Stategies to Increase your Level of Physical Activity

Introduction

Arthritis is a difficult disease to live with because it affects every aspect of your life. It influences your health, your fitness, your sense of well being, your ability to do the things you’d like to do and, if you have persistent pain, it can really drag you down. However, there are many things you can do to help yourself.

For example, if you are overweight, losing a few pounds and maintaining that lower weight can do wonders for your arthritis. Another thing you can do for yourself to manage your arthritis more successfully is to increase your level of physical activity (PA). In this article we will outline the benefits that are likely to occur if you become more physically active, the barriers to becoming more active, and the ways you can begin to increase your level of physical activity (PA).

Does Physical Activity Really Help Arthritis?

The short answer is, yes! Studies have consistently shown that exercise or PA, either aerobic activity such as brisk walking or resistance exercises such as lifting weights, are safe and effective ways of reducing pain and disability, and enhancing physical fitness in arthritic patients. It is important to note that the studies have also shown that exercise does not make your disease worse, a common fear of persons thinking about increasing their PA.

In addition to less pain and disability, regular PA also helps your joint range of motion or, at the very least, keeps them from getting worse. Because of this, the American College of Rheumatology (ACR) recommends moderate intensity PA for the management of osteoarthritis. Some newer studies are showing that patients with rheumatoid arthritis can also benefit greatly from increasing their level of PA, and that PA in these patients is safe and does not make the rheumatoid arthritis worse.

Table 1 below summarizes the benefits that are possible when persons with arthritis increase their level of physical activity. As can be seen, the benefits are many and they are not limited only to the arthritis itself; PA can also improve general health, fitness, mental health, energy level, and sense of well being.

Table 1: Benefits of Physical Activity (PA) in Persons with Arthritis

Domain Direction
of Effect
Magnitude
of Effect
Comments
Health & Fitness Increase Moderate to Large
  • PA can improve general health and reduce your risk of certain illnesses (e.g., cardiovascular disease)
  • PA can improve fitness level and your capacity to perform your day-to-day activities
Mental Health Increase Small to Moderate
  • PA can improve your mood and give you a more positive outlook on life
Energy Level Increase Moderate to Large
  • PA can increase your energy level and vitality
Functional Capacity Increase Moderate to Large
  • PA can improve your ability to perform the day-to-day tasks such as walking, carrying groceries, or climbing stairs
Pain Reduce Small to Moderate
  • After a few days of PA, you may notice a reduction in your joint pain and stiffness
Quality of Life Increase Moderate to Large
  • PA can improve your sense of well being and your willingness to engage more fully in life

If it’s so Beneficial, How Come I’m not doing it?

You’re not alone. It’s estimated that less than 30% of the adult US population meets the Surgeon General’s physical activity guidelines. There are many reasons for this, and we can only touch on a few of the more common ones here. First, just like the general population, barriers exist which prevent us from consistently being more physically active. Among the most common are: lack of time, inclement weather, fear of over doing it, dislike of sweating, poor motivation, lack of knowledge of the benefits of PA, no access to equipment and so on.

Second, there are barriers to PA that are specific to arthritis. The most common of these barriers are shown in Table 2 along with a series of possible ideas to address them. Each of these barriers arises because of living with a chronic disease. As we talked about earlier, arthritis is a disease that really affects every aspect of your life. So, it’s not surprising that your willingness to become more active would be limited by factors such as pain, fear, fatigue, low confidence, and so on. However, the good news is that each of these barriers can be addressed by taking a few simple actions, like those outlined in Table 2 below that will start you on the path toward becoming more active.

Table 2: Barriers to Physical Activity in Persons with Arthritis

Barrier Strategies to Overcome The Barrier
Pain
  • Realize that in the long run exercise will help to reduce paino
  • Apply ice or heat 20-30 minutes prior to activity
  • Take pain medication 30 minutes prior to activity
  • Focus on how pain changes as you become more physically active
Fear
  • Focus on how increasing your activity will likely improve your fitness and quality of life
  • Realize that the chances of making your disease worse through physical activity are very small
  • Start slow and gradual and always make safety your first priority
Fatigue
  • Realize that activity will likely improve your energy level significantly
  • Keep the progression gradual so you don’t get too tired
Low Confidence
  • Make a deal with yourself that you’ll give physical activity a fair try
  • Set specific goals for increasing your physical activity and reward yourself when you achieve them
  • Focus on the improvements you notice as you become more physically active
Psychological Distress
  • Realize that once you become more physically active your mood and outlook are likely to improve greatly
  • Be realistic; don’t expect too much too soon
  • Find ways to involve others in your physical activity

Don’t I have to Exercise Vigorously Many Times a Week to See Benefits?

Perhaps the most important barrier to increasing your level of PA is the belief that in order to get benefits you must exercise vigorously every day like an athlete. It was long thought that measurable health benefits could only be obtained from vigorous exercise performed for a minimum of 20 minutes per session at least three times per week. It is now clear that this is simply not the case. It has been shown that simply accumulating 30 minutes of moderate-intensity PA on most, and preferably, all days of the week substantially increases fitness and reduces the risk of developing a number of life threatening disease. This means you can perform one bout of PA for 30 minutes or multiple bouts of PA for shorter times (e.g. 3 ten minute bouts). It doesn’t matter as long as you meet the Surgeon General’s recommendation of 30 minutes of moderate-intensity PA on most, if not all, days of the week as a way of improving the health, fitness and well being of the population.

Examples of moderate intensity PA include: brisk walking, recreational swimming, bicycling, pushing a lawn mower, gardening and yard work, thorough house cleaning and the like (see Table 3 below for more suggestions to help get you moving).

The most important thing is to start getting more active and to find the types of activities that you can stick to long term. It is better to do a little bit of PA consistently than it is to develop an elaborate program that you cannot stick to for more than a couple of weeks.

Table 3: Ways to Get Yourself Moving

Find an activity that you can perform that produces little or no joint pain such as walking, cycling or swimming
If these sorts of activities produce too much pain, try some or all of the following:

  • Gardening or home repairs
  • Try an exercise video
  • Wash your car
  • Play with kids
  • Avoid labor saving devices (elevators, escalators)
  • Vacuum your carpets
  • Do some gentle exercises while watching TV

How Do I Start?

That’s simple: just START. Talk with your doctor, get the okay, and then make a commitment to yourself that you will become more physically active. Again, the important thing is to do something; it doesn’t really matter what it is as long as it gets you moving and that it’s the sort of activity that you can do safely and consistently. Use the questions in Table 4 below to help you to finalize your commitment and develop your PA program. Remember keep it simple, fun, and safe. Now get out there and do something!

Table 4: Questions to Consider When You Decide to Get More Active

  • What are the consequences of doing nothing at all?
  • What barriers keep me from being more active?
  • How can I address these barriers?
  • What can I do to get more active?
  • When am I going to start?
  • Would I be better at sticking to it if I get someone to do it with me?
  • How will I know if it is working?
  • What will I do if I get bored with the activity I’m doing?

Read Getting Active: A Real Life Example, an article that outlines step-by-step a physical activity program that worked for patients in a research study.

Summary and Key Points

  • Increasing your level of physical activity is likely to benefit your overall health, as well as your arthritis and its symptoms
  • You don’t have to commit to taking part in a traditional exercise program to derive the benefits of increased physical activity
  • Accumulating short bouts of physical activity over the course of the normal day is likely to improve your health and your arthritis
  • It’s more beneficial to do a little bit of physical activity consistently than to do a lot of physical activity inconsistently
  • Start slow and gradually increase your level of physical activity
  • Set specific physical activity goals and be sure to reward yourself when you accomplish them
  • Focus on the benefits of increasing your physical activity and give yourself a pat on the back for doing something on your own to manage your arthritis
  • As you become more active and are feeling better, consider increasing the intensity of your PA.
  • Before you start increasing your level of physical activity, discuss it with your doctor

Recommended Reading:

  • Promoting Physical Activity: A Guide for Community Action. Champaign, IL: Human kinetics, 1999.
  • Exercise and Your Arthritis. Arthritis Foundation, 1998.

Updated: July 31, 2012

Kevin Fontaine, PhD

About Kevin Fontaine, PhD

Associate Professor of Medicine
Johns Hopkins University