Avoid Doing This When Training Clients with Rheumatoid Arthritis

Training clients with rheumatoid arthritis may require certain considerations. Rheumatoid arthritis severity occurs on a scale. Therefore, each client may require different considerations when offering training advice.

In this article, we’re going to cover some of the most common considerations to look out for when training clients with rheumatoid arthritis.

Rheumatoid Arthritis Severity

Rheumatoid arthritis is defined as a chronic and progressive disease whereby the lining of your joints becomes inflamed which causes stiffness, swelling, and pain.

As rheumatoid arthritis is a chronic and progressive disease, the severity differs between individuals. The Rheumatoid Arthritis Severity Scale (RASS) was created by doctors to determine the disease’s activity, functional impairment, and physical damage caused by rheumatoid arthritis. These three areas are scored on a scale of 1-100. Here’s how the three factors differ:

  • Disease Activity Score: Looks at the severity of the disease, categorising it into remission, low, moderate, or severe
  • Functional Impairment: The functional ability of movement in your hands, arms, and legs
  • Physical Damage: Scarring and destruction or deformity at the joints and bones around them

There are three types of rheumatoid arthritis; rheumatoid factor positive, rheumatoid factor negative, and juvenile rheumatoid arthritis. It’s important to note what type of rheumatoid arthritis your client has before creating a training programme. Here’s how the three conditions differ:

  • Rheumatoid Factor Positive: Indicates the presence of rheumatoid arthritis and the rheumatoid factor antibodies are elevated
  • Rheumatoid Factor Negative: Indicates the presence of rheumatoid arthritis but the rheumatoid factor antibodies are not elevated
  • Juvenile Rheumatoid Arthritis: Form of arthritis in children aged 16 or younger

Understanding your client’s severity of the condition is an important factor to consider when deciding if training styles are working, what to consider next, and how to prevent damage or progression. Thus, when training clients with rheumatoid arthritis, firstly consider where they are on the RASS.

Benefits of Exercise for Clients with Rheumatoid Arthritis

Training clients with rheumatoid arthritis requires careful planning and understanding of their individual needs. Rheumatoid arthritis can be progressive and affect many joints in the body. Therefore, plans may need to be tweaked over time to ensure you’re giving your client the best programme that meets their current needs and abilities.

As a general rule, joint protection is the main priority when training clients with rheumatoid arthritis. Again, the specific programming will differ between clients, but providing the right intensity can lead to many benefits for your client. If programmed correctly, your client will gain the following benefits:

  • Reduced loss of bone mass
  • Joint function maintenance
  • Maintenance of muscular strength
  • Weight control
  • Decreased pain
  • Improved mood
  • Increased range of motion
  • Improved sleep

Things To Avoid When Training Clients with Rheumatoid Arthritis

We cannot stress enough the importance of looking at the individual needs of the client before developing a training programme. But, what we’ll look at now are some of the most common considerations to look out for when training clients with rheumatoid arthritis.

Many people with rheumatoid arthritis will avoid exercise due to fear the activity will create more joint pain. As we’ve seen above, exercise provides many benefits for those with rheumatoid arthritis. However, due to the physical limitations, rheumatoid arthritis can provide, certain considerations need to be made. When training clients with rheumatoid arthritis, aim to avoid the following:

  • Avoid exercise in periods of flare-up
  • Avoid fast-paced movements
  • Avoid contact sports
  • Avoid excessive flexion and extension
  • Avoid excessive repetitions
  • Avoid impact
  • Avoid positions that are uncomfortable or dangerous

Depending on the severity of your client’s rheumatoid arthritis, some of these points may not apply. That’s for you, your client, and their physical therapist to decide based on their individual needs.

General Exercise Recommendations for Clients with Rheumatoid Arthritis

According to NHS physical activity guidelines adults aged 19 to 64 should aim to:

  • Perform strengthening activities that work all the major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms) at least 2 days a week
  • Perform at least 150 minutes of moderate-intensity activity a week or 75 minutes of vigorous-intensity activity a week
  • Spread exercise evenly over 4 to 5 days a week, or every day
  • Reduce time spent sitting or lying down and break up long periods of not moving with some activity

In addition, people with rheumatoid arthritis may need to perform exercises to maintain and increase the movement in their joints.

Conclusion

Training clients with rheumatoid arthritis is very much an individualised approach. In terms of what and how much exercise your clients should be performing is the same as that of the general population, with the addition of more focus on joint movement. But, you need to consider the severity of your client’s arthritis, their training experience, and how much pain or discomfort they’re experiencing day to day. As a guide, there are common themes you may want to avoid when training clients with rheumatoid arthritis, but again it will depend on the individual.

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