Overview of Rheumatoid Arthritis
This condition is a systemic, inflammatory disease that affects the articular and connective tissues. The disease process is characterized by periods of exacerbations and remissions. Clients develop progressive degeneration of articular structures, which lead to severe deformities and disabilities. The disease initially affects the joints of the hands, feet, and cervical spine. Progressions affect numerous tissues and organs, which may limit activities. During periods of exacerbations, clients experience severe limitations in mobility. Prolonged periods of rest result in joint pain and stiffness, which further reduce the client's activity level. The client may develop limited aerobic capacity, which affects endurance as the condition progresses.
Nonarticular Manifestations of Rheumatoid Arthritis
Comorbidities to Consider
Keys to Examination of Clients
Recent imaging studies of joint structures may help determine the progression of joint degeneration and connective tissue involvement.
Assess the ankles and feet for signs of extensive degeneration, which may benefit from orthotics and assistive devices during exercise activities.
Recommended Baseline Testing of Fitness Levels
Screen the client's posture, range of motion, and strength to determine general mobility.
Measures of aerobic fitness can be assessed with walking or cycling tests.
Condition-specific quality-of-life inventories, levels of fatigue, and depression are useful measures for determining the effects of an exercise program.1
Type: Walking, cycling, recreational activities, weight training
Intensity: Low to moderate intensities
Duration: Start at 20 minutes
Frequency: Three to five times per week
Clients initially benefit most from a supervised exercise program that combines strengthening activities, aerobic training, and recreational activities.1,2,3,4,5 Recreational activities of badminton, indoor soccer, basketball, volleyball, and step aerobics have been successfully used in group exercise sessions.2 Clients' mobility and exercise tolerance will be greatly diminished during periods of exacerbations. Clients may experience temporary joint pain after participating in strength training. Joint pain that continues for longer than 1 hour would indicate that the exercise was excessive. Clients with extensive damage of large lower extremity joints should avoid activities that excessively load these joints.
Aerobic exercise of bicycle ergometer for 20 minutes at a perceived exertion level of 4 to 5 out of 10 is recommended along with 20 additional minutes of recreational activities. An intensive exercise program described by de Jong et al combines the effects of strength training and aerobic and recreational activities.2...