Rheumatoid Arthritis and exercise physiology


Young beautiful woman in the gymSeveral months ago I was referred to the Exercise Physiology department of the local hospital to help with my ‘fibromyalgia’.  Even though I have no symptoms of fibromyalgia.

Exercise physiology is still a pretty valuable service for someone with Rheumatoid Arthritis, so I kept myself on the list, and today was my appointment.  In a nutshell, an exercise physiologist will assess current function, strength and mobility and prescribe exercise to improve and/or maintain function.

It started well. When I explained that I don’t believe I have fibromyalgia, and that all my symptoms are in fact explained by uncontrolled inflammatory arthritis, my therapist laughed.  She agreed doctors told them ‘all kinds of shit’.  And let’s worry about it too much.

At her prompting, I told her that I have friends with fibro, and they certainly have different and far more severe symptoms than I do.  And I don’t suffer in the ways that they do.  That I feel in my case ‘fibro’ is just a garbage dump diagnosis, because my bloodwork is clear.   I have ultrasounds and bone scans that show active inflammation, and prednisone helps my symptoms markedly.  These things imply uncontrolled inflammatory arthritis.  My main symptom is pain.  Often severe and unremitting.  But it is very definitely joint pain, and not widespread and diffuse.

She agreed we will proceed under the assumption that I have active inflammation, and plan my exercise therapy accordingly.

Good start!

So she took a history, and asked about my goals.  I told I wish to reduce my pain levels if possible, maintain muscle strength and maintain mobility and range of motion.  My right shoulder, lower back and hips are my main trouble spots right now.

Then she ran me through some functional tests.  Raising arms overhead, and to the side and to the back.  She tested how well I can get up off the floor without assistance.  I did some squats.  Some core strength tests.

The core strength exercises were very similar to exercises I do in my Centergy class every week.  And I did very well on the strength score.  Validation that while I’m getting a bit bored of that class, it really is the best thing for me to be doing for my body.  And I need to keep it up.

She also tested my flexibility, which is pretty dismal.

From here she will come up with a program of exercise for me to follow.  It’s a six week program, and I should attend twice per week.  One session in the gym and one in the hydrotherapy pool

I’ve never done hydrotherapy.  People tell me it’s fantastic. I have to admit, I’m not keen. I am NOT a water baby. I HATE swimming.  But this does sound more like a great big warm bath, so I will give it a shot.

The gym work is going to focus on strengthening my lower back in the hope that it will decrease pain and improve function.  Just from the brief assessment, she could see that I am compensating in all sorts of bad ways to get an exercise done.  For example, my form during squats is terrible.  She believes that’s because of my arthritic hips, tight hip flexors and quads.  She has already told me I am trying to go deeper than my joints will allow, and causing myself more problems with muscle tightness.  So I have to accept that I can’t do ‘proper’ squats. I have to do baby squats.  To protect my knees, my lower back and my hips.

I’m stubborn to the point of stupid, and I pretty much knew this already.  I’m a qualified personal trainer.  If I were my client I would tell me to suck it up and accept my limitations.

But I’ll take it from my new exercise physiologist.  She knows her stuff.  She listened to me.  When I told her that I am in constant pain but I exercise anyway, she didn’t argue.  When I told her that I take extra oxycodone so that I can go to the gym TO exercise, she understood.  She did say that someone like me is unusual – people generally won’t exercise through pain. They will stop.  She didn’t say it in a way that implied she didn’t believe me.  She said it in a way that implied that I am unusual!

I told her I have exercised all my life, and love exercise.  That before arthritis entered my life I used to run 5km three or four times a week.  Not competitively, I was slow as a wet week.  Just for enjoyment and to keep myself fit and healthy.  Consequently I remain physically stronger than most people in my position.  I had a pretty strong base to start with.  And a very strong desire to keep exercising.

Maybe I’m not strong compared to healthy people.  But I can still do push-ups on my toes.  Only six correct push-ups, as I found out today in my strength assessment.  At that point the pain in my wrists and shoulder is too much.  And my muscles aren’t as strong as they used to be.  I used to do easily double that, only a year or so ago.  The last year my decline has been accelerating and I will do anything I can to slow it down.

So I have a little hope that my exercise physiologist can help me in that regard.  I’m hopeful she can show me how I can keep exercising, weight training, and maybe even light jogging, with adaptations.  With less pain. During my latest prednisone burst (over now) I had been doing a bit of jogging on the treadmill.  Because I love it.  For me, it is the best stress relief, to just do a slow jog with my ipod. Escape from everything.

Of course it causes quite some pain, now that I’m only on 15mg of prednisone.  But, in truth, a light jog doesn’t really hurt any more than walking does.  And it gives me more benefits.  So I’m hoping to keep doing it.

There are days though when my head is just not in the game. Where I feel sorry for myself.  Where it feels too hard.  Where I just think it’s not fair that it has to hurt so damn much for me to do something that’s good for me…something that I enjoy.  The number of those kinds of days is directly related to the number of high pain days I am having.   And I am now back to three or four high pain days per week.  No mild days.  And let’s not talk about the nights.

If I didn’t take oxycodone I would be spending most of my time on the couch.  So I keep exploring pain relief options.  I keep looking for ways to keep active.

And it’s Monday. That means it’s Orencia day. Usually Monday’s are bad…which shows me that Orencia is helping.  Tuesdays I am nauseous and extra fatigued.  Wednesday and Thursdays have tended to be better days.  Today will be my tenth shot.  I believe it is helping a little.  And I believe it will improve more over coming weeks. I have to believe.

And in the meantime I am going to start hydrotherapy.  A new adventure.


  1. Thank you! That’s what I need! I’m going to ask my rheumy about an exercise physiologist at my next appointment. I have a job which involves being on my feet all day and lifting heavy things, so I can see how unbalanced my muscles are and I know I do all kinds of unhelpful compensatory things to pull it off. This post is a light in the tunnel.

  2. Hi I really hope you enjoy the hydrotherapy. She sounds like a good and thorough woman. I’m really glad to hear that the Orencia is helping and hope it further improves for you.

  3. I hope it does you some good. I don’t think it will do any harm at least. I should probably give it a go myself. I could join the YMCA and go in the mornings…but that would mean I would have to get up at like 6:00 a.m. before work. I always have an excuse!!! LOL! I’ve heard good things about hydrotherapy though and I should really try it.

    • That’s not an excuse…6am is not a reasonable time for anyone with RA…LOL. I’ll blog about the hydrotherapy. Im not keen, but I’m lucky to have the opportunity.


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