exercise carefully.

Speaking of walking, I would like to take this opportunity to state that, contrary to what the “experts” claim, walking is not for everyone. Some of us have severe deformities in the metatarsals, which leaves very little cushioning…even with good shoes and orthotics. This is just one example of comparing your exercise needs with your arthritic limitations. For someone whose feet are severely afflicted, swimming or rollerblading would be a better option.

Another example might be someone whose neck is affected. While walking might not present a problem, many yoga poses would be out of the question and might even be dangerous. This is why it is important to discuss your exercise options with your doctor before starting. Not only can he/she offer suggestions he/she can also discuss which exercises should not be attempted.

Study beforehand

Again, this probably sounds like overkill, but if you’ve been out of the game for awhile, it can’t hurt to watch others before attempting a workout yourself, especially if you are planning on taking a class. While aerobics/aquatics/yoga/tai chi/pilates teachers may be very knowledgeable in their field, chances are that they don’t know squat about arthritis. Ask an instructor if you can watch an actual class before signing up. Watch carefully and take notes about possible problems. Afterwards, approach the instructor and ask if certain poses, steps, etc can be modified (and they almost always can); you may even decide that this particular class is not for you. Most instructors will be happy to work with you. If not, that is a red flag that you may not be dealing with a professional. Avoid any instructor who seems unsure of him/herself, is unable/unwilling to answer your questions or who seems threatened by the idea of adapting any part of the routine.

This is also an excellent way to “review” an exercise tape. Most exercise videos can be rented from the local video store; if not, the more reputable exercise programs offer a money-back guarantee. Either way, try to watch the tape more than once before attempting to follow the routine. The terrific thing about workout videos is that you can stop them. If there is a part you don’t understand or a move that you feel you should modify (and even Tae Bo can be modified!), stop the tape and write a note to yourself. Later, after you have warmed up, you might want to try out the adapted form before you start the actual workout.

Plan your exercise time and keep it sacred.

Morning stiffness makes exercise nearly impossible for some of us; evening fatigue for others. Pay attention to your body and decide when the best time is for you. If you are a procrastinator or if you really, really hate exercise, you might even consider “scheduling” exercise time on your calendar. Writing anything down as an appointment somehow makes it seem more important…

Exercise Time!
You must warm up before any type of exercise…

That includes yoga, tai chi, pilates, swimming or any other kind of “soft” exercise. Some of you are probably saying, “You mean, I gotta stretch before I stretch?”—which is a common misconception. Warming up is not stretching; it is the light exercise you do to warm you muscles before you even stretch. A few minutes on the treadmill (or around the block), marching in place, or easy dancing are all excellent ways to warm up. Five minutes is fine for non-arthies, but I feel that arthritic folk should probably aim for ten. Since our muscles are stiffer, they are more prone to injury.

Still not convinced? Okay, well here’s what the experts at AskMen.comhave to say:

“The theory behind warm-ups is that muscular contractions are dependant on temperature. Because increased muscle temperature improves work capacity and a warm-up increases muscle temperature, it is assumed that one is necessary.

“The amount of knee fluid also increases with a warm-up, oxygen intake improves, and the amount of oxygen needed for exercise is reduced. This is why performance improves after warming-up. Nerve messages also travel faster at high temperatures. Your reflexes will be faster and so will your muscular reactions, therefore you will reduce the potential risk of injuries.”

And, as an infamous lover of the hard way, let me share what happened to me—pre-arthritis—when I didn’t warm up properly. I was late for ballet class, and instead of warming up properly, I jumped in with the rest of the class who were in the middle of the barre (a series of advanced leg stretches performed on a chest-high bar). Since the teacher didn’t notice me sneak in, I thought I was pretty slick; in fact, I was winking at one of my classmates when something popped in my left hamstring, sending me and my smartass grin to the floor. That was 7 years ago, and I still have problems with that hamstring. Please…it’s only ten minutes. Take the time to warm up.

then stretch.

Even so, it’s not enough to just warm up your muscles. They must also be stretched to avoid injury. Any reputable class or video will have both a warm up and a stretch incorporated into their routine; if you are on your own, and are unsure about what to stretch and how, Carol Dickman offers 21 different stretches on her website Stretch.com.

Don’t go for the burn.

The “burn” is for Jane Fonda and millions of other non-arthies; we have built-in burns that don’t need to get worse. If you are following an instructor, stay well below his/her pace; there will be time enough to catch up as you build up your strength. In fact, for the first few times, stay well below the level that feels challenging. This may seem frustrating, but it will help you prevent flares and muscle blowouts, which will ultimately help you attain the level that is best for you.

Cooling down.

Okay…everybody makes mistakes. Perhaps kickboxing wasn’t such a great idea. If the exercise you chose truly hurts you, by all means, stop—gradually. During any aerobic activity, blood is sent to the extremities and, of course, the heart rate is increased. If you stop suddenly without cooling down, it puts extra stress on the heart, causes the blood to pool in your legs and can lead to muscle stiffness and tenderness…and who needs that?

Cooling down is much like warming up except that you are gradually slowing rather than quickening your pace. Walking in place or on the treadmill, taking a couple of slow laps in the pool, or even just lifting your knees to waist level until your heart rate normalizes are all ways of cooling down. By finishing up with a five-minute stretch, you further decrease your chances of next-day muscle aches.

Afterwards…
Hit the water.

Warm water seems to have restorative powers for arthritic folk. Five minutes in a Jacuzzi is heaven, but even a hot shower or bath is a nice way to finish up a workout and prevent stiffness. Make it a bubble bath and you’ve rewarded yourself for a job well done!

Schedule lightly.

The first few days of a new workout—or an increase in level—is not the time to finish all those chores that you’ve put off for a week. Keep the errands and housework to a minimum. Order out. Give your kids the car keys or teach them the fine art of walking. Until you know how your body is going to react, allow yourself time to recover.

Re-evaluate.

Remember: the next morning is Judgement Day.

Ease out of bed slowly and assess your level of stiffness and pain. Some increased stiffness and soreness should be expected, but if you are truly in pain then you need to re-assess your workout. Could you reduce the intensity or adapt some of the movements? Would it be possible to perform the same exercise at a slower pace or at half the duration? Chances are good that by adjusting the tempo or time, you will be able to continue your workout. If, however, you don’t feel that an adjustment is possible, then it’s time to look for a different way of exercising.

Fortunately or unfortunately, exercise is not an option for folks with RA. We must exercise regularly to protect our bodies from further degeneration. If care is taken, if we are ready and prepared to adapt, there are many types of exercise that are still open to us. And, whether or not you truly like exercise, when you work out, it feels as if you have broken a barrier…and isn’t feeling less limited, even by a small degree, worth all of the sweat and soreness?

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