There is a delicate balance between doing too much and doing too little.

These days we are continually reminded about the need to exercise in order to keep fit and healthy. This is particularly necessary for people who have a sedentary lifestyle. Anyone who is over the age of 40 needs to take exercise regularly in order to maintain their muscle strength and reduce the risk of osteoporosis. This is even more essential for those of us who have rheumatoid arthritis because we need strong muscles to support our joints, particularly if they are damaged due to cartilage erosion.

All joints need to be put through their natural range of movement daily, preferably a few times a day, and ideally this should be incorporated into your daily routine. Any exercise that is incorporated into daily life is much more likely to happen. We all know how people sign up at fitness centres in January and stop two months later. The same will apply with sets of exercises; people always mean to do them and start off remembering for a couple of weeks, then they forget.

PLANNING YOUR EXERCISE

Work out a way of planning the exercise so that it can easily be fitted into your day. This can be done by having a set of exercises to do when you are sitting down at a table, others for when you are in a car in traffic and another set for when you are relaxing in an easy chair. Alternatively you could get into a pattern of:

• doing yoga each day
• swimming regularly; or
• doing aqua-aerobic exercises in the water.

These three activities are useful because you can go at your own pace in a way that suits your needs without a need to compete. All three allow you to put all your joints through their complete range of movements.

• You could try a gym but take care that your programme is appropriate for you. Always show it to a Physiotherapist or an Occupational Therapist or your GP and discuss the type of exercise that will be beneficial for you.
• Walking is also good exercise. It can be just short distances to the post-box or to a friend’s house, or it could be a little dog-walking or shopping where there are only a few light items to carry.
• Cycling can also be good exercise, but again not for too long or it can put a strain on the shoulders, wrists and fingers as well as your knees and hips.

If you are using the last two activities you will also need exercises for the hands and wrists.

Finding a balance

You need to be able to maintain or improve muscle strength without damaging your joints. You also need to be able to stretch the tendons and ligaments as well as putting each joint through its natural range of movement as far as is possible without pain. It is always a question of finding a balance, varying the joints that you are using and not holding any position for too long.

Do not do anything strenuous and listen to your own body. Always start with short gentle exercise and build up slowly. If you are not able to do some of the exercises just do what you are able to manage.

If you have other medical conditions apart from rheumatoid arthritis talk to your GP first and find out how much exercise is beneficial. If you have a medical condition that affects your heart or lungs this will obviously make exercise more difficult.

EXERCISE AT THE TABLE

The following set of exercises was given to me when I first attended Occupational Therapy. The local OT unit still uses most of these exercises.

These exercises will be beneficial for the hands and wrists. They should be performed slowly, stretching as much as possible. Relax between repetitions and gradually increase the repetitions. Reduce the repetitions if your hands hurt.

• 1Rest the forearm on the table. Curl your fingers up gently into a fist then gradually uncurl.
• 2Place your hands palms down onto the table with the fingers stretched out. Walk your fingers towards the thumb.
• 3Hold your hands out in front of you and touch each fingertip onto the thumb. Now touch the base of each finger with the thumb.
• 4Hold your hands out in front of you. Have the fingers make a loose fist then circle the hand at the wrist clockwise and anti-clockwise and then up and down.
• 5Press hands and forearms flat on the table, palms down. Lift up the thumb ... hold ... and then ... down. Repeat with all the fingers and the other thumb.
• 6Start as for 5 then roll hands over trying to touch the table with the tips of the thumbs. Roll back to starting position.
• 7Put one hand and forearm flat on the table, place the other hand on top. The hand on top will help to straighten out the fingers of the hand underneath. Repeat with the other hand.
• 8Put an envelope or a piece of thin card between your thumb and index finger. Try to pull it away with the other hand whilst resisting with your thumb and index finger. Repeat this with the other fingers and the other hand.

USEFUL YOGA EXERCISES

While I have been writing this book I have looked for research to support my ideas. Until the last few years there has been little or no research on complementary approaches to illness so there are few studies on these topics in relation to rheumatoid arthritis. As far as yoga goes I have found a study by Dr Ian Haslock1 in which he concluded that rheumatoid arthritis patients could gain definite benefits from yoga. The benefits included reduced pain, increased mobility, increased energy, and reduced tension and stress.

Yoga is an appropriate way to maintain a good range of movements in all your joints. It is a form of exercise that is not competitive and all the moves are done gently and gradually. Yoga helps to strengthen muscles and increase flexibility. Any good yoga book or yoga teacher will advise beginners to exercise for short periods at a time and to stop if there is pain. You will be able to find a selection of moves that will exercise different parts of the body. Remember that if you have rheumatoid arthritis it is not advisable to hold static positions for too long; ten to twenty seconds will be enough. Never do the exercises if your joints are inflamed. During a flare-up rest is best, or otherwise only very gentle exercise.

Here is a selection of moves that I have found useful over the years. These can be found in any basic yoga book but it is a good idea to begin by attending a yoga class as an introduction to this form of exercise. It is easier to learn initially from a teacher and then use a book to help you carry on with the exercises at your own pace. It is advisable to make the teacher aware of any problems that you may have e.g. pain or reduced range of movements. In fact most teachers will probably ask about medical conditions as a matter of course. You will also need to bear in mind joint protection techniques. The teacher may be able to help you to formulate a personal exercise plan. There are different forms of yoga, some of which place more emphasis on meditation while others focus more on exercising the body. All forms will teach yoga positions and all of the tutors will be able to recommend suitable books.

Ankle bends

This exercise relieves swollen ankles and feet, improves circulation and removes fatigue in the legs.

Stand with your feet apart. Roll onto the sides of your feet. Roll your feet outwards and then inwards.

The blade

This relieves tension in the shoulders and upper back and can relieve arthritic pain. It also stretches the shoulder joints.

Bend your elbows and bring your fingertips together so that they touch in front of the chest. Now draw your shoulder blades together. Hold for ten seconds and release slowly.

The flower

This improves flexibility and reduces stiffness in the fingers.

Make your hands into a fist and open your fingers, gently resisting while you do it, like a flower opening in the morning. Release.

Now stretch your fingers open and gradually close into a fist, again resisting while you do it.

Gently move your fingers or shake your wrist.

Hands to wall

This strengthens the arms and wrists and releases tension in the shoulders.

Stand straight, facing a wall about an arm’s length away. Place your palms against the wall with the fingers almost touching. Slowly bend your elbows. Press your palms against the wall and lean forward, resisting all the while until your forehead is against the wall. Hold for ten seconds and return just as slowly.

Posture clasp

This improves the posture and eases tension in the shoulders. It also maintains the flexibility of the shoulder joints and strengthens the arms.

Try to bring your left arm up your back as far as it will go with the palm facing out. Lift your right hand straight up above your head, bend the elbow and bring this hand towards the centre of your back. Try to grasp your left hand by inching your hands gradually together. Hold for a few seconds then gently release. Reverse the hands.

Sitting warrior

This relieves pain in the heels and knees. It is beneficial to prevent fallen arches and flat feet common in rheumatoid arthritis patients.

Kneel in an upright position with your knees together and your feet about half a metre apart. Slowly lower your body to sit between your feet. Keep your back straight and your toes pointed. Relax down. If this hurts too much then sit with your ankles crossed. Gradually over a period of time try to do the exercise with your feet further apart. Alternatively you could place a cushion on your feet and sit on that.

The tree

This will improve circulation and balance. It also encourages good posture and tones the leg muscles.

Stand with your feet together and your arms by your side. Bend your right leg so that the sole of the foot rests against your left thigh. Slide your foot onto your thigh. Your heel should be as high as possible up your thigh. Bring your arms up over your head so that the palms come together. Hold for a about ten seconds or as long as balance permits. Lower your legs and hands slowly.

I have chosen a selection of yoga exercises that are beneficial for the hands and feet, shoulders and knees. These are the most commonly affected joints in rheumatoid arthritis. These exercises will help to maintain a good range of movement in these joints. Try to exercise daily.

The following exercises have been adapted from yoga exercises and simplified. They are easier to do if you have a lot of joint damage.

EXERCISES FOR THE CAR

These can be done when the car is stopped in a queue or perhaps when you are parked and waiting for someone.

Neck exercises

• 1Gently and gradually stretch the neck back and then forward, down onto the chest and back to the normal position.
• 2Now gently and slowly turn to the left and then to the right and back to centre.

Exercises for the shoulders

• 1Lift the shoulders and roll them up and outwards.
• 2Hold the steering wheel with an arm holding each side of the wheel. Have the arms at full stretch and push for a few seconds.

EXERCISES FOR THE CHAIR

Ankle exercises

Stretch the feet out in front of you and circle the feet outwards and then inwards. Now stretch the toes as far forward as you can to the floor. Now bring the toes up as far as you can.

Hand exercises

Place the forearms on the arms of the chair, hands free over the edge with palms down and the fingers relaxed. Lift hands up ... hold ... put hands down.

STANDING EXERCISES

You can do these when, for instance, waiting for a kettle to boil.

Shoulder exercises

• 1Start with the hands at the side and then bring each hand as far as you can up your back, palm outwards.
• 2Now start with your arms above your head, hands together. Bring your arms outwards and gradually down to your sides. Do one hand at a time if this is easier. You can reverse this if possible and start with the arms at the sides and bring them slowly out and up until they touch together over the head.

Elbow exercises

• 1Put your hands behind your head and circle your elbows.
• 2Put your hands into loose fists. Touch them together in front of you at chest height. Now stretch both arms out from the elbows as far as you can and in again.
• 3Touch your fingertips onto your shoulders then stretch your arms out to the front and then open out to the sides.

EXERCISES AT THE KITCHEN SINK

• 1Gently open and close your fingers when washing up and wriggle them around in the water.
• 2Bring the palms up and down a few times keeping the wrists still.

EXERCISES ON THE BED

• 1Lie flat on your back with arms at your sides. Now reach your arms up and back so that they lie flat with your hands above your head. Bring them slowly down.
• 2Lie on your front with your arms by your sides. Now lift your head and shoulders gently up and back, hold and gradually lie down again.
• 3In the same position turn your head to one side, back to the centre and then to the other side to exercise your neck.

EXERCISES FOR THE BATH

Exercise for the arms and shoulders

Sit with your forearms on the edges of the bath. Gently lift yourself up from the water and down again. You could also do the neck exercises as above.

Exercise for the fingers and wrist

Sit with your hands on your thighs. Have the palms flat down and your fingers spread out. Press gently down on your thighs and then relax.

You can also do the shoulder exercise as above (see standing exercises) or the ankle exercises (see exercises for the chair).