Did you know that one in five people in Canada live with arthritis – a collection of more than 100 chronic conditions that involve inflammation (swelling, redness and stiffness) in the joints and other parts of the body? While arthritis most often impacts weight-bearing joints like those in the hips, knees and spine, it also affects non-weight-bearing ones like the joints in the fingers. Regardless of what parts of the body arthritis affects, it often leads to chronic pain, limited mobility and fatigue – all barriers to getting active.
So, we interviewed Dr. Manuel Ester, PhD, an exercise specialist and post-doctoral associate at the University of Calgary’s McCaig Institute for Bone and Joint Health whose team does applied research to better support physical activity for people with inflammatory arthritis, a category of arthritis where the joint damage is caused by inflammation instead of cartilage breakdown as with osteoarthritis. We talked about the link between physical activity and the condition, the benefits of physical activity for people who have inflammatory arthritis, the most common barriers to physical activity experienced by those with it, tips for getting active while living with inflammatory arthritis and where to find support.
Can regular physical activity help prevent a future inflammatory arthritis diagnosis?
“Physical activity may reduce the risk of inflammatory arthritis, but we’re not sure if it can completely prevent it,” said Dr. Ester.
“One study, for example, that followed more than 30,000 women over seven years showed that the most physically active group, which was made up of women who walked or biked daily for more than 20 minutes and did over one hour of weekly structured exercise, had a 35% lower risk of developing rheumatoid arthritis (a type of inflammatory arthritis) than the least active group, which was made up of women who walked or biked for less than 20 minutes a day and did under one hour of structured exercise a week. However, this study was observational, so other factors may have played a role, and while it shows some link, it doesn’t tell us that physical activity directly prevents rheumatoid arthritis – just that it reduces the risk. There are currently no strong studies where people were followed up with many years after they exercised in a well-controlled environment to find out whether they developed rheumatoid arthritis.”
Is physical activity safe for people with inflammatory arthritis?
“Many people with inflammatory arthritis fear that physical activity could make their condition worse, but research actually shows that physical activity is safe for people with it. Reviews of 26 randomized controlled trials (RCTs) – studies that compare the effects of different interventions by randomly assigning study participants to different groups – on people with inflammatory arthritis and 13 RCTs on people with rheumatoid arthritis found no negative impacts from physical activity. And in a review of 63 RCTs on people with rheumatoid arthritis, spondylarthritis and osteoarthritis, small and temporary symptoms (specifically muscle soreness – a normal reaction to exercise) were only reported in seven (11%) of the RCTs.”
What are the benefits of physical activity for those living with inflammatory arthritis?
“Overall, there are lots of short- and long-term benefits,” said Dr. Ester.
“For instance, research shows that physical activity helps people with rheumatoid arthritis manage the fatigue and pain symptoms. It also reduces their cardiovascular disease risk, anxiety and stress (which are all typically higher in people with inflammatory arthritis), and lowers hospitalization risk and care needs. Studies have also shown decreased inflammation and disease activity when those living with inflammatory arthritis engage in physical activity.”
What types of physical activity are best for people who have inflammatory arthritis?
“There’s no best form of physical activity for people with inflammatory arthritis,” said Dr. Ester.
“The best physical activity is the one you’ll actually do. However, if you have more swelling or damage in affected joints, you can try low-impact activities like swimming in a pool, cycling on a stationary bike or leisurely walking, for instance.”
What barriers and challenges do those with inflammatory arthritis experience when it comes to staying active?
“Sticking to physical activity habits in the best circumstances is challenging, so adding a chronic condition like inflammatory arthritis to the equation makes it so much harder. My research team and I recently asked 15 individuals who have rheumatoid arthritis to list the challenges they face when it comes to staying active and rank them from most to least impactful. We learned that their top three challenges were unpredictable symptom fluctuations, chronic fatigue and lack of rheumatoid arthritis-specific physical activity knowledge. The top three factors that helped them get active were motivation to maintain their function, gaining knowledge about how to adapt physical activity to their rheumatoid arthritis-related challenges and increased confidence after experiencing the benefits of physical activity.”
What tips do you have for getting active when you have inflammatory arthritis?
1. “Ask your doctor if physical activity is right for you and seek help from a qualified exercise professional. This is especially important if you were recently diagnosed with inflammatory arthritis or haven’t been active for the last few months or years.
2. Make sure you’re adequately hydrated and fueled before and after engaging in physical activity.
3. Keep it fun by doing activities that fill your cup and bring you joy, whether that’s walking with a friend or following along with an online yoga video. The more you enjoy an activity, the more likely you’ll stick with it.
4. Do a mix of different types of physical activity, such as aerobic exercise, strength-training, and balance– and flexibility-promoting exercises.
5. Start small, progress slowly and avoid overdoing it.
6. Listen to your body to note how it responds to getting active. If you experience severe fatigue or soreness for several days after doing a certain activity, it could be a sign that it’s not the right fit for you or that you did too much of it. Next time, adjust and scale back the intensity or duration, or try a different activity.
7. Give yourself grace and slow it down when you have severe fatigue, flare-ups or other symptoms. Sometimes it’s best to rest and take it easy until they fade.
8. Plan and have solutions ready in case you have a flare-up, feel fatigued or experience pain. For example, if you’re too fatigued to go for a 30-minute walk, try a 10-minute gentle stretching session instead. Or if you have a flare-up, do an activity that doesn’t involve using the impacted joints or parts of your body.
9. Set simple goals and track your habits. They could be as simple as doing some daily outdoor movement.
10. Celebrate your small wins and progress. It can be encouraging to see how many days you got active and the variety of activities you did.”
Where can people living with arthritis find support for getting active?
“On top of talking to your doctor, who may refer you to a qualified exercise professional or physiotherapist, you can find support for getting active through many programs and resources, including:
- JustOneMove.ca, a website that empowers people with inflammatory arthritis to get active and live life to the fullest. It was created by people who have a solid understanding of the condition, including physical activity experts, researchers (including my team and I), rheumatologists, physiotherapists and people with inflammatory arthritis. JustOneMove.ca has tons of useful resources, including an arthritis toolkit with tips and FAQ responses from experts, a movement vault with safe, arthritis-friendly activities that you can filter by type, body area, joints used, time, equipment and more to help you find exactly what you’re looking for, a community space where people with inflammatory arthritis share inspiring stories about their successes and challenges with physical activity, and more!”
- GLA:D Canada education and exercise programs for people with osteoarthritis in their knees and hips;
What was the inspiration behind creating JustOneMove.ca?
“My team and I searched for existing information about physical activity and inflammatory arthritis and talked to patients and healthcare providers to find out the biggest challenges that people with the condition face. Most of what we found was generic and not very practical. For example, much of it doesn’t give great tips for building physical activity habits and making them stick. We created JustOneMove.ca with the goal of making physical activity as simple and actionable as possible for people with inflammatory arthritis.”
To sum up, we learned from Dr. Ester that although people with inflammatory arthritis face added barriers to getting active, research shows that physical activity is safe and beneficial for them, reducing inflammation and helping them manage their symptoms.
