Rheumatoid arthritis is a chronic disorder in which the immune system attacks body tissues. It’s a debilitating disease, with inflammation causing damage to bones and cartilage, leading to stiffness, swelling, pain and deformity in the joints of the fingers, wrists, elbows, knees and feet.
Rheumatoid arthritis usually arises in adults over 20, with peak incidence between the age of 40 and 50, and is more common in women than men by a factor of three to one. The National Audit Office estimated that in 2009 there were more than 690,000 people in the UK living with the condition. Within 10 years of diagnosis, 30% are considered severely disabled, with reduced life expectancy.
There isn’t a cure, but rheumatoid arthritis can be relieved through physical therapy, exercise and weight control, as well as medication to reduce inflammation.
Regular exercise has been found to reduce pain and stiffness in the affected joints and to strengthen muscles around the joints, improving endurance and flexibility.
The benefits of exercise for rheumatoid arthritis sufferers
The right kind of exercise, ideally supervised by a qualified personal trainer, can bring significant benefits. Resistance and aerobic training can reduce pain and stiffness, increase flexibility and muscle strength, improve mood and reduce the risk of cardiovascular disease.
What precautions should a personal trainer take?
A fitness instructor working with a client with rheumatoid arthritis should educate themselves about any side effects of the medication their client is taking.
They should also take care to protect the client’s joints by starting with low-impact aerobic and functional strength exercises. Promoting flexibility is a key goal, and the intensity of the work out should only be increased once the client’s muscles are suitably conditioned.
Other considerations include avoiding intensive, very repetitive exercise, scheduling afternoon or evening exercise to allow time for morning joint stiffness to ease and being aware of the ways in which pain or swelling can affect the client’s performance.
If the client does experience pain or swelling, the exercise should be halted or changed to a form of exercise that is not weight-bearing. If a client’s rheumatoid arthritis deteriorates over time, exercise prescription should be adjusted accordingly and the personal trainer should recommend regular consultation with an appropriate medical specialist.
Manual therapies
These can include soft tissue massage, manipulation, stretching and passive movements – all to suit the client’s level of condition and symptoms.
Pharmacology treatment
Pharmaceuticals can relieve symptoms of rheumatoid arthritis, from pain to swelling. It can also help to slow or even halt the progress of the condition.
The most common pharmacological intervention for those with rheumatoid arthritis is analgesics and non-steroidal anti-inflammatory drugs (NSAIDs).
Analgesics include paracetamol, acetaminophen, codeine, co-proxamol and dihydrocodeine – these block the brain’s ability to feel pain.
NSAIDs include aspirin, ibuprofen, naproxen and diclofenac – these inhibit cyclooxygenase-1 and cyclooxygenase-2 enzymes, which catalyse the formation of prostaglandins (lipids that control inflammation).
Finally, corticosteroid like Prednisolone and Depo-medrone can help to reduce inflammation and immune system activity.
