In addition to medication, exercise is one of best treatments for rheumatoid arthritis. This may be frustrating to hear, since RA joint pain and fatigue can make physical activity seem unappealing. It can help to understand how physical activity helps reduce RA symptoms and how to exercise safely.

This article discusses how exercise helps treat RA 1 Masuko K. Rheumatoid cachexia revisited: a metabolic co-morbidity in rheumatoid arthritis. Front Nutr. 2014;1:20. Published 2014 Nov 24. PMID: 25988122 doi:10.3389/fnut.2014.00020 , 2 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. PMID: 32910153 doi:10.1093/rheumatology/keaa364 and describes specific exercises to try.

Rheumatoid arthritis can occur in joints throughout the body, such as the knees, ankles, hips, elbows, and shoulders. Watch: Rheumatoid Arthritis Overview Video

Exercise Reduces RA Joint Pain

Research shows exercise reduces RA-related joint pain. It does this by reducing the underlying cause of pain: inflammation. Exercise tends to lower the amount of C-reactive protein and other signs of inflammation in the blood. 3 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. PMID: 34320079 doi:10.36660/abc.20200028 , 7 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

Learn about Blood Tests to Help Diagnose Rheumatoid Arthritis (RA)

Exercise Increases Joint Strength and Flexibility

People with RA tend to have less muscle mass than others, even when their body weights are the same. 1 Masuko K. Rheumatoid cachexia revisited: a metabolic co-morbidity in rheumatoid arthritis. Front Nutr. 2014;1:20. Published 2014 Nov 24. PMID: 25988122 doi:10.3389/fnut.2014.00020 Exercise helps build and maintain muscle strength.

Exercises that get joints moving, combined with gentle stretching, can also help maintain or increase joint flexibility. When joints are strong and flexible, the body is more stable. Keeping balance and doing everyday tasks are easier.

See Knee Strengthening Exercises


Exercise Reduces Fatigue and Depression

Chronic autoimmune diseases, including rheumatoid arthritis, increase the likelihood of experiencing fatigue and depression. Research studies suggest exercise helps counteract depression 8 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. PMID: 30394312 doi:10.1016/j.bbi.2018.10.005 , 9 Felger JC, Lotrich FE. Inflammatory cytokines in depression: neurobiological mechanisms and therapeutic implications. Neuroscience. 2013;246:199-229. PMID: 23644052 doi:10.1016/j.neuroscience.2013.04.060 , 10 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 , 11 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 , 12 Brady SM, Fenton SAM, Metsios GS, et al. 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;41(2):335-344. PMID: 33258004 doi:10.1007/s00296-020-04751-w and RA-related fatigue. 13 Rongen-van Dartel SA, Repping-Wuts H, Flendrie M, et al. Effect of Aerobic Exercise Training on Fatigue in Rheumatoid Arthritis: A Meta-Analysis. Arthritis Care Res (Hoboken). 2015;67(8):1054-1062. doi:10.1002/acr.22561 , 14 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

See Chronic Arthritis Pain and Depression

Exercise Reduces the Risk of Heart Disease

Rheumatoid arthritis increases the risk of developing heart disease by about 50%. 15 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 Experts believe the body-wide inflammation linked to RA can damage the heart and blood vessels.

Exercise is a great way to fight heart disease, whether RA has been diagnosed or not.

Guidelines for Exercising with RA

There are no specific recommendations for how much exercise people with RA or other autoimmune diseases need. Instead, experts recommend that almost everyone follow these general guidelines: 16 How much physical activity do adults need? Centers for Disease Control and Prevention. Last reviewed October 7, 2020. Accessed October 4, 2021.

  • Get a total of at least 150 minutes of moderate aerobic exercise each week. Workout time can be spread out—for example, 30 minutes of exercise 5 times a week. Any physical activity that gets the heart beating faster than normal counts as moderate aerobic exercise.
  • Doing vigorous aerobic exercise for at least 75 minutes each week is okay, too. Sweating, breathing harder, an increased heart rate, and muscle fatigue are signs of vigorous exercise. 17 Perceived Exertion (Borg Rating of Perceived Exertion Scale). Centers for Disease Control and Prevention. Last reviewed September 17, 2020. Accessed November 2, 2020.
  • In addition to aerobic exercise, do strength exercises that build muscles at least 2 days a week.

Some strength exercises require equipment, such as weights and resistance bands. Other exercises, such as squats, hip bridges, and many yoga poses, use a person’s own body weight for resistance. When doing strength exercises, slow, controlled movements can help build muscle and guard against injury.

See Shoulder Strengthening Exercises

Adjust recommended guidelines for individual ability

The above guidelines are only recommendations. If 150 minutes of moderate aerobic activity per week is too easy, increase the length or intensity of workouts. If 150 minutes a week is too challenging, begin with a smaller weekly goal and gradually increase it.

In general, any amount of aerobic exercise is better than none.

See Aerobic Exercise for Knee Arthritis and Aerobic Exercise for Shoulder Arthritis


When Exercise Makes RA Pain Worse

Joints may feel uncomfortable or mildly painful during exercise, particularly early in a workout, while the body is warming up. Typically, pain levels return to normal after working out.

If pain remains or becomes worse after a workout, it is a sign that the workout should be changed or scaled back. A physical therapist or trained physician can work with an individual one-on-one and help customize a safe workout plan.

See Ways to Get Exercise When You Have Arthritis

Pain caused by physical activity may prompt a physician to recommend increasing medication dosage or trying a new medication. They may also recommend lifestyle changes, such as quitting smoking, eliminating certain foods, managing stress, or improving sleep habits.

Dr. Catherine Lutsey is a Doctor of Physical Therapy at the Shirley Ryan AbilityLab. She has practiced as a physical therapist for more than a decade, and her specialties include the spine, sports injuries, and arthritis.