Essential-Information-and-Expert-Advice-booklet-on-physical-activities-and-exercise-for-people-with-RMDs

Physical activities
<strong>and</strong> exercise
for people with
rheumatic <strong>and</strong>
musculoskeletal
diseases
walking
dancing
home gym
cycling
tai chi,
qigong,
yoga &
Pilates
swimming
& water
exercises
home &
garden
<strong>Essential</strong> information
<strong>and</strong> expert advice

Physical activities <strong>and</strong> exercise
for people with rheumatic <strong>and</strong>
musculoskeletal diseases
Contents
1.0 General information <strong>and</strong> advice PAGE
1.1 Benefits of physical activity 3
1.2 Good posture <strong>and</strong> body alignment 3
1.3 Good technique <strong>and</strong> using aids <strong>and</strong> adaptations 3
1.4 Safety 4
1.5 How much exercise <strong>and</strong> how often 4
1.6 Level of exercise 4
1.7 Starting out 4
1.8 Getting it right 4
1.9 Best time to exercise 5
1.10 Keeping motivated 5
1.11 Exercising to music 5
2.0 Being physically active <strong>and</strong> exercising inyour daily life
2.1 Setting goals 6
2.2 Making time 6
2.3 Joining a gym or exercise class 6
2.4 Measuring results 6
2.5 Home exercise DVDs 7
2.6 Assistive technologies <strong>and</strong> equipment 7
3.0 Questions <strong>and</strong> answers
Q 1: Should I warm-up <strong>and</strong> cool-down before <strong>and</strong> after doing exercise? 8
Q 2: Can I exercise when I’m in pain? 8
Q 3: What should I do if I feel pain when I’m exercising? 9
Q 4: Can I exercise when I’m having a flare? 9
Q 5: How can I be physically active when I am constantly tired? 9
Q 6: Will even small amounts of physical activity help me lose weight? 9
4.0 Glossary of common terms used to describe different types of exercise 10
Acknowledgement
We would like to thank Christina Opava, Professor of Physiotherapy at the
Karolinska Institute, Stockholm, Sweden, for providing her expert advice <strong>and</strong>
for reviewing all the materials provided in this World Arthritis Day series on
physical activity <strong>and</strong> exercise.

1.0 General information <strong>and</strong> advice
Being physically active is good for general health <strong>and</strong>
can have specific benefits for people with rheumatic or
musculoskeletal disease (RMDs). The most appropriate
form of activity will depend on a number of factors including
the type of RMD you have, which joints are affected <strong>and</strong>
the level of joint damage etc. This is why it is important to
consult your doctor or physiotherapist about the type of
exercise you need therapeutically, as well as the type of
activities you enjoy doing to keep you healthy.
The less active you are in daily life the more your joints will
stiffen up, the less energy you will have to perform tasks
<strong>and</strong> the less exertion it will take for you to feel pain.
Before you start
Please always talk to your doctor or physiotherapist
before you start any new form of exercise. If you have
never taken an exercise class, it is important that you
learn to use the correct techniques from a qualified
instructor.
The term physical activity is used to describe any form
of daily activity that involves movement, rather than sitting
or lying still. This could include playing with children,
doing housework, walking the dog, gardening etc. Being
physically active can have many benefits for people with
RMDs including releasing stiffness <strong>and</strong> lifting your mood.
The term exercise is used to describe planned, structured
<strong>and</strong> repetitive movements that are performed frequently,
at a given intensity <strong>and</strong> for a set duration of time. Exercise
can be therapeutic, such as in rehabilitation, or taken as an
enjoyable way of improving or maintaining:
• Muscular strength <strong>and</strong> endurance
• Flexibility <strong>and</strong> joint mobility
• Motor functions including coordination <strong>and</strong> balance
• Aerobic capacity <strong>and</strong> increased energy expenditure,
which can help with weight control
• Bone mineralisation contributing to the prevention of
osteoporosis
• Mood <strong>and</strong> self-esteem leading to increased positivity
1.1 Benefits of physical activity
There are so many ways that physical activity can benefit
your body <strong>and</strong> your mind. Staying physically active can
help alleviate pain, stiffness <strong>and</strong> fatigue as well as helping
to keep you mobile. When you are physically active you are
also helping to ‘feed’ your joints as cartilage depends on
joint movement to absorb nutriwents <strong>and</strong> remove waste.
Being physically active can also be stimulating, give you a
sense of achievement <strong>and</strong> lift your mood.
1.2 Good posture <strong>and</strong> body alignment
It’s easy to let yourself slump when you are tired or to hold
yourself awkwardly when your muscles are stiff <strong>and</strong> painful,
but this can put extra stress on your body. Trying to keep
your body as well aligned as possible not only allows you
to move more freely, but can also help with other functions
such as breathing, digestion <strong>and</strong> your mood. Think tall <strong>and</strong>
imagine there is a string attached to the top of your head
that is gently pulling you up, whilst at the same time allow
your shoulders to relax down.
1.3 Good technique <strong>and</strong> using aids <strong>and</strong> adaptations
Many musculoskeletal problems <strong>and</strong> injuries are caused by
using poor technique when performing everyday tasks such
as st<strong>and</strong>ing, sitting <strong>and</strong> lifting. If you already have an RMD
it is important that you consciously adopt good techniques
<strong>and</strong> that you adapt your work spaces to your needs.
There are many aids <strong>and</strong> specially designed items for
people with RMDs that can be used to help you with
everyday tasks such as opening bottles <strong>and</strong> cans, holding
cooking pots <strong>and</strong> picking items up from the floor (see also
equipment).
An occupational therapist will be able to advise you on
home <strong>and</strong> workplace adaptations. In some countries
physiotherapists run special courses for people with
RMDs to show them how to adopt correct techniques
for using equipment <strong>and</strong> performing tasks such as
ironing, vacuuming <strong>and</strong> other everyday activities. Your
physiotherapist will be able to help you with your posture
<strong>and</strong> body alignment.
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Physical activities <strong>and</strong> exercise
for people with rheumatic <strong>and</strong>
musculoskeletal diseases
1.4 Safety
Most accidents happen in the home, so do take particular
care if you are stretching for hard to reach items, using
a ladder, lifting or moving heavy items, or working with
slippery or hot surfaces. If you have tasks where there is
an extra risk that you could slip, fall or injure yourself, ask
a family member or friend to help – with two of you, tricky
tasks will be more fun <strong>and</strong> safer.
1.5 How much exercise <strong>and</strong> how often
When you repeat activities regularly your body will adapt
over time <strong>and</strong> you will find you can do more with less effort.
Regular exercise can also help slow, or prevent loss of
function due to disease progression.
Ideally, you should try <strong>and</strong> do thirty minutes of exercise a
day, or at least three times a week. If you can’t commit to
thirty minutes at a time, then exercise for a shorter time, but
with 100 percent concentration. Put the time in your diary
<strong>and</strong> stick to it!
Did you know?
The word ‘fit’ comes from:
Frequency – how regularly you exercise
Intensity – how hard you exercise
Time – how long you exercise
Now the word fitness is used to describe health <strong>and</strong>
the ability to meet the dem<strong>and</strong>s of a physical task.
Try <strong>and</strong> include some stretching/flexibility exercises every
day, muscle strengthening <strong>and</strong> endurance exercises two
to three times a week <strong>and</strong> some form of aerobic exercise
for 20 minutes three times a week. Some forms of exercise
combine different types of exercise in one session, e.g.
dancing.
The key is to find things you enjoy doing so being active is
something you look forward to <strong>and</strong> becomes part of your
daily life.
1.6 Level of exercise
What will be a hard or difficult form of exercise for one
person may be much easier for someone else. For
example walking, cycling or swimming at a gentle pace
(low intensity), might have an aerobic effect (increase your
heart rate <strong>and</strong> breathing) for some people, whilst others
would need to exercise at a moderate to high intensity to
experience the same effect. This will depend on a number
of factors such as your age, your general state of health,
disease progression <strong>and</strong> how regularly you have been
exercising. Choose a level of exercise that works for you.
1.7 Starting out
If you haven’t exercised before, or you have not exercised
for a while, always start gently <strong>and</strong> build up slowly over
time. It is better to do little <strong>and</strong> often than to overdo things
<strong>and</strong> push yourself too hard when you start exercising.
When you reach your required level of function, you will
need to keep up regular activities to maintain this level.
If you’ve never done any exercise before it is very important
that you check with your doctor or physiotherapist first <strong>and</strong>
learn correct techniques from a qualified instructor.
1.8 Getting it right
How you exercise <strong>and</strong> using the correct techniques is very
important to ensuring that what you are doing is having the
desired effect. If you are using a manual or video, always
follow instructions carefully. We recommend you go through
your exercises with your physiotherapist or a trained
instructor who can show you the right way to perform your
moves <strong>and</strong> will help you to adapt any exercises you are not
able to manage. Your doctor, physiotherapist or trained
instructor will also be able to advise you how to adjust
exercises to your needs.
TIP
Let the teacher know about any specific problems you
have, or movements you are unable to perform before
starting a class. This will allow the teacher to give you
an alternative movement, or to modify the way you
perform a movement, or adopt a yoga pose.
Your teacher should also ensure you are performing
each movement correctly <strong>and</strong> with good technique.
It’s easy to get into bad postural habits, such as having
one shoulder higher than another. When this happens your
body compensates <strong>and</strong> you start to hold yourself unevenly.
Because you are doing this daily, it can feel strange when
4

Best time to exercise
Morning
If you have morning stiffness, warm
up with gentle stretching <strong>and</strong> mobility
exercises. Research suggests people
who exercise in the morning are more
likely to stick to their programme.
Try doing your strength <strong>and</strong> aerobic
routine after your warm-up stretches
<strong>and</strong> mobilising exercises.
Afternoon
Some research suggests that the
best time to exercise is late afternoon
(around 16.00 - 17.00) when your
body temperature is at its highest,
muscle strength is at its greatest
<strong>and</strong> you are least likely to sustain an
injury.
Evening
Most research suggests that exercise
can improve sleep quality, even when
taken in the morning or afternoon. It
is not clear if evening exercise keeps
you up, but If you find exercising in
the evening stops you sleeping, find
another time of day, as a good night’s
sleep is important for your health.
you even up your body so you are correctly aligned. This
is why it is helpful to exercise in front of a full length mirror,
as this will show you the correct alignment, even if this may
feel strange at first.
Good posture <strong>and</strong> body alignment are an important aspect
of dance technique. From head to toe, to the tips of your
fingers, every part of your body is involved in giving shape
to your dance. Lengthening your spine <strong>and</strong> holding in your
abdominals not only gives you better control <strong>and</strong> balance,
but creates fluid <strong>and</strong> elegant lines <strong>and</strong> a confident, alert
appearance, all of which can be practised in your everyday life.
1.9 Best time to exercise
You can’t always choose when you exercise because
of work or family commitments. In general, if you can
consistently exercise at the same time, you are more likely
to keep to your programme <strong>and</strong> get better results. However,
if you are having a flare you may need to adjust the time
<strong>and</strong> intensity of your exercises.
1.10 Keeping motivated
Some people are naturally inclined to be less active than
others but when you have a rheumatic or musculoskeletal
disease (RMD), pain, fatigue <strong>and</strong> stiffness can add to
reasons why might you want to move as little as possible.
Just knowing something is good for you is not motivating
enough for most people, so it can help if you set yourself
some small, realistic goals <strong>and</strong> build an element of
enjoyment or reward into increasing your daily physical
activities. Because RMDs can fluctuate you may need to
reassess your goals <strong>and</strong> modify what you can do when you
are having a flare, or if you are undergoing rehabilitation. Do
discuss this with your physician or physiotherapist.
It can also help to exercise with a friend or in a group. A
number of organisations for people with RMDs offer special
classes <strong>and</strong> activities for people with RMDs. Exercising
with others can be more fun than exercising alone <strong>and</strong>
you could meet new like-minded people. Making a
commitment to go for a walk with a friend or attending a
regular class also makes it more likely you will stick with
an activity. Many groups for people with RMDs organise
walks <strong>and</strong> swims to raise funds – joining one of these
events will be good for you <strong>and</strong> for your organisation!
Two of the main reasons people give for not exercising are
lack of results <strong>and</strong> lack of time (see 2.1 <strong>and</strong> 2.2). Try varying
the type of exercise you take – check out the different
physical activities suggested in our fact sheets. Invest in
a pedometer <strong>and</strong> count the number of steps you take in a
day. Every step counts from moving around in your kitchen
to walking the dog
1.11 Exercising to music
Exercising to music that you enjoy can be motivating <strong>and</strong>
– depending on the type of music you like – can give you a
beat to move to.
Music helps you focus <strong>and</strong> keeps you motivated:
Following the rhythm of the music whilst you exercise is
pleasurable <strong>and</strong> helps you concentrate on what you are
doing, whilst taking your mind off negative feelings such as
fatigue.
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Physical activities <strong>and</strong> exercise
for people with rheumatic <strong>and</strong>
musculoskeletal diseases
Even when you are feeling low, music can help lift your
mood <strong>and</strong> get your feet tapping – you can even sing along
as you exercise! When you listen to music you enjoy you’re
more likely to be motivated <strong>and</strong> adhere to your exercise
programme.
Music acts as a performance aid: Music can help you
keep up your pace or cool down. Choose an energising
tempo for aerobic exercise, a steady beat for repetitions in
strengthening exercises <strong>and</strong> for warm up exercises, <strong>and</strong>
slow, mellow music for stretching <strong>and</strong> relaxation. When you
are in sync with the music exercise seems smoother <strong>and</strong>
you can time each section of your workout. If you have an
iPod you can download 30 minutes of tracks to keep you
going <strong>and</strong> help you time each element of your session.
2.0 Being physically active <strong>and</strong>
exercising in your daily life
Even if you can’t get out to exercise, there are many ways
you can increase your physical activity in your daily life at
home, as well as doing a more formal exercise regime (see
fact sheets on ‘Home Gym’ <strong>and</strong> ‘Home <strong>and</strong> Garden’)
2.1 Setting goals
Before you start to put more activity into your daily life you
need to decide what you want to achieve, for example you
may want to improve your general fitness <strong>and</strong> wellbeing
to be able to get out <strong>and</strong> about more, or you may have
more ambitious goals such as to participate in competitive
sports. We recommend you discuss your goals <strong>and</strong>
the best type of exercise for you with your doctor or
physiotherapist before starting.
Setting goals can help keep you motivated, which is
important if you are exercising on your own. Have an
aspiration, focus on what you can do, set yourself small
achievable goals which come with a reward. For example,
if you improve your strength <strong>and</strong> stamina it may help you to
attend a special event or go on a holiday.
2.2 Making time
It’s very easy to put off exercising, especially if you are
working out at home. You need to be disciplined. Ideally,
you should try <strong>and</strong> do thirty minutes of exercise every day
or at a minimum three times a week. To add variety to your
workouts you can alternate strength training, flexibility
training <strong>and</strong> aerobic training, such as going for a brisk walk
or bike ride, on different days. If you can’t commit to thirty
minutes at a time, then exercise for a shorter time, but with
100 percent concentration. Put the time in your diary <strong>and</strong>
stick to it!
2.3 Joining a gym or exercise class
Joining a gym, exercise or dance class, swimming pool
or sports centre provides you with a formal structure <strong>and</strong>
access to a qualified teacher. Investing in an activity,
committing to exercise at specific times in the week <strong>and</strong>
working out with others can all give you an added incentive.
A number of organisations for people with RMDs also run
classes.
If you are not able to join a formal exercise session, then
create your own regime – see the fact sheets on Home
Gym, Home <strong>and</strong> Garden, Cycling, Swimming <strong>and</strong> Walking
all of which you can do on your own or with friends.
2.4 Measuring results
To be effective exercise needs to be done regularly, at a
given intensity <strong>and</strong> for a set amount of time. As your body
adapts to the extra work you are doing when you exercise,
so you will see improvements.
Because your body’s response to exercise is not instant
you may not notice any immediate difference. You can
keep an exercise diary in which to note a few simple
measurements.
Depending on the aims of your exercise programme, you
can note how far you can stretch, how many times you can
repeat a movement with or without an added weight of xx
grams / kilos etc.
You can also note how you are feeling at the start of your
programme – your general well being, your mood, your
sleep <strong>and</strong> what you are able to do. For example, do you get
out of breath when you climb more than 10 stairs or walk
a certain distance? Do you find it hard to pick up objects
because your grip is weak, or you are too stiff to bend?
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Once you have set your baseline measurements at
the beginning of your programme you can take the
measurements again four to six weeks later <strong>and</strong> see if
you can notice a difference. Once you have reached your
desired goal, then you must continue to keep up your
exercise programme at a maintenance level. If you have
been sticking to your routine <strong>and</strong> cannot see a measurable
difference, don’t be despondent. When you have an RMD
<strong>and</strong> your body’s ability to perform certain movements may
be declining, success may be in maintaining your range of
movement or level of fitness over a longer period of time.
It is also recommended that you have periodic check-ups
with your physiotherapist or physician, who can monitor
your progress <strong>and</strong> advise you if you are experiencing any
changes in your condition.
2.5 Home DVDs
If you are going to use a DVD, do be careful that you are
using the right techniques to perform the movements. You
can go through the exercises with your physiotherapist or a
trained instructor to make sure you are adopting the correct
position <strong>and</strong> using the right muscles. Your physiotherapist
or a trained instructor can also help you to adapt any
exercises that you may find too difficult or that are not
suitable for your joint problem. Use a full-length mirror or
ask a friend to help you check your technique at home.
TIP
• Move to Improve! Incorporate physical activity
<strong>and</strong> exercise into your daily tasks
• Set yourself achievable goals <strong>and</strong> challenges to
stay motivated <strong>and</strong> rewarded
• Use aids to help you stay physically active <strong>and</strong>
able to do more
2.6 Assistive technologies <strong>and</strong> equipment
A range of equipment is available to help you perform
everyday tasks <strong>and</strong> remain physically active.
‘Grabbers’: If you have problems bending your back <strong>and</strong>/
or your knees, you can use a specially designed ‘grabber’
to help you reach items on the ground.
Walking sticks: There are a number
of different types of walking sticks
to choose from depending on your
need <strong>and</strong> preference. These include
traditional wooden sticks with a crook
h<strong>and</strong>le, adjustable lightweight aluminium
walking sticks with ergonomic h<strong>and</strong>les which spread the
weight over a wider area <strong>and</strong> are shaped for right or left
h<strong>and</strong> use, folding walking sticks, shooting sticks with a seat
built in <strong>and</strong> hiking poles.
Walking frames: Many people desist
from using a walking frame for as long
as possible because they feel it makes
them look old <strong>and</strong> infirm, even if using
one would allow them to go to places
<strong>and</strong> do things they would otherwise
not be able to do. Walking frames can vary from a simple
frame to a folding frame with wheels <strong>and</strong> an added
shopping basket. Using a walking frame can help you get
about <strong>and</strong> remain independent.
Household
appliances: vacuum
cleaners: Choose a
lightweight model (6kg
or less). Light cylinder
cleaners are less bulky
<strong>and</strong> easier to carry close to your body. Check that:
• the cleaner is well balanced when being carried
• the cleaner can be held clear of the ground, on upright
cleaners check that the cleaning head stays in position
when carried
• it is small enough to be carried close to the body
• the carrying h<strong>and</strong>le has rounded edges <strong>and</strong> a
comfortable grip, for uprights check this with the flex
stored
• the carrying h<strong>and</strong>le can be used with one h<strong>and</strong> or two
• the accessories stored in the cleaner stay in position
when it is moved
Other vacuum cleaners have small bodies which can rest
on stairs, or with long extensions that allow you to clean
without having to move the body of the cleaner.
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Physical activities <strong>and</strong> exercise
for people with rheumatic <strong>and</strong>
musculoskeletal diseases
Other useful household gadgets: There are any number
of useful, mostly inexpensive, household gadgets that can
help you in your day-to-day life. These include:
• Stools to perch on
• Jar openers
• Bath or basin plugs with h<strong>and</strong>les
• Tap turners
• Broad h<strong>and</strong>le kitchen utensils
• Knob turners
Adaptable gardening tools:
There are many adaptable gardening tools to choose
from. H<strong>and</strong> tools come with large easy to hold grips <strong>and</strong>,
if needed, wrist supports. Some of these tools also come
with interchangeable heads.
Choose a spade or fork of the right length <strong>and</strong> weight to
help avoid some of the stresses <strong>and</strong> strains of digging.
T-shaped h<strong>and</strong>les can help you push the tool into the soil
<strong>and</strong> a centre tread gives you maximum force.
Equipment: Most exercise classes will provide mats
<strong>and</strong> other equipment needed for the class. Some of this
equipment can also be purchased <strong>and</strong> used at home, such
as exercise bikes, resistance b<strong>and</strong>s <strong>and</strong> exercise balls (see
‘Home Gym’). Ensure you have been fully instructed on
how to use any equipment before you try it at home.
Clothing: You need to be able to move freely <strong>and</strong> not be
restricted by what you are wearing so a T-shirt <strong>and</strong> leggings
or tracksuit bottoms are ideal for most forms of exercise.
Shoes: Most forms of weight-bearing exercise will require
you to wear trainers that support your foot <strong>and</strong> provide
some form of cushioning from the impact to your feet.
Some forms of dance may suggest a specific type of shoe.
Ensure the shoes you choose are wide fitting so your
feet have plenty of space. Some yoga <strong>and</strong> tai chi classes
may recommend bare feet to prevent you slipping <strong>and</strong> to
connect you to the ground. If you want to wear something
on your feet choose soft flexible shoes with thin soles, such
as Kung-fu slippers or socks with grips on the soles. Built
up trainers may skew your connection with the ground,
which is considered a vital source of energy <strong>and</strong> balance in
eastern practices.
3.0 Frequently asked questions
Below is general advice for people with rheumatic <strong>and</strong>
musculoskeletal diseases (RMDs), but individuals may
have specific problems. Always check with your doctor
or physiotherapist before you start a new form of physical
activity or exercise.
Q 1: Should you warm up <strong>and</strong> cool down before <strong>and</strong>
after doing exercises?
A: It is always a good idea to do some gentle movements
to warm up <strong>and</strong> prepare your body before you go into a
more intense routine. When you have finished the intense
part of your routine, slow down <strong>and</strong> do some stretching
exercises.
Q 2: Can I exercise when I’m in pain?
A: Many people with RMDs find their pain is preventing
them from taking up exercise, but being physically active
is crucial if you have an RMD. If you are avoiding moving
around when it hurts there is a risk you will lose the mobility
<strong>and</strong> the strength you need to perform daily tasks. Your
body will adapt quickly to being physically activity – or to
being inactive. The less active you are in daily life the less
energy you will have to perform tasks <strong>and</strong> the less exertion
it will take for you to feel pain.
Talk to your doctor about pain control that will make it
easier for you to start exercising. In many cases the need
for extra pain control will wane over time if you are engaged
in regular exercise.
Often pain decreases when you are exercising, partly
because the body’s own pain relief system is activated
by muscle work <strong>and</strong> an increase in endorphin levels.
Additionally, many exercise classes will involve your
concentration. Concentrating on what you are doing not
only helps with your body awareness, but also activates the
corresponding motor areas of your brain taking your mind
away from the pain.
Swimming in warm water can help reduce pain, because
your joints are not jarred when you are supported by water.
8

Q 3: What should I do if I feel pain when I’m exercising?
A: Although mild muscle soreness after taking exercise
is normal, especially when you take up a new form of
exercise, this should disappear after 24 hours. If you
experience sharp pain during, or immediately after exercise,
this could be a signal of injury. Learn to recognise <strong>and</strong>
interpret your pain <strong>and</strong> adjust the amount, duration <strong>and</strong>
intensity of exercise you are doing according to what you
find ‘acceptable’ pain levels. You may find that your pain
levels reduce as you start to go through your exercise
routine. Some people with RMDs find it helps to take a
painkiller before doing exercise.
Q 4: Can I exercise when I’m having a flare?
A: Many people with RMDs are concerned they will make
things worse if they move their joints when they are having
a flare. Overuse of an actively inflamed joint (hot, swollen
<strong>and</strong> painful) may aggravate the inflammation <strong>and</strong> increase
the damage, but this does not mean total inactivity is better.
• Use an ice pack wrapped in a cloth to help ease
inflamed joints
• Learn to ‘read’ your body <strong>and</strong> adjust your level of activity
as necessary
• If you have a flare up avoid vigorous activity, but do
continue to move your joints gently to help maintain your
range of movement
• As your flare subsides you can gradually resume your
normal activities <strong>and</strong> exercise routine, but start slowly
<strong>and</strong> build up
• If you are concerned ask you physician or
physiotherapist
Q 5: How can I be physically active when I am
constantly feeling tired?
Get a good night’s rest. Lack of sleep can cause fatigue.
Reduce your levels of physical activity in the hour before
you go to bed <strong>and</strong> have a hot relaxing bath. Reduce or
avoid caffeine (from tea, coffee, cola <strong>and</strong> chocolate) in the
evenings. Make sure your sleep environment – comfort of
your bed, room temperature, level of darkness <strong>and</strong> noise
etc. – is conducive to sleep. Set your alarm in the morning,
as too much sleep can also cause fatigue.
Q 6: Will even small amounts of physical activity help
me lose weight?
A: In order to lose weight you will need to reduce the
amount of calories you eat whilst increasing the amount
of calories you burn. The best way to burn calories is to
increase your levels of physical activity. The amount you will
burn depends on your body size, age <strong>and</strong> gender, but as a
rough guide:
• 60 minutes of energetic gardening (digging, raking etc.)
burns 300 kcals
• 60 minutes of brisk walking burns 200 kcals
• 90 minutes of football burns 600 kcals
• 45 minutes of dancing burns 450 kcals
In the long run, improving your body composition
(increasing muscle <strong>and</strong> decreasing fat) by being more
physically active will lead to small, but important increases
in your basal metabolic rate (the rate at which you burn
energy).
If you are overweight <strong>and</strong> have inflamed or damaged joints
you should discuss the best way to exercise safely with
your physiotherapist before commencing on a regime.
A: You may find that fatigue is stopping you doing things
you want to do, so it is worth spending time planning <strong>and</strong>
prioritising your daily <strong>and</strong> weekly tasks to help you manage
your fatigue. Pace yourself <strong>and</strong> spread out tasks that are
likely to be tiring. Try <strong>and</strong> build rest periods <strong>and</strong> activity
periods into your day, so you are not too exhausted by the
evening. Just as overdoing physical activity can make you
tired, so inactivity can make you weak <strong>and</strong> fatigued. Being
physically active will improve your muscle tone, feeling of
wellbeing <strong>and</strong> energy levels.
9

Physical activities <strong>and</strong> exercise
for people with rheumatic <strong>and</strong>
musculoskeletal diseases
4.0 Glossary of common terms used to describe different types of exercise
Aerobic / cardiovascular
Balance
Endurance
Flexibility
High impact
Low impact
Mobility
Posture
Strength
Weight bearing joints
Weight bearing exercises
Exercise that raises the heart rate <strong>and</strong> breathing e.g. walking, cycling, swimming,
dancing etc. at a moderate or high intensity
The ability to control the body’s position when either stationary or moving
How long you are able to exercise at low, medium or high intensity
The ability of muscles to stretch. Stretching muscles helps to keep them supple <strong>and</strong>
relieves stiffness
Exercises where the body weight impacts forcefully against a surface,
for example running or jumping
Exercises where there is minimal impact through the joints <strong>and</strong> pelvic floor
or where the body is supported whilst exercising, e.g riding a bicycle or swimming
The ability of joints to move through a range of motion
Good body alignment when st<strong>and</strong>ing, sitting <strong>and</strong> moving around
The extent to which muscles can exert force by contracting against resistance
(e.g. free or fixed weights, b<strong>and</strong>s, moving in water etc)
Joints that support the weight of your body against gravity when you are upright,
i.e. your spine, hips, knees, feet <strong>and</strong> ankles
Exercises where your body is working or moving against gravity, for example walking
(swimming is non-weight bearing because the water supports your body weight).
Weight bearing exercises also help maintain bone density <strong>and</strong> reduce the risk of
osteoporosis
10

Physical activities
<strong>and</strong> exercise
for people with
rheumatic <strong>and</strong>
musculoskeletal
diseases
walking
dancing
home gym
cycling
tai chi,
qigong,
yoga &
Pilates
swimming
& water
exercises
home &
garden
<strong>Essential</strong> information
<strong>and</strong> expert advice