If walking is comfortable, this can be a great way to get aerobic exercise and to strengthen muscles that support the joints.
Koster suggests patients keep a walking journal, start slowly and use a heart rate monitor. Keeping track of your heart rate, feelings of exertion and any pain can help you get a baseline for your abilities. To start, try walking on flat land for 15 minutes.
The Arthritis Foundation Aquatic Program puts on water aerobics classes across the nation to help people reduce pain, decrease feelings of isolation, build strength and flexibility and improve day-to-day life, according to the organizations website.
Low impact is best, Kestor said. The more we can exercise the joints and muscles without triggering more inflammation, the better. In higher impact exercises, the pressure on the body can cause swelling, he explained.
Swimming is another great low-impact exercise, but Kestor issues a word of caution for both this sport and water aerobics:
“Patients typically feel a lot better in the water because of the buoyancy, so people tend to overdo it,” he said. “The take home message is to always act on the conservative side and gradually increase your workload.”
For those who need less stress on knee, foot and ankle joints, biking is an excellent form of exercise, according to the Cleveland Clinic. Whether you’re on a stationary bike or riding a cruiser through the countryside, biking can help build or maintain cardiovascular fitness without added pressure on the body.
Ideally, a workout program can include many of the exercises listed.
“A program that’s based on walking, cycling, aquatics classes and nutrition gets things firing on all levels,” Koster said. “It’s a nice, balanced strategy.”
Research from the Hospital for Special Surgery in New York City showed that weekly hospital-based fitness programs significantly improved balance, pain, enjoyment of life, and the severity and frequency of falls in a group of 200 patients. The programs included dance fitness and several other types of exercise.
Pilates was also effective in the HSS study and is a type of exercise Baker uses with patients.
“Pilates teaches you how to align your body and use your core to maintain alignment,” she said. “That is incorporated into our exercise program and it is crucially important.”
Because many people start exercise programs after leading sedentary lives, they may not think about or know how to use their core. For this reason, core isolation exercises a necessity in physical therapy.
Leg raises can help target notoriously weak muscles in the leg, such as the abductors or those in the outside of the thigh, Baker said. This is important to build overall strength and restore functionality to the joints. To do leg raises, lie on your right side with your head resting on your right arm and your body stacked in one line. Keep your right leg flat on the ground as you lift your left leg as high as it will go or until the leg is perpendicular to the ground. Repeat the exercise ten times for three sets on each side, stopping if you experience any pain.
Squats not only work many muscles, but can help train the body to do essential every-day activities, such as getting out of a car, Baker said.
Koster agrees, citing seniors who lives by themselves and need “to be able to get into their dish washer, bend down to get the dish and stretch up to put it away.”
Work with your physical therapist to learn proper squatting technique and variations on this common exercise that can help increase mobility and strength.
Although just a handful of scientific studies have considered the effects of yoga on arthritis, the results have been promising, according to The John Hopkins Arthritis Center. Yoga may help improve joint health, physical functioning, quality of life, and mental and emotional well-being.
The recumbent stair stepper is particularly effective for those with back pain, balance disorders or who don’t feel comfortable exercising upright on an elliptical or treadmill, Koster said. These machines help build quadricep, glute and hamstring mobility, as well as exercise the knee and ankle.
For this strengthening exercise, Baker often starts her patients with a step that is just a couple of inches off the floor. Depending on the strength of the patient, the step can be adjusted to the point that a person’s thigh is parallel to the ground. Baker then shows patients how to step up while engaging muscles in the core and around the joints.
“It’s back to teaching,” Baker said, citing common technical mistakes patients make in this exercise. “People tend to go up and down stairs with their knee driving forward of their toes, most of the weight on the front of the foot and overusing the quads.”
After patients understand the mechanics, Baker takes them to a stairwell and asks them how they would climb multiple stairs using the method. If they understand the technique and how to engage their muscles, this can help patients limit pain in their daily activities, where they’ll likely have the most problems, Baker said.
“When your joints get inflamed and are arthritic they don’t’ want to move, even though movement can be good for them,” Koster said. Manual stretching done on your own or with a physical therapist can help loosen the muscles key for exercising the joints. Stretching is therefore important in any program for arthritis sufferers. Koster recommends long-duration stretching—holding positions gently for 30 seconds up to a minute—and often has his patients use a strap to stretch muscles including the hamstrings.
Quadriceps also often need a good stretch and can be harder to reach, especially while maintaining good form, Baker said. A lot of people are not flexible enough to grab their foot or can only do so while torquing and throwing their hips out of alignment. Instead of this common technique, Baker recommends the stretch pictured to the left.
Keeping your hips level, move the leg you want to stretch onto a chair or box behind you, while keeping a soft knee on your standing leg. Start with both knees together and, as you need more of a stretch, you can move into a deeper stance, like the one pictured. The support knee should never come forward of the toes as it bends.