Can exercise trigger a flare?

A participant in our survey recently asked: “My daughter loves to walk and jump. Is it possible RA in ankles flares only after walking (or jumping) for a long time?”

I think yes, too much exercise can trigger a flare. Here’s why:

Let’s first put the Question in perspective. Exercise is essential to nourish the joints. Your bones at the joints are covered with cartilage. Cartilage does not contain any blood vessels and picks up its nutrients from the fluid in the joint space. It also dumps its waste there. As your joints move, the fluid in the cartilage is refreshed rapidly. Thus, movement helps keep joints healthy.

Does exercise have any direct effects on the bone and joint cells?

Yes, and the effect depends on how strenuous the exercise is (Deschner et al., 2003; Nam et al., 2009)

To decipher the effect of mechanical strain (exercise) on cells, scientists put pressure on cells in a chamber. They then measure the proteins or cytokines secreted by the cells (Deschner et al., 2003; Nam et al., 2009).

Do these cytokines increase inflammation or suppress inflammation?

At low pressure, chondrocytes or bone cells make more factors (e.g. IêB) that suppress inflammation and even degrade them slower. In fact, mild mechanical pressure reduced inflammation to extra IL-1 beta by 250 fold. Movement or low mechanical strain suppressed break down of cartilage.

In contrast, cells under high pressure secreted proteins that increased inflammation including IL-1 beta, and TNF alpha. These IL-1 beta and TNF alpha also triggered a cascade of other inflammatory proteins. If these cells were still in the body, it may trigger a red, swollen joint.

Thus, these studies explain how strenuous exercise can aggravate joint diseases, including rheumatoid arthritis.

The studies also support the benefits of mild exercise. Mild exercise not only brings more nourishment to the cartilage in the joints, it also reduces inflammation. What is mild exercise? It probably depends on the person and their stamina.

A couple of weeks ago, I was walking a mile for the Arthritis Foundation’s Arthritis Walk in Bethlehem, PA. Weather was pleasant and so were the participants. About 10 min into the walk, I heard, “Mom, are we almost there yet?” asked a young child. “My feet hurt.” We had probably only walked a ½ mile. I think that family had chosen to walk 3 miles for the Arthritis Foundation’s annual Fundraising Walk. The half mile walk appeared to be too strenuous for her but not for her family.

If you’re looking for exercises suitable for RA patients, consider yoga, walking, swimming, Callanetics (not jumping jacks which is calisthenics) and interval training.

Most importantly, choose an exercise that helps you feel good and that you continue doing week after week, year after year. Or, do different exercises every other day or each day of the week. I especially like interval training which raises my metabolism (burn more calories while I sleep).

Wishing you a wonderful June!


P.S. 60 second commercial: Kathy is available for consulting with you or your loved ones on your case of rheumatoid arthritis as a health coach.


Deschner, J., C. R. Hofman, N. P. Piesco, et al. (2003). Curr Opin Clin Nutr Metab Care 6(3): 289-293.

Nam, J., B. D. Aguda, B. Rath, et al. (2009). PLoS One 4(4): e5262.


This information is not medical advise. Please consult your healthcare provider before changing your routine.