Every activity counts!
Physiotherapist Sofia Sandström is a specialist in rheumatology. She often meets patients who tell her how exercise can make them feel less tired, sleep better and experience less pain. Her best tip for getting started is starting slowly and take one step at a time.
Who are you?
My name is Sofia Sandström and I work as a specialist physiotherapist in rheumatology. I have worked in rheumatology since 1995 at the Karolinska Hospital in Solna, near Stockholm. The Centre for Rheumatology (CFR) opened in 2016 and I started up the physiotherapy activities here with my colleague Julia Karlström.
I have always been very interested in exercise and the joy of movement. I also have a background working in the health care sector – and I have also led various types of training at the Friskis & Svettis gym chain.
In my work, I meet patients of all ages from 18 to 90. Everyone is different, so my job is about customizing. I work to match the patient to exactly what they need as we have no rehabilitation facilities here at CFR. Some people can work out on their own with a few tips and bits of advice from me, and I can print Physical activity Recipe (FaR) and follow up on the phone. Someone else may need more physiotherapeutic help with rehabilitation, in which case I will refer them to a primary care physiotherapist / rheumatology specialist physiotherapist.
How does RA affect exercise?
Newly diagnosed patients are often worried about physical activity and exercise. Some retain the old-fashioned idea that it is dangerous to move when you have rheumatism. It’s important to listen to the patient's concerns and provide the right information.
I usually tell people with RA that they need to exercise as much as people without the disease. Physical activity and exercise have a good effect on pain and increase physical function and well-being. It also helps as a preventive measure against cardiovascular disease. Everyone with RA should be physically active regardless of their age, physical function and degree of disease. The most important thing is that you find an activity or form of exercise you enjoy and which suits your own ability. The intensity should be adjusted to what you can manage and how you feel at the moment in terms of your symptoms.
One of the most important things is, above all, to understand what the patient thinks is fun. Is it possible for them to continue exercising as before or resume an activity? For example, do they need to add some strength training to strengthen the muscles around the knee so they can dance?
Most people with RA can exercise at a moderate level of effort. There is no indication that it is harmful to the joints or will cause damage. We recommend varied workouts including mobility, strength and fitness, which can be adjusted and allow for regular movement.
People sometimes say "I am absolutely not an exercise person and I would never set foot in a gym". But you don’t need a gym to be active. There are many possibilities. Maybe start walking, swimming, following a yoga session on Youtube, or exercising strength training at home by just sitting and standing 10 x 3 times with a chair. And remember, any physical activity and exercise is better than none! To start somewhere with something, that's the key.
What are your top tips for people who want to get active?
Firstly, it really does get results and you will feel so much better. In my profession, I see how exercising affects people's entire lives. Many people tell me how they feel less tired, sleep better, experience less pain or have quit smoking after becoming more active in their daily lives.
My first tip is to start from where you are today, one step at a time. Start slowly, increase slowly and vary your workout. Remember that everyone feels weak sometimes, things happen or you can be too busy at work. At those times it’s OK if you just do something rather than everything. Don’t let exercise become another chore and don’t complicate it: a little is always better than nothing at all! Find the joy of movement and enjoy what you find good at the moment. Consider these issues:
What does my everyday life look like?
What can I do for physical activity and exercise today?
What do I think / think is fun?
What would I like to try?
Is there anything I'm worried about? What do I see as obstacles?
Is there anything I need to learn more about before I start?
Physical movement can give you so much, helping with both pain and fatigue. It triggers the endorphin system, the body's own pain relief. Don't give up if you haven't found something you don't like yet. Just try something else.
How can I get started?
You have plenty of options if you feel you need help with exercising:
Consult your rheumatologist. Maybe there is a physiotherapist they can refer you to.
Contact a physiotherapist through your health center. Say that you have and you want help getting started with exercise.
The Swedish Rheumatic Society has a lot of knowledge and information. You can also call their helpline Reuma Direct which can help you further.
Sneak up the workout!
Start with low loads to reduce the risk of making your symptoms worse
Gradually increase after about two weeks to get your body used to new stress
Customize your workout by varying the load and exercises according to your symptoms and disease progression
Remember the 24-hour rule: any increased pain and swelling should have returned to the same level as when you started exercising after 24 hours. If it has not done so, it is important you adjust your training and don’t give up
If you find it difficult to work out on land due to pain, try exercising in water, preferably warm pool training. You can do strength and mobility training and work on general fitness in water. Water is the world's best training tool!