Exercise (aerobic + resistance)

Reduces pain and improves function. Multiple systematic reviews and guidelines conclude that both aerobic and strengthening programs produce small–moderate improvements in pain, physical function, and fitness in RA. Cochrane

Safe and recommended as standard care. EULAR (European Alliance of Associations for Rheumatology) explicitly states that general public-health PA targets are applicable to people with RA, and exercise should be part of routine care throughout the disease course. The 2018 recommendations (with an update underway) provide clear, evidence-based endorsement. BMJ Advances in Rheumatology

Addresses cardiovascular and fatigue burden. RA confers elevated cardiovascular risk and disabling fatigue; structured training (including HIIT and strength work) improves cardiorespiratory fitness, fatigue, and overall health metrics. British Journal of Sports Medicine

Fits within integrative RA management. The American College of Rheumatology (ACR) guideline recommends consistent engagement in exercise alongside DMARD therapy as part of comprehensive care. ACR Journals

Baseline principle: EULAR affirms that the WHO adult physical-activity targets are appropriate for RA—tailored to symptoms, flares, and joint status. That means aiming for 150–300 min/week of moderate aerobic activity (or 75–150 min vigorous), plus muscle-strengthening ≥2 days/week, with added flexibility/balance work. Progress gradually and individualize to disease activity. BMJ Advances in Rheumatology

Aerobic training (pick one or mix):

• Frequency/volume: 3–5 days/week to reach the WHO weekly total. Sessions can be broken into 10–20-minute blocks if needed. Options include brisk walking, cycling, swimming/aquatics, or low-impact machines. World Health Organization
• Intensity: Moderate (you can talk but not sing) is a reliable target; some patients can incorporate intervals/HIIT once symptoms are stable (e.g., short hard bouts interspersed with recovery), which improves fitness and health metrics in RA. British Journal of Sports Medicine
• Environment tips: Aquatic exercise reduces joint load and can be especially helpful during stiffness or mild flares. wwl.nhs.uk

Resistance (strength) training:

• Frequency: 2–3 non-consecutive days/week. BMJ Advances in Rheumatology
• Prescription: 8–10 exercises covering major muscle groups; 1–3 sets of 8–12 reps each. Start light (e.g., bands or light free weights), emphasize slow control and full (comfortable) ranges, and progress load by ~5–10% when sets feel easy and form is solid. SAGE Journals
• Hands/feet: Use padded handles/bands, adaptive grips, or wrist/foot orthoses if needed to protect tender small joints. (See patient-facing ACR/Arthritis Foundation resources for practical adaptations.) American College of Rheumatology

Flexibility & balance:

• Gentle daily range-of-motion for affected joints, plus 2–3 days/week of stretching and balance drills (e.g., Tai Chi, single-leg stands). These are embedded within EULAR/ACR advice. BMJ Advances in Rheumatology

During a flare (swelling, warmth, marked tenderness):

• Prioritize range-of-motion, isometrics, and light activity (e.g., short walks, water-based movement). Defer heavy resistance/high-impact until the flare settles; then return gradually to prior loads. wwl.nhs.uk

Getting started resources:

• ACR’s patient page and the Arthritis Foundation provide practical “how-to”s, warm-ups, and joint-friendly options. American College of Rheumatology

EULAR recommendations (2018; update in progress): Establish that standard public-health PA targets are suitable and beneficial for RA and other inflammatory arthritides; promote aerobic, strength, flexibility and reduce sedentary time. BMJ Advances in Rheumatology

ACR Guideline (2022; updated materials 2023–2024): Strongly recommends consistent exercise as part of integrative RA management (with DMARDs), summarizing evidence across modalities. Open-access summary/PDF available. CDC Stacks

Cochrane review – dynamic exercise (aerobic and/or strength): Shows improvements in pain and physical function and supports safety of land-based programs. Cochrane

Meta-analysis (2022, BMC Sports Sci Med Rehabil): Aerobic exercise is effective and safe for RA; RCT synthesis across outcomes. (Free full text/PDF.) BioMed Central

Multicentre RCTs (HIIT + strength): High-intensity interval and strength training improve cardiovascular health, fitness and multidimensional fatigue in RA, supporting inclusion of intervals when disease is stable and supervised as needed. British Journal of Sports Medicine

Narrative/systematic overviews: Summarize consistent gains in function, fitness, strength, cardiovascular risk factors, and fatigue with appropriately dosed exercise. ScienceDirect