Rheumatic diseases can lead to significant levels of pain, discomfort, and fatigue. As a result, patients may be wary of physical activity and avoid it for fear of causing their symptoms to flare up. Is that actually beneficial, though?
In recent years, there have been studies published that focus on the effects of exercise on rheumatic diseases, both in terms of how physical activity can affect patients and which activities are most beneficial for specific diseases. What do we know about the impact of exercise on rheumatic diseases and its outcomes, and what can you tell your patients looking to improve their symptom burden?
Rheumatic Diseases and Weight
A 2022 study in RMD Open examined the role of both exercise and weight on the outcomes of patients with rheumatic and musculoskeletal diseases, and found that weight did play a role for certain rheumatic conditions.¹ The researchers found that higher weight in rheumatoid arthritis (RA) often correlated with worse pain and disease activity, as well as likelihood for additional comorbidities.
The researchers also found similar results in patients with axial spondyloarthritis (axSpA), with higher weight correlating with more pain, fatigue, and disease activity. Those with psoriatic arthritis (PsA) experienced worse pain and function with higher weight, while weight loss was associated with improved function and reduced disease activity.
Exercise by Rheumatic Disease
While some patients may be concerned that physical activity could exacerbate symptoms, research suggests that inactivity and weight gain are more likely to increase rheumatic disease activity. With this in mind, what have researchers found about the way physical activity affects specific rheumatic conditions?
Rheumatoid Arthritis and Exercise
Exercise is often recommended for patients with rheumatoid arthritis due to its tendency to hasten muscle mass loss.² The RMD Open study found inconsistent results with specific exercise types, with potential improved outcomes from a combination of aerobic and muscle training.¹ The investigators did, however, note that home exercise correlated with reduced pain and function.
Low impact exercises are better for patients with RA-based damage to joints, older patients, and those experiencing significant pain. This can include walking, yoga, swimming, and cycling.³
Axial Spondyloarthritis and Exercise
While aerobic/muscle strengthening exercises showed small improvements in RA, patients with axSpA consistently saw larger improvements in function and reduced disease activity.¹ Participating in only muscle strengthening also showed medium positive effects in reducing pain, and there were similarly positive results for both home-based and group-based exercise.
There is evidence to suggest that high impact exercise regimens can help patients with axial spondyloarthritis. A 2019 study in the British Journal of Sports Medicine, in breaking up 100 participants into a high intensity exercise group and a standard activity control group over 3 months, found that the group that performed high intensity cardiorespiratory and muscular strengthening exercises saw greater improvements in pain, fatigue, stiffness, and inflammation.⁴
Osteoarthritis and Exercise
Both aerobic exercise and aquatic exercise showed mild effects on pain, function, and health-related quality of life in patients with osteoarthritis.¹ In addition, low intensity exercise like walking and stretching to improve range of motion can be helpful, as can muscle strengthening exercises that protect the joints.⁵
Psoriatic Arthritis and Exercise
Physical activity can be very beneficial to patients with psoriatic arthritis. A 2021 review published in Clinical Rheumatology examined a number of studies on the link between exercise and PsA disease activity, and found that exercise benefitted patients in terms of pain, fatigue, and quality of life.⁶ Muscle strength also improved while cardiovascular comorbidities were reduced.
For patients with these rheumatic diseases and others, the specific regimen they are looking for will ultimately depend on the severity of the symptoms they are experiencing and the ways their condition has affected their muscles and joints over time. Whatever the routine ends up being, health care professionals should let patients know that physical activity will not increase their disease activity, and is instead much more likely to alleviate their symptoms.
- Gwinnutt JM, Wieczorek M, Cavalli G, Balanescu A, Bischoff-Ferrari HA, Boonen A, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm T, Walker-Bone K, Welling J, Zlatković-Švenda MI, Guillemin F, Verstappen SMM. Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open. 2022 Mar;8(1):e002168. doi: 10.1136/rmdopen-2021-002168. PMID: 35361692; PMCID: PMC8971792.
- Rheumatoid arthritis: is exercise important? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/in-depth/rheumatoid-arthritis-exercise/art-20096222. Updated July 22, 2022. Accessed November 29, 2022.
- Best exercises for rheumatoid arthritis. Arthritis Foundation. https://www.arthritis.org/health-wellness/healthy-living/physical-activity/other-activities/best-exercises-for-rheumatoid-arthritis. Accessed November 29, 2022.
- Sveaas SH, Bilberg A, Berg IJ, et al. High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): A multicentre randomised trial of 100 patients. British Journal of Sports Medicine. 2019;54(5):292-297. doi:10.1136/bjsports-2018-099943
- Benefits of exercise for osteoarthritis. Arthritis Foundation. https://www.arthritis.org/health-wellness/healthy-living/physical-activity/getting-started/benefits-of-exercise-for-osteoarthritis. Accessed November 29, 2022.
- Kessler J, Chouk M, Ruban T, Prati C, Wendling D, Verhoeven F. Psoriatic arthritis and physical activity: a systematic review. Clin Rheumatol. 2021 Nov;40(11):4379-4389. doi: 10.1007/s10067-021-05739-y. Epub 2021 Apr 29. PMID: 33913069.