How do rheumatoid patients exercise?

*Read Only For Medical Professionals Does joint pain require exercise? When it comes to the treatment of rheumatoid arthritis (RA), the first thing that comes to mind is the use of drugs, but in fact, in addition to drug treatment, problems such as diet and exercise that are closely related to people's daily life are also RA patients.
Very concerned content
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We have talked about diet before (how can rheumatoid arthritis be prevented? Start by learning to eat!), today, let Xiaobian take you to clarify the inextricable relationship between exercise and RA patients
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 Joint pain and exercise? What are the benefits? RA is a systemic autoimmune disease with unknown etiology mainly involving peripheral joints
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Mainly manifested as chronic, symmetrical, progressive, erosive polyarthritis
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The basic pathological changes are synovitis, pannus formation, and gradually involve joints and articular cartilage, eventually resulting in joint deformity and loss of joint function
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 Morning stiffness, joint pain and tenderness, joint swelling, and joint dysfunction caused by RA seriously affect the quality of life of patients
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Do RA patients who have been plagued by various pains really still need to exercise? The answer is yes
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As early as the "2018 Guidelines for Diagnosis and Treatment of Rheumatoid Arthritis in China" [1], it was clearly pointed out that RA patients are advised to pay attention to life>
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 Exercise not only relieves pain, effectively improves muscle strength and endurance, but also increases joint range of motion to promote venous and lymphatic return, thereby helping to eliminate joint swelling
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In addition, it can also reduce the patient's anxiety, depression and tension, and play a positive role in the psychological state
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This is also demonstrated in the "Summary of the Best Evidence for Exercise Interventions in Patients with Rheumatoid Arthritis" [2]
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The article systematically searched domestic and foreign guideline and evidence-based center websites, professional society websites and relevant researches on exercise intervention in RA patients, and made a comprehensive summary using evidence-based methods
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Finally, the evidence was summarized from 8 aspects, and 19 pieces of the best evidence were formed, see Table 1
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 Table 1 Summary of the best evidence for exercise intervention in patients with RA Therefore, rather than whether patients with RA should exercise, we should discuss how patients with RA should exercise
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 Unlike most people who exercise now to lose weight and shape, the purpose of exercise in RA patients is to enhance physical fitness, maintain joint stability, enhance muscle strength and endurance, prevent joint contracture deformities, and improve flexibility and balance
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 However, at the same time, many factors need to be considered when exercising in RA patients, such as age, physique, previous exercise level, disease activity status, and the existence of joint structural damage
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Therefore, when performing a certain exercise, it is recommended to discuss the exercise method with the doctor to strive for a better adjuvant therapy effect [3]
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How should RA patients exercise? I understand that RA patients also need proper exercise, and that patients with different conditions have different exercise methods, but what should be done specifically? Don't worry, the editor has sorted out three types of exercise that are commonly used in RA patients, and then let's look down~ ■ Joint range of motion training can promote blood circulation, promote the dissipation of inflammation, relieve pain, and relax tight muscles and make muscles Metabolism increases, making the joints it wraps firmer
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Each joint activity should be maximized, but the amount of exercise should be appropriate, and the improvement of systemic symptoms should not be affected [4]
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 (1) Knuckles: One hand helps the other to flex the distal knuckles first, then the proximal knuckles and metacarpophalangeal joints
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Then alternate making a fist and extending your fingers
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When stretched flat, the palms and fingers can be placed flat against the table; (2) Wrist joint: Put the palms together, place the wrists flat on the table, and flex to the sides repeatedly; (3) Elbow joint: The palms are upward, and the arms are flat forward stretch
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Repeated flexion and extension of the elbow joint; (4) Shoulder joint: relax the shoulder, swing the hand back and forth or do a circular motion, and touch the opposite shoulder with both hands from front to back; (5) Knee joint: knee flexion exercise in prone position, repeat Forced flexion and extension of the calf can be performed alternately with both lower limbs; (6) Ankle joint: Repeatedly flexion, dorsiflexion, inversion, valgus and left and right rotation of the ankle joint
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Each activity must be maximized; (7) Neck joints: Repeatedly do the flexion and extension of the neck, flexion of the head and neck from left to right, and left and right rotation
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The above joint exercises are performed once a day in the morning, at noon and in the evening, 5 to 30 times each time
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 ■ Strengthening muscle strength training The muscle strength of RA patients is significantly weakened, which is about 60% of that of healthy people of the same age, which makes the buffering effect of muscles and tendons on the joints also weakened, and the joints are often in an unstable state, which aggravates the damage of the joints
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Therefore, enhancing muscle strength is very important for joint stability and joint function maintenance [5]
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①Isometric contraction: Active and rhythmic static contraction and relaxation of the affected muscles and the muscles around the affected joints, the contraction lasts for 5~10s at the maximum muscle output, such as static training exercises such as yoga; ②Isotonic contraction: the The joints are maintained in a relatively stable position, or the movement speed and limb movement speed are controlled to enhance muscle strength without aggravating arthritis or causing pain
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If the patient is in a supine position, straighten and raise one lower limb by about 10° (more than 10° will not be better), and keep it for 15 to 20 seconds before lowering it slowly; ③ Progressive resistance exercise or bare-hand resistance exercise: in muscle strength On the basis of strengthening, or attach a heavy object to the moving limb, or use fixed objects, body weight, training equipment, etc.
, to exert resistance to muscle contraction, such as lifting dumbbells, pulling springs, manpower confrontation, squatting and standing up
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Each exercise must follow the principle of gradual, gradually increasing resistance
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Focus on training the extensor muscles, adhere to the gradual and individual treatment, so that the patient has a gradual adaptation process to the rehabilitation exercise, and avoids the recurrence of the disease
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Exercise at least 2 times a day, which can be done at the same time as joint range of motion training
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The training should not cause severe pain, and there may be mild muscle fatigue after training
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Before each exercise, do a small amount of preparatory activities, and then gradually increase the amount of exercise to the appropriate heart rate range, about 100 to 120 times/min
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 ■ Aerobic exercise Moderate aerobic exercise (heart rate reaches 60% to 80% of the maximum heart rate during exercise) can not only relax the muscles and relieve the spasm of the tissues around the joints, but also help the blood circulation of the local joints and prevent inflammation.
Accumulation of sexual substances and promote the dissipation of inflammation
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It can not only improve the patient's physical function, but also improve the patient's psychological, social function and self-awareness of health, thereby improving the overall quality of life of the patient [6]
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 Aerobic exercise includes walking, jogging, cycling, swimming, bed rest and other exercises
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If the condition allows, you can go to the park for a slow walk, and insist on walking for 20 to 30 minutes every day
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Jogging has a large amount of exercise, and a combination of light running and walking can be used for better results
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Do not move too far or use too much force
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If joint discomfort occurs during exercise, stop immediately and try again after resting for a while [7]
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Cycling can exercise leg muscles, exercise joint endurance, and help reduce joint symptoms.
Moreover, due to the lever principle of pedals, cycling can not only exercise the knee joint, but also will not cause a burden on the knee joint.

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Bedside exercise is simple and practical
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The specific method is to sit on the edge of the bed, let the calf hang against the edge of the bed or just touch the ground, and then slowly exert force to lift the calf to a horizontal position, then slowly lower it, and practice repeatedly for 10 to 20 minutes
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 Summary Through the above content, we can know that in fact, in addition to conventional drug treatment, RA patients have so many exercise methods to improve their condition
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Through appropriate exercise, the range of motion and quality of life of RA patients can be significantly improved, thereby reducing the disability rate
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Therefore, as long as the diagnosis is timely, the treatment is reasonable, pay attention to exercise, and establish a positive and healthy attitude, I believe that patients can have a higher quality of life! References [1] Rheumatology Branch of Chinese Medical Association.
2018 Guidelines for Diagnosis and Treatment of Rheumatoid Arthritis in China [J].
Chinese Journal of Internal Medicine, 2018, 57(4):10.
[2] Gao Chao, Wu Xue, Xu Anqi, et al.
Summary of the best evidence for exercise intervention in patients with rheumatoid arthritis[J].
PLA Nursing Journal, 2020, 37(10):5.
[3] Fang Linkai, Huang Caihong, Xie Ya, et al.
Practice guidelines for patients with rheumatoid arthritis[J] ].
Chinese Journal of Internal Medicine, 2020, 59(10):9.
[4] Tian Fengqin.
The effect of functional exercise on the curative effect of rheumatoid arthritis patients [J].
Modern Medicine and Health, 2010, 26(7):2.
[5 ] Wu Mingfang.
Exercise prescription for patients with rheumatoid arthritis[J].
China Tissue Engineering Research, 2002, 6(019):2842-2843.
[6] Xie Xia, Chen Hong.
Exercise therapy in patients with rheumatoid arthritis The application status of [J].
Chinese Journal of Nursing, 2015, 050(009):1100-1103.