How to exercise with rheumatoid arthritis: what to do in a flare, how to build strength and cardio in remission, and when to speak to your rheumatologist.
Yes, people with rheumatoid arthritis (RA) should exercise. The 2022 American College of Rheumatology guideline recommends regular exercise over none, and reviews have not found that exercise damages joints. The practical skill is matching the activity to how your joints are behaving this week: gentle movement in a flare, progressive strength and cardio in remission.
This is general education. Your rheumatologist and physiotherapist know your joints, medicines and disease activity, so use it as a starting point for that conversation.
Why does exercise help rheumatoid arthritis?
RA is an autoimmune condition in which the lining of the joints becomes inflamed. Fatigue, stiffness and pain make many people move less, and that lowers muscle strength and fitness. Weak muscles then give joints less support, and the cycle continues.
The Cochrane review of dynamic exercise in RA (8 trials, 575 adults with low to moderate disease activity) found moderate evidence that land-based aerobic training improves aerobic capacity, with no harmful effect on disease activity or joint damage. Most studies were short, so long-term joint outcomes are less certain. The 2022 ACR guideline strongly recommends consistent exercise over no exercise for people with RA. The 2018 EULAR recommendations, written by a task force of experts from 16 countries, say physical activity should be an integral part of standard care in inflammatory arthritis.
Exercise does not replace your disease-modifying medicines. It sits alongside them.
How should I exercise during a flare?
A flare means one or more joints are hot, swollen, stiff for longer than usual, and painful. Rest has a place, but long rest costs you muscle quickly.
During a flare:
- Keep daily gentle range-of-movement exercises for each joint, 5 to 10 slow repetitions, within comfort.
- Walk for 5 to 15 minutes if your feet, knees and hips allow it. Skip it if the leg joints are the ones flaring.
- Use warm water (a pool or a warm shower) for movement if available.
- Pause strength work and heavy gripping on the swollen joints. You can still train unaffected areas, for example legs if only the hands are flaring.
- Use pain as a guide. Pain that settles within an hour after activity is acceptable. Pain that lingers into the next day means you did too much.
The Johns Hopkins Arthritis Center notes that there is no data showing exercise causes flares, but pacing still matters. If a flare lasts more than a few days despite your usual treatment, contact your rheumatology clinic rather than waiting.
What should my weekly plan look like in remission or low disease activity?
When joints are calm, you can build up. A reasonable target for most adults with RA mirrors the general WHO guidance: build towards about 150 minutes of moderate aerobic activity a week and muscle strengthening on 2 days. It may take months to get there, and that is fine.
| Component | Starting point | Build towards |
|---|---|---|
| Aerobic (walking, cycling, water exercise) | 10 minutes, 3 days a week | 30 minutes, 5 days a week at a pace where you can talk |
| Strength | 1 set of 8 to 10 repetitions, 2 days a week | 2 to 3 sets of 10 to 15, 2 to 3 days a week |
| Mobility | 5 minutes each morning | 10 minutes daily |
| Balance | Single-leg stand near a counter, 20 seconds each side | 30 seconds each side, eyes forward |
Increase one thing at a time, by no more than about 10 percent a week. These doses are common starting points in practice, not trial-proven prescriptions. If a joint is hot or more swollen the next morning, step back one level.
How do I do strength training with painful hands, knees or feet?
Many people avoid strength training, yet it does the most to protect your independence.
- Choose joint-friendly options: resistance bands, light dumbbells with padded or large-diameter handles, or machines with a wide grip.
- Use a sit-to-stand from a chair (see how to do a squat) for legs, and a glute bridge if knees are sore in standing.
- For the back and shoulders, try a resistance band row. Loop the band around a door handle or a pole and keep wrists neutral.
- Do 1 to 2 sets of 10 to 15 repetitions at an effort of about 5 to 6 out of 10.
- Rest 60 to 90 seconds between sets and a day between sessions for the same muscles.
If your hands hurt to grip, use wrist straps, a wide-handled band, or leg and trunk exercises that need no gripping. Do not push through sharp pain, and do not force deformed joints into positions they resist.
What aerobic activity suits RA in Malaysia?
Heat and humidity are real issues. Fatigue is already common in RA, and a 33 degree afternoon makes it worse.
- Early morning walks at a shaded park such as Taman Tasik Titiwangsa or your neighbourhood lake, before the sun is high.
- Mall walking in air-conditioned malls when it is hot or hazy. See mall walking in the Klang Valley.
- A stationary bike at home or the gym, which takes load off knees and ankles.
- Warm-water exercise in a pool. Water supports body weight, which many people with painful joints find comfortable.
On hazy days, move indoors. Our guide on exercising in Malaysia’s heat and humidity has practical timing and hydration tips.
What are the common mistakes?
- Stopping everything after one bad day. Reduce the dose and keep a small amount going.
- Doing a week’s exercise on one good day, then being flattened for three days. Spread it out.
- Skipping the warm-up. Stiffness is worst in the morning, so allow 5 to 10 minutes of slow movement and a warm shower before training.
- Training through a hot, swollen joint.
- Ignoring the spine. Neck involvement can occur in long-standing RA, so tell your doctor about new neck pain, tingling or arm weakness before doing neck-loading exercises.
When should I check with my doctor first?
Speak with your rheumatologist before starting or changing your exercise plan if you:
- have just been diagnosed or changed medication;
- have unstable or heavily damaged joints, or have had joint replacement (see exercise after knee or hip replacement);
- take steroids long term, as bone strength may be affected; ask about bone density;
- have heart disease, high blood pressure or diabetes, which are more common alongside RA. See when to get medical clearance.
Stop and seek urgent medical advice for chest pain, breathlessness out of proportion to effort, a single very hot, red, severely painful joint with fever, sudden weakness or numbness in the arms or legs, or new neck pain with numbness or loss of coordination.
Where do I go next?
For the wider picture on managing long-term conditions, see our hub on exercise for chronic conditions and the general article on exercise for arthritis and joint pain. If a parent with RA needs hands-on support, see the ageing parents guide. A physiotherapist can supervise a programme and tailor the load to your joints.
Key takeaways
- Exercise is recommended in RA. Guidelines advise it over no exercise, and reviews show no harm to joints.
- In a flare, switch to gentle range-of-movement work and short walks, and rest the swollen joints.
- In remission, build towards about 150 minutes of aerobic activity and 2 days of strength work, increasing slowly.
- In Malaysia, exercise early or indoors and use water or cycling to spare painful joints.
- Check with your rheumatologist before starting, and seek urgent care for a single hot swollen joint with fever or new neurological symptoms.