The recommendation to get regular exercise if you have rheumatoid arthritis (RA) is backed up by plenty of scientific research. Experts say there are at least 4 ways exercise may help ease the signs and symptoms of RA.
1. Exercise reduces inflammation
Regular exercise tends to lower inflammation levels in the body. Inflammation is measured using blood tests that check for inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Test results for these markers tend to be high during an RA flare and low when RA is well controlled. Studies show that exercise helps lower inflammatory markers. 1 Tan Q, Li Y, Guo Y. Exercise Training Improves Functions of Endothelial Progenitor Cells in Patients with Metabolic Syndrome. Exercício Físico Melhora as Funções das Células Progenitoras Endoteliais em Pacientes com Síndrome Metabólica. Arq Bras Cardiol. 2021;117(1):108-117. doi:10.36660/abc.20200028 , 2 Kasapis C, Thompson PD. The effects of physical activity on serum C-reactive protein and inflammatory markers: a systematic review. J Am Coll Cardiol. 2005;45(10):1563-1569. doi: 10.1016/j.jacc.2004.12.077 , 3 Campbell PT, Campbell KL, Wener MH, et al. A yearlong exercise intervention decreases CRP among obese postmenopausal women. Med Sci Sports Exerc. 2009;41(8):1533-1539. doi: 10.1249/MSS.0b013e31819c7feb , 4 Chen Z, Li B, Zhan RZ, Rao L, Bursac N. Exercise mimetics and JAK inhibition attenuate IFN-γ-induced wasting in engineered human skeletal muscle. Sci Adv. 2021;7(4):eabd9502. Published 2021 Jan 22. doi:10.1126/sciadv.abd9502 , 5 Ding Y, Xu X. Effects of regular exercise on inflammasome activation-related inflammatory cytokine levels in older adults: a systematic review and meta-analysis [published online ahead of print, 2021 Jun 12]. J Sports Sci. 2021;1-15. doi: 10.1080/02640414.2021.1932279
Exercise may affect RA inflammation levels in a few ways 2 Kasapis C, Thompson PD. The effects of physical activity on serum C-reactive protein and inflammatory markers: a systematic review. J Am Coll Cardiol. 2005;45(10):1563-1569. doi: 10.1016/j.jacc.2004.12.077 :
- Exercise promotes anti-inflammatory responses in the body. Exercise causes muscle cells in the body to release chemicals called anti-inflammatory cytokines. Cytokines are tiny protein molecules that act as messengers among cells and tell the immune system what to do.
- Exercise suppresses pro-inflammatory responses in the body. Inflammation is caused by an over-active immune system. Exercise can help tamp-down immune system activity.
- Exercise helps reduce excess fat tissue, which promotes inflammation. Fat tissue can release substances that promote inflammation, such as certain hormones and pro-inflammatory cytokines.
Some experts suspect that exercise can reduce fat tissue’s pro-inflammatory effects even if you don’t lose weight. 6 Park YM, Myers M, Vieira-Potter VJ. Adipose tissue inflammation and metabolic dysfunction: role of exercise. Mo Med. 2014;111(1):65-72. PMID: 24645302 How exercise influences inflammation and RA disease activity continues to be researched.
Lowering inflammation levels in the body can ease RA disease activity as well as reduce the signs and symptoms of other diseases, such as diabetes and heart disease.
2. Exercise helps build back lost muscle
As RA develops, the body loses muscle tissue and strength. This loss is noticeable at every stage of the disease—at diagnosis, when RA is active, and even when RA is in remission. 7 Farrow M, Biglands J, Tanner S, et al. Muscle deterioration due to rheumatoid arthritis: assessment by quantitative MRI and strength testing. Rheumatology (Oxford). 2021;60(3):1216-1225. doi:10.1093/rheumatology/keaa364 Body weight may remain stable or even increase, 8 Masuko K. Rheumatoid cachexia revisited: a metabolic co-morbidity in rheumatoid arthritis. Front Nutr. 2014;1:20. Published 2014 Nov 24. doi: 10.3389/fnut.2014.00020 suggesting that while muscle tissue decreases, fat tissue increases.
Adding exercise to a treatment plan can:
- Build muscle tissue. While muscle tissue accounts for about 45% of body mass in healthy people, it typically accounts for less body mass in people with rheumatoid arthritis. 4 Chen Z, Li B, Zhan RZ, Rao L, Bursac N. Exercise mimetics and JAK inhibition attenuate IFN-γ-induced wasting in engineered human skeletal muscle. Sci Adv. 2021;7(4):eabd9502. Published 2021 Jan 22. doi:10.1126/sciadv.abd9502 Exercise helps increase muscle mass.
- Improve joint function. Muscles move our joints. Exercise to build muscle tissue can improve how well your joints work (joint function).
- Protect joints. Muscles support joints. Building muscle helps protect joints from damage and injury.
Strength exercises may involve equipment, such as weights or resistance bands. Exercises that use body weight, such as squats and certain yoga poses, can also build muscle strength. 9 How much physical activity do adults need? Centers for Disease Control and Prevention. Last reviewed October 7, 2020. Accessed October 4, 2021. https://www.cdc.gov/physicalactivity/basics/adults/index.htm
3. Exercise lowers the risk of heart disease
People with rheumatoid arthritis are 48% more likely to develop heart disease than the general population. 10 Avina-Zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis. 2012;71(9):1524-1529. doi:10.1136/annrheumdis-2011-200726 RA inflammation is thought to damage the heart and blood vessels.
Exercise reduces the risk of heart disease by:
- Lowering inflammation that can damage the heart and blood vessels
- Burning excess fat, which may contribute to heart disease
No matter what, exercise is a great way to fight heart disease—whether RA has been diagnosed or not.
4. Exercise eases symptoms of fatigue and depression
People with chronic autoimmune diseases, such as rheumatoid arthritis, are more likely to feel depressed and fatigued. Exercise can help reduce both depression 11 Shimojo G, Joseph B, Shah R, Consolim-Colombo FM, De Angelis K, Ulloa L. Exercise activates vagal induction of dopamine and attenuates systemic inflammation. Brain Behav Immun. 2019;75:181-191. doi: 10.1016/j.bbi.2018.10.005 , 12 Felger JC, Lotrich FE. Inflammatory cytokines in depression: neurobiological mechanisms and therapeutic implications. Neuroscience. 2013;246:199-229. doi: 10.1016/j.neuroscience.2013.04.060 , 13 Fakra E, Marotte H. Rheumatoid arthritis and depression [published online ahead of print, 2021 Apr 28]. Joint Bone Spine. 2021;88(5):105200. doi: 10.1016/j.jbspin.2021.105200 , 14 Gautam S, Tolahunase M, Kumar U, Dada R. Impact of yoga based mind-body intervention on systemic inflammatory markers and co-morbid depression in active Rheumatoid arthritis patients: A randomized controlled trial. Restor Neurol Neurosci. 2019;37(1):41-59. doi: 10.3233/RNN-180875 , 15 Brady SM, Fenton SAM, Metsios GS, Bosworth A, Duda JL, Kitas GD, Veldhuijzen van Zanten JJCS. Different types of physical activity are positively associated with indicators of mental health and psychological wellbeing in rheumatoid arthritis during COVID-19. Rheumatol Int. 2021 Feb;41(2):335-344. doi: 10.1007/s00296-020-04751-w and fatigue 16 Rongen-van Dartel SA, Repping-Wuts H, Flendrie M, Bleijenberg G, Metsios GS, van den Hout WB, van den Ende CH, Neuberger G, Reid A, van Riel PL, Fransen J. Effect of Aerobic Exercise Training on Fatigue in Rheumatoid Arthritis: A Meta-Analysis. Arthritis Care Res (Hoboken). 2015 Aug;67(8):1054-62. doi: 10.1002/acr.22561 , 17 Zielinski MR, Systrom DM, Rose NR. Fatigue, Sleep, and Autoimmune and Related Disorders. Front Immunol. 2019;10:1827. Published 2019 Aug 6. doi: 10.3389/fimmu.2019.01827 in people who have chronic diseases.
Research suggests there are a few possible reasons why exercise helps. Exercising:
- Releases chemicals in the body, such as endorphins and dopamine, which can help improve your mood and reduce sleepiness
- Reduces body-wide inflammation, which is linked to depression and fatigue
- Gives you a sense of accomplishment and control over RA symptoms
While depression and fatigue may not completely go away with exercise, they may decrease and become less noticeable.