Hi again Dr.s. I was just at your Philly seminar this past weekend but had to leave before the Q/A. I wasn’t sure if the topic of arthritis would come up during the seminar so I didn’t ask this question over the weekend. I have listened to every podcast by BBM and searched the forum as well regarding this topic. With that said, my 46 year old sister has been recently diagnosed with Rheumatoid arthritis. She used to resistance train and run frequently but her symptoms of weakness and swollen joints of the hands / ankle / feet were getting increasingly worse that stopped and got checked by the Dr. (which eventually lead to her diagnosis). My question is this: I have taken away from most of what you have discussed regarding training with arthritis (and just about any injury) to do what you can (under your pain tolerance). Manage load, volume and ROM to best suit your training ability that day. I just wanted to know if this holds true with RA as well. I wasn’t sure if there are any other considerations with people dealing with RA . I have had her listen to your podcast on osteoarthritis and sent her some links to articles Austin has written. She was very grateful for the info! We just wanted to be certain about the protocol for RA. Thanks! As my wife and I said to you before we left, thank you so much for the seminar! It was the best training I have ever received regarding coaching by a LONG SHOT!
Is her RA being treated?
RA patients have particularly strong reasons to train, as they are at greater risk for multiple things that can be modified by resistance training:
- A muscle wasting syndrome called “Rheumatoid Cachexia” that results from the chronic inflammation, anabolic resistance, and accelerated catabolism
- Osteoporosis
- Cardiovascular disease (actually the most common cause of death in these patients)
As well as several others. There is substantial evidence on strength training in RA as well: 1. Summers GD, Deighton CM, Rennie MJ, Booth AH. Rheumatoid cachexia: a clinical perspective. Rheumatology (Oxford) 2008; 47:1124.
2. Sokka T, Häkkinen A, Kautiainen H, et al. Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Rheum 2008; 59:42.
3. Mikkelsen UR, Dideriksen K, Andersen MB, et al. Preserved skeletal muscle protein anabolic response to acute exercise and protein intake in well-treated rheumatoid arthritis patients. Arthritis Res Ther 2015; 17:271.
4. Lemmey AB, Marcora SM, Chester K, et al. Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. Arthritis Rheum 2009; 61:1726.
5. Baillet A, Vaillant M, Guinot M, et al. Efficacy of resistance exercises in rheumatoid arthritis: meta-analysis of randomized controlled trials. Rheumatology (Oxford) 2012; 51:519.
6. Rall LC, Meydani SN, Kehayias JJ, et al. The effect of progressive resistance training in rheumatoid arthritis. Increased strength without changes in energy balance or body composition. Arthritis Rheum 1996; 39:415. I would combine a strength training program with education about pain (which you now know much more about, having attended the seminar), in order to help frame her understanding and minimize fear-avoidance / catastrophizing if she experience symptom fluctuations in the course of training.
Yes, she said last night was her 3rd dose of methotrexate which she has been told may take up to 12 weeks to work. She is also on duexis for pain.
I will continue working with her regarding her strength training program and pass along what I have learned from you about pain.
Thanks Austin!
A bit of a ramble…
This is relevant to me, to a degree. I have Psoriatic arthritis. Strangely 99% of my flare ups manifest in my feet. I take Humira once a week for it (and to treat my Crohn’s Disease.) I’m about three weeks in the SS novice program, and I’ve encountered three flareups - one in my left hand (first time) and two in my feet. I had to take a steroid pack one time. (This is somewhat of a win, as previously whenever I had a flareup in my feet I had to take steroids to tackle the inflammation. I’ve experienced pain but it was manageable. In the past, when I get them, walking is very difficult.) My doctor wants to put me on Methotrexate - but I’ve been resistant, because when on the drug you can’t drink any alcohol. (I’m not a big drinker, but I enjoy a drink or two a week.)
With all that said, the program has made me stronger than ever before, and I feel that’s helped lessen the severity of my flareups.
I’m an oldish guy; I’m 47 and 5’11 and 229lbs. My very modest lifts represent PRs - which have increased every workout: my bench is 175lbs, my squat is 130lbs and my deadlift is 305lbs. (Incidentally, I’m trying to cut weight, as I think that may help reduce inflammation - but that’s hard to do, given the protein requirements!)
While I feel great about increasing my strength I’m worried that the program puts too much intensity on the feet (for me); as a result, I’m considering reducing the frequency of deadlifts to once a week
Njudsen, I was diagnosed 2 weeks ago with rheumatoid arthritis. My rheumatoligist basically told me the drug and alcohol don’t work well together, but given the way the drug is taken. Once a week. If I took the drug on a Wednesday and had a drink on Saturday i would be ok. How is your strength training going so far. I have been interested in strength training for a while, but was afraid to due to my ankle pain etc from the disease. Now that I’m being treated I am not