Brunilda Nazario, MD
It can be hard to find the time and energy to exercise when you have a newborn at home. If you also have rheumatoid arthritis (RA) and are having a flare, exercise may be the very last thing you feel like doing. RA is an autoimmune disease in which the body mistakenly attacks its own joints. RA tends to strike in your childbearing years, and having RA can make it harder to shed any pregnancy pounds. RA often goes into remission while you're pregnant, only to flare a few months after the baby is born.
Finding time for exercise is one of the most important things you can do. Exercise will help you get your pre-pregnancy body back faster – and take some of the excess weight and pressure off of your aching joints.
The first step is to get clearance from your obstetrician or rheumatologist that it is OK to start exercising again. If you had a cesarean section delivery, for example, you may need to wait six weeks until you are fully healed. Talk to your doctor to find out when you can safely start exercising and how much exercise is right for you.
“Movement is good for the joints, and we know that people with RA do worse if they are inactive,” says Shreyasee Amin, MD, a rheumatologist at the Mayo Clinic in Rochester, Minn. “This is true if you are pregnant, not pregnant, or recently gave birth.”
Exercise has benefits for everyone – especially women with RA. For starters, people with RA are at increased risk for heart disease, and regular exercise helps reduce this risk. What’s more, exercise helps build bones. Like many people with RA, you may have taken or take steroids to manage inflammation, which can weaken bones. Exercise also boosts endorphins, the body’s natural feel-good chemicals, which can help combat baby blues or depression. Endorphins are also natural painkillers, so a 20-minute swim or walk may also help relieve your joint pain if you are flaring.
Once you're ready to begin, start with a brief warm-up to help get creaky joints limber. Warming up can include arm circles, wrist circles, high knees, and side and forward-and-backward kicking, says Margaret Schwarz, a personal trainer in New York who specializes in pre- and postnatal fitness. You may want to work with a trainer or physical therapist who has experience with arthritis. Together you can design an appropriate, personalized warm-up and exercise program that takes your goals and overall health into account.
Schwarz’s exercise Rx for RA? “Aim for at least 20 minutes of cardiovascular exercise four to six times a week to prevent heart disease and burn enough calories to lose your postpartum weight,” she says. Over time, you'll want to gradually increase that 20 minutes. Try low-impact exercises such as swimming, walking, bicycling, or using an elliptical machine. “Try and move as much as possible,” says Schwarz. “Swimming is great because it makes one feel weightless. Consider taking a swim class with your baby when he or she is old enough.”
Strength training and stretching are also important, she adds.
“Light resistance training is necessary to maintain muscle strength which, in turn, makes stronger bones,” Schwartz says. It’s a win-win situation: Stronger muscles also help lower joint pain by better supporting your joints. Strength exercises involve working the muscle against resistance with or without weights, elastic bands, or machines. The key, says Schwartz, is "low weights and high reps." Stretching and holding different joint and muscle groups for 10 to 30 seconds each may boost flexibility. After your routine, it’s time to decompress. “Cooling down may [include] sitting and breathe deeply and coming to a steady state,” she says.
When you have RA, it’s important to listen to your body and heed its warning signs. “There is a difference between 'I can't continue' pain and 'I feel a little uncomfortable' pain,” Schwartz says. If you are in a lot of pain, take a break. And figure out the exercise routine that works best for you. “Many people with RA have morning stiffness, so it may be better to exercise later in the day,” she says. “Know your body, work within your limits and when in doubt, ask for advice, help or feedback.”
SOURCES:Shreyasee Amin, MD, rheumatologist, Mayo Clinic, Rochester, Minn.Margaret Schwarz, personal trainer, New York.
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