Anyone given a diagnosis of rheumatoid arthritis hears two opposite things, often in the same month: "you need to move" and "do not overload your joints". The result is that many people, when in doubt, move less, and this is the only mistake the evidence allows us to call one.
A caveat that is not a formality: rheumatoid arthritis is a systemic autoimmune disease, and the treatment that changes its course is pharmacological and is decided by the rheumatologist. What follows concerns movement, which is a complement, not a cure, and not an alternative to therapy.
The real question: does moving hurt?
It is the fear that stops everyone, and there is a study that tackles it head on.
A randomised trial published in the British Journal of Sports Medicine in 2024 assigned 87 people with rheumatoid arthritis (86% women, aged 20 to 60) to a supervised programme of high-intensity interval training plus strength work, or to a control group.
The results on fitness are clear: cardiorespiratory fitness significantly improved (mean difference of 3.71 mL/kg/min in VO₂ max), together with oxygen pulse and waist circumference.
But the data that matters most for anyone who is afraid is a different one, and it is an absence: no significant difference in pain, in the disease activity score (DAS28) or in erythrocyte sedimentation rate. The authors conclude that high-intensity supervised exercise improves cardiovascular health, fitness and general health without worsening pain and disease activity (High-intensity interval training improves cardiovascular and physical health in patients with rheumatoid arthritis, Br J Sports Med, 2024).
Training, even intensely and under guidance, did not switch the disease on.
And fatigue, the symptom that is talked about least
Ask people living with rheumatoid arthritis what their worst symptom is and many will not say pain: they will say fatigue. It is also the one that medications affect least.
A multicentre randomised trial published in Arthritis Research & Therapy in 2025 measured exactly that. At three months there were significant differences in favour of the group that trained, for general fatigue (−4.0) and physical fatigue (−4.9), measured with the MFI-20, and for the overall health assessment (−12.8). At six months the differences were still present, and at twelve months they remained significant for physical fatigue, depressed mood, pain and overall assessment (High-intensity exercise improves multidimensional fatigue and health-related quality of life in rheumatoid arthritis, Arthritis Research & Therapy, 2025).
An effect that lasts a year, on a symptom that medications do not do much about, is better news than it is usually presented as.
Two honest qualifications: in both studies the exercise was supervised, and the participants had a managed disease, not an acute phase. This is not saying "do HIIT on your own tomorrow morning".
What changes in practice
You are not fragile by definition. Caution is needed for joints that are actively inflamed, not for the whole body forever. If your wrists are involved, there are a hundred ways to train legs and trunk that do not load them.
The load has to increase. Repeating the same very light exercises for years keeps reassurance but not strength. In the studies that work, the load progresses.
Fatigue is not treated by resting more. It is counterintuitive, and it is exactly the point of the data above: conditioning improves fatigue, deconditioning makes it worse.
During a flare you adjust, you do not stop. You reduce the load on the inflamed joints, keep moving elsewhere, and talk to the rheumatologist.
When you need a doctor, not exercise
- A joint that is hot, swollen and very painful and has appeared within hours: it needs to be assessed, not trained.
- Fever, general malaise, unexplained weight loss.
- A sudden change in your symptoms compared with your usual pattern.
- Any symptom that appears after starting or changing a medication.
- Pain or stiffness in the neck with tingling or loss of strength: in long-standing rheumatoid arthritis the cervical spine deserves specific attention, and it should be mentioned to the doctor before starting any programme.
What we can do, and what we cannot
We do not treat rheumatoid arthritis and we do not replace the rheumatologist: the drug that changes the course of the disease is prescribed by them. What can be done by video call is to build a strength and conditioning programme that takes into account the joints involved, to watch how you perform it, and to make it progress over time instead of leaving it static. The first consultation lasts twenty minutes and is free: it also serves to tell you whether, at your current stage, this is the right step.
Sources
- High-intensity interval training improves cardiovascular and physical health in patients with rheumatoid arthritis: a multicentre randomised controlled trial. British Journal of Sports Medicine, 2024
- High-intensity exercise improves multidimensional fatigue and health-related quality of life in rheumatoid arthritis: a randomised controlled multicentre study. Arthritis Research & Therapy, 2025
