Safe Exercise During Flare-ups

[Guest guest]

Safe Exercise During Flare-ups

December 4, 2003

Dr. Iversen:

What are the exercise guidelines during an acute inflammatory stage? Well,

range of motion exercises are recommended - about two to three repetitions a

day in the joints that are involved. And for a patient that multiple joint

involvement, that can be quite onerous. Generally what we try to do is to

incorporate range of motion activities into daily life, and sometimes we

recommend patients, first thing in the morning before they get out of bed,

to try ranging their shoulder, moving a little bit of their hips and knees,

because stiffness is very prominent then. So you can do some activities as

you are in the shower, some while you are in the bed, so that you cover all

the exercises that you need to do, but it is not so onerous. Exercise at

this point should never increase pain, and we try to avoid stretching, even

though you might have a contracture at this point, because the joint is very

tender, and needs to be protected. It is recommended that you perform

isometric exercises, so that is just a tightening of the muscle without any

joint movement; making a fist, or contracting our quad muscle is a common

exercise people know. But, studies have shown that isometric exercises,

although they seem very simple, if you hold them for six seconds, and you do

a series of repetitions, can increase strength quite significantly. The one

thing to be careful of with isometric exercises is it does tend to increase

cardiac demand, so if you have a cardiac condition, it is good to get some

advice from your physician before you start these exercises.

So the other stage of rheumatoid arthritis is the subacute stage. So at this

point, your inflammation has subsided; your joints aren?t so hot and

swollen. At this point, now, you can begin to increase the frequency and

number of repetitions of both your range of motion exercises and your

isometric exercises. And because the inflammation has subsided, you can

begin to work on flexibility exercises or stretching out your joints. Heat

can be used to increase the extensibility or relax the muscle tissue is

probably a better way of explaining it, and that will enable you to get more

movement from your joint. We also recommend doing a daily joint check ? a

very quick check of your range of motion within your joints to ensure that

there isn?t a joint that is involved that you might be overlooking; for

example, the elbow. It is very often you don?t extend it all the way out,

and you might not recognize that your elbow is actually getting tight, so a

joint check is just a quick way of ensuring that you actually are ranging

all the joints that you should be.

What are dynamic exercises, and when should they be used? Dynamic exercises

are the form of exercises people most commonly think of. These are exercises

where the muscle fibers actually lengthen and shorten, to move the joint

through a range, so doing a curl-up. Dynamic exercises with light resistance

are appropriate to use. And what do we mean by light resistance? Well, if

you went to a gym and a physical therapist was to assess your strength, it

would be somewhere between 20 and 40 percent of your one repetition max, so

your one weight you can lift. The only time that we recommend avoiding

dynamic exercises is in the presence of a popliteal cyst, which is a bit

bulge in the back of your leg, behind your knee, or if your joint has

internal joint derangement - meaning that your joint is actually subluxed or

moved out of place. The frequency and duration of these dynamic exercises

truly depends on the severity of your disease, and how long you have had

your disease, but overall, dynamic exercises have really been shown to be

very beneficial and they don?t need to be fancy or use fancy equipment. You

can do leg extensions at home with a one to three pound weight, and studies

have shown that even something that simple, if you adhere to it, at least

for six weeks, can actually demonstrate benefits in strength.

http://www.healthtalk.com/rheumatoidarthritis/programs/120403/page-06.cfm