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High-intensity interval walk training associated with decreased disease activity in rheumatoid arthritis

A recent study has shown exciting new benefits associated with exercise for people living with rheumatoid arthritis (RA).

image of someone on a treadmill

Rheumatoid arthritis is an autoimmune disease with hallmark symptoms of inflammation and resulting pain. It is a disease process (like cancer or diabetes) where the body’s immune system mistakenly attacks its own healthy joints. It is a relatively common disease – approximately 300,000 or 1 in 100 Canadians get it – and is often devastating to a person’s body if not treated properly.

Researchers at Duke University in North Carolina found that 10 weeks of high-intensity interval walk training was associated with decreased disease activity and improved immune function for adults with RA. High-intensity interval walk training refers to a popular form of exercise that includes short bursts of fast-paced walking at maximum effort followed by less intense recovery periods.

The study included twelve physically inactive adults over the age of 55, with a confirmed diagnosis of RA. Participants completed a 10-week program consisting of 3x 30-minute sessions a week of supervised treadmill walking. This Included a 5-minute warm up and 5-minute cool down. Within the training session, participants walked at 80-90% of their maximum effort in intervals of 60 to 90 seconds. These high-intensity intervals were followed by recovery intervals at 50-60% maximum effort. Speed and interval times varied for each person based on a cardiorespitory fitness test, but none exceeded walking pace. 

Disease activity was assessed by a rheumatologist through a count of swollen and tender joints, perceived general health and blood tests to measure inflammation. Cardiovascular fitness and immune functions were assessed using a variety of clinical and laboratory tests, as well as standardized questionnaires. At the end of the 10 weeks, the following outcomes were observed:

  • RA disease activity reduced by 38%, with a significant decrease in swollen joints, erythrocyte sedimentation rate (ESR) and improved self-perceived health. An ESR blood test measures the rate at which red blood cells settle in the period of one hour, revealing inflammatory activity in the body. 
  • Improved immune functions suggesting a reduced infection risk and inflammatory potential 
  • Cardiorespitory fitness increased by 9%
  • Resting blood pressure and heart rate both reduced 

 There is a substantial amount of research on exercise and rheumatoid arthritis, but few studies have reported the actual lowering of disease activity scores. As stated by the researchers, this study suggests that,

“High intensity interval walking could be an efficient, tolerable, and highly effective intervention to augment disease activity and improve overall health in patients with RA.”

There are certain limitations to the study such as the small sample size and no control group, but the findings will hopefully encourage more research in the area. In addition, these findings add to a growing body of research on the benefits of exercise for people with arthritis. To learn more about the study, click here.


To learn more about physical activity and arthritis visit the following pages:

Yoga and Arthritis

Person doing a yoga poseThe most recent EULAR recommendations for pain management in inflammatory arthritis and osteoarthritis (OA) include physical activity and exercise as a part of a patient’s treatment plan. Physical activity has been shown to significantly ease joint pain and increase mobility, for this reason, exercise is increasingly being prescribed by physicians and other healthcare providers.

Some examples of well-known and effective exercises for people with arthritis include walking, biking and swimming. These are low-impact aerobic exercises, meaning they will generally be easier on the joints and cause your heart rate to increase. Are there other activities that could also benefit people living with arthritis, such as yoga?

Yoga is a group of physical, mental, and spiritual practices which originated in ancient India. Yoga increases flexibility, balance and muscle strength, improves fitness, and relieves pain. A recent study conducted by a team of researchers in China found that if practiced regularly, yoga can effectively alleviate pain and improve joint function for people with knee arthritis. According to the researchers, whole body benefits involve “reducing stress, lowering blood pressure, and metabolic regulation.” A healthy metabolic regulation affects how your body absorbs the nutrients it is getting.

The specific research method used in this study was a meta-analysis. Researchers looked at previous studies where yoga was used as an intervention to treat knee arthritis, and then analyzed the results of all of these studies to determine the efficacy of the activity. In total, 13 clinical trials with 1,557 patients with either knee osteoarthritis or rheumatoid arthritis were analyzed, with a specific focus on how yoga impacts pain reduction, joint function, and general wellbeing. This research method provides a more wholistic picture on the impacts of yoga on arthritis outcomes than a single study would.

Researchers concluded that if yoga is practised regularly, it is helpful in reducing symptoms, promoting physical function, and general wellbeing for patients with knee arthritisThey added: “This review indicates that yoga intervention could be used for relieving OA pain; however, in the absence of high-quality studies with low risk of bias, the true benefits of yoga, although promising, are still undetermined.”

Researchers believe that there are two reasons why yoga can help reduce pain in patients with knee arthritis:

  • Yoga increases joint stability by strengthening muscles and therefore, reduces physical pain. Strengthening the knee muscles to support your body weight is a primary goal in an arthritis treatment plan.
  • Yoga promotes proper body positioning and helps reduce stress. The stress reducing component is effective in pain management for patients with knee arthritis.

In addition, people who practiced yoga also experienced an increased awareness of their mental health. They were found to be more accepting of their condition and more detached from the psychological experience of pain.

While more research is still needed, yoga is a fun form of physical activity that can be practiced anywhere, either alone or with others, making improving arthritis outcomes even more convenient. To learn more about exercise and arthritis, listen to this JointHealth™podcast featuring physiotherapist and researcher Linda Li, from Arthritis Research Canada.

Yoga for arthritis

Related imageYoga, t’ai chi, qi gong, and walking, are joining the treadmill and exercise bike as ways to safely and effectively increase physical activity. Keep in mind that yoga is not just represented by pretzel-like poses requiring considerable strength and balance. Beginner yoga classes may provide simple, gentle movements that gradually build strength, balance, and flexibility – all elements that may be especially beneficial for people with arthritis. In an article on Johns Hopkins Arthritis Center, Steffany Haaz Moonaz, PhD and registered yoga teacher (RYT-500) will demystify yoga for arthritis patients and their providers. For her doctoral project, she worked with Dr. Susan Bartlett and Dr. Clifton Bingham in the Johns Hopkins Arthritis Center to develop and test a modified yoga program for people living with arthritis. Click here to read the results of the study. We picked out some key questions that people living with arthritis may have before they start a yoga program.

What are the benefits of yoga?

Yoga is a safe and effective way to increase physical activity. Yoga can increase muscle strength, improve flexibility, enhance respiratory endurance, and promote balance. A recent study shows that yoga is associated with increased energy and fewer bodily aches and pains. Due to its meditative nature, yoga also benefits mental health by lessening feelings of anxiety, depression, and psychological stress.

Have scientific studies of yoga been done in arthritis patients?

Johns Hopkins has recently published an article with the results of a clinical trial of yoga that they have conducted in the Johns Hopkins Arthritis Center. The study provided “critical evidence showing that in people with arthritis who are sedentary, yoga appears to be safe, feasible, and enjoyable for people with both rheumatoid arthritis and osteoarthritis and that it results in important physical and mental health benefits for people who practice it regularly.” Yoga programs developed as a follow up also found improvements in balance, functional reach, upper body function, and pain.

What is the best way to try yoga? 

Let your doctor know you are interested in doing yoga. Ask if there are any limitations or restrictions you should be aware of. Have your doctor write these recommendations so you can speak to a qualified yoga therapist or teacher and develop a yoga routine best suited to you. For the first few lessons, keep a mental note of how you feel during your yoga class. Are there positions that hurt? Are there modified methods for such positions?

What can I expect to do in a beginning yoga class?

There are three main components to most western yoga classes: poses (asanas), breathing techniques (pranayama), and relaxation. Some classes will include meditation or chanting. Remember, do not do anything that is uncomfortable. All yoga poses can be modified for your safety and comfort.

Yoga Poses for Arthritis Patients from Johns Hopkins 

Below is an excerpt from Johns Hopkins:

These are a few yoga poses that you may want to try at home.  Before beginning any new activity, be sure to consult your doctor.  It is important to listen to your body.  If you feel any sharp pain, instability or lightheadedness, stop and rest or adjust to a more comfortable position.  A well-trained and experienced yoga instructor will be able to offer more individual guidance to adapt the poses for your needs and limitations.