In this article: Why should everyone Exercise? Why should people with arthritis Exercise? How much should you exercise & how can you balance exercise & rest? How to exercise Types of Exercises Exercise Guidelines When should you exercise? How to succeed in your Exercise program Examples of joint mobilising and strengthening exercises

If you have arthritis there's a lot you can do to help yourself, starting with the right sort of exercise. People with Arthritis are often confused by the conflicting advice they receive about exercise and rest. The Arthritis Foundation of Kuala Lumpur has prepared this leaflet to help you understand why, when, how and how much you should exercise and how you can develop a balanced routine, starting today.

Why should everyone Exercise?

Exercise:

• Decreases pain

• Strengthens muscles

• Strengthens bones and minimises osteoporosis (thin bones)

• Maintains and increases joint movement

• Increases heart and lung fitness

• Improves posture

• Controls weight and reduces body fat

• Relieves muscle tension

• Decreases stress levels

• Enhances body shape

• Improves sleep patterns

• Helps develop a positive attitude and healthier lifestyle

Why should people with Arthritis Exercise?

Exercise:

• Keeps your joints mobile and reduces joint pain

• Increases your muscle strength

• Prevents joint deformities

• Maintains and increases your ability to perform daily tasks

• Increases your general fitness and sense of well being

• Helps to minimise the effects of osteoporosis.

How much should you exercise & how can you balance exercise and rest

If you have arthritis you must find the right balance between exercise and rest. This usually means periods of rest alternating with periods of activity. Prolonged rest causes people with Arthritis to feel stiff when they begin to move whereas sustained exercise or activity may cause tiredness and pain. Careful attention to rest, exercise and the way we hold our joints is an important part of pain management. More rest is needed to settle an inflamed joint or in a general flare-up, but too much rest will weaken muscles and increase stiffness. During periods of remission or well being the amount of exercise can be increased, this will help strengthen the muscles around the joint and prevent the joint from becoming unstable during periods of active disease.

So use these principles as a guide:

• When joints are inflamed, rest is needed. The amount and type will depend on how inflamed your joint is.

• Rest does not always mean lying down - it can also mean changing your posture, wearing your splint, or doing a different activity.

• If joints ache only on certain movements, have a rest from those movements.

• Joints that are stiff need more exercise.

• Joints that are weak and unstable require more support.

• Just as rest and exercise are important, so is relaxation. Relaxation will enhance your rest periods and decrease your stress levels. Some methods of relaxation are slow deep breathing and meditation.

How to exercise

Exercise routines should start with a warm up period and end with a cool down routine

• Warm up period - flexing and strengthening exercises lead to a gradual increase in your activity level. They raise the temperature in your muscles and joints and safely prepare your heart to work harder with more vigorous exercise.

• Aerobic activity - uses large muscles of your body in a rhythmical, continuous activity. The most effective activities involve your whole body : walking, swimming and cycling are good examples of aerobic activity.

• A cool down routine - a short five or ten minute period of exercise after you have finished a more vigorous activity which helps your body gradually relax again.

Types of Exercise

There are three main types of exercise which together help to maintain the mobility of your joints, the strength of your muscles and your overall fitness.

1. Mobilising exercises - designed to maintain or increase the range of motion of a joint. It's a good idea to take all your joints through their full range of motion each day. Remember that being busy, (for example doing housework) is not exercising. Pay special attention to joints that are stiff, as they need more exercise. However, never force a stiff joint to move more than it is able.

2. Strengthening exercises - designed to increase the power of muscles. This will help joints to bear weight, to move objects, and to maintain strong, stable joints. Isometrics are good strengthening exercises for joints with arthritis, because they involve tightening muscles without moving joints.

3. Fitness exercises - have a beneficial effect on the heart and lung and increase general body fitness. Good examples for people with arthritis are swimming,  walking, cycling and dancing. Always progress slowly with these exercises.

All of the above exercises need to be included in your weekly exercise routine for arthritis.

Exercise guidelines

• Try to perform your exercise program 3 or 4 times each week.

• Concentrate on quality rather than quantity - better to do less properly, than more poorly.

• Move your joints slowly and smoothly - do not jerk them.

• Be aware of pain and swelling and exercise gently if either is present.

• If pain after exercise lasts more than two hours or joints become swollen, it means you've overdone it - so do less next time. Perhaps you need to change your program?

• Muscles and joints are exercised more effectively when they're warmed up - after a bath or shower may be a good time.

• Exercise in warm water is a good way to exercise your whole body, because the buoyancy of the water supports the joints so they can move easily and freely. It also helps tight muscles to relax.

• Do not continue with an exercise that causes severe pain.

• If you have a joint replacement, check with your surgeon or physiotherapist about what movements to avoid.

When should you exercise?

Remember to exercise when you are :

• Least stiff

• Have least pain

• Are least tired

• And when your medications are working most effectively

Some tips:

• Have a short rest period daily - lie as flat as possible with all your joints out straight.

• Avoid sitting in low, soft chairs. Ensure there is an adequate backrest, with your hips at right angles and your feet resting comfortably on the floor or stool.

• Stand as tall as possible, but be comfortable.

• Avoid sitting or standing for long periods.

How to succeed in your Exercise programme

• Start slowly, progress gradually and set realistic short term goals

• Exercise with a friend and if this is not possible keep a record.

• Use the right equipment - wear supportive, shock-absorbing footwear, e.g. Joggers

• See a Physiotherapist for expert advice on an exercise program, and for individual attention

• Find the correct balance between exercise and rest

Check with your doctor before starting a new exercise program if you have any other medical problems, such as asthma, diabetes, epilepsy, a heart condition, high blood pressure, obesity, or if you are or have been a smoker.

Some exercise examples

Exercise should be fun, so find a way of exercising your body that you enjoy. Here are some suggestions :

• General fitness activities - swimming, walking, jogging, cycling and dancing.

• Classes- fitness, stretch, hydrotherapy (water exercise), aquarobics, yoga, and tai chi.

• Sports - tennis, table-tennis, bowls, golf, badminton, croquet, and others.

• Individual exercise routine to perform at home. If you have arthritis you need to exercise your joints daily. Remember to consult a physiotherapist for your personal exercise program, for specific treatment on joints and posture advice.

Avoid contact and competitive sport and know your limits.

Examples of joint mobilising and strengthening exercises