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How vigorously should we exercise our rheumatoid arthritis patients?

The deleterious effects of joint inflammation on joint mobility, muscle strength, and daily function have been well recognised. The traditionally prescribed local and systemic rest for the inflamed joints will increase these adverse effects. Physiotherapy, in particular, exercise therapy, is therefore one of the cornerstones of the management of rheumatoid arthritis. The primary goal of exercise therapy is to improve joint mobility, muscle strength, and aerobic and functional capacity. Gentle passive and active range of motion (ROM) exercises together with isometric muscle exercises are the most frequently prescribed treatments and are still recommended in the textbooks, in particular for the patients with active disease. Weight bearing and conditioning exercises have long been discouraged because of fear of damaging the joints. But are isometric and stretching exercises powerful enough to improve muscle strength, physical condition, and ultimately functional capacity? Functional capacity, in particular, is the major outcome variable of our therapeutic efforts in rheumatoid arthritis. Therapeutic interventions capable of improving functional capacity have, therefore, high priority.