A 20-Minute Pilates Workout for People With RA

Pilates is a low-intensity muscle-strengthening workout, making it ideal for people with rheumatoid arthritis (RA).

“People who are in pain, who are dealing with immobility issues from rheumatoid arthritis, often defer from exercise, because they think it's going to harm their joints, when the exact opposite is true,” says Vagishwari Murugesan, MBBS, a rheumatologist at Trillium Health Partners and an adjunct lecturer at the University of Toronto.

But people with RA tend to do best with activities that are challenging yet gentle on joints — Pilates fits that bill and also engages a lot of different muscles, which can counteract the muscle loss many people experience as RA progresses, Dr. Murugesan says.

Below, Alyson Mackay, DPT, a physical therapist, board-certified orthopedic clinical specialist, and certified Pilates teacher at Hospital for Special Surgery in New York City, offers a 20-minute Pilates workout for people with RA. These six exercises naturally build upon each other, gently strengthening your muscles from head to toe.

Pay attention to any cues from your body while exercising. Some muscle soreness is fine, but sharp pain is a signal to stop an exercise, Murugesan says. Also, if you’re exhausted after the workout to the point that it’s affecting your daily life, you may be pushing yourself too hard. Try scaling back the frequency or intensity of your workouts, Murugesan says.

Lie on your back on a mat or another comfortable surface with your knees bent 90 degrees and your feet flat on the floor. Engage your abs and push through your heels to lift your hips until your body forms a diagonal line from head to hips to knees. Hold this position for 30 seconds, then lower your hips to the mat. Repeat for a total of three sets.

If you can’t hold the position for 30 seconds, make a note of how long you can hold it. Gradually build up to 30 seconds over time.

If you’re ready for a challenge and you have a stability ball, squeeze it between your knees while you hold the position for more ab engagement. If you have a Pilates ring, position your legs inside it and push your thighs out against it for more glute engagement, Mackay says.

Lie on one side on a mat or another comfortable surface. Use a pillow to support your head if that’s most comfortable for you. Stack your hips and knees on top of each other, and bend your knees toward your chest. Keep your heels together and your toes apart, forming a V with your feet. Squeeze your heels together and lift your top leg as high as you can without moving your hips or back. Return your top leg to the starting position. Complete two to three sets of 10 reps, then repeat on the other side.

If this movement feels too easy, place a mini loop resistance band around your legs just above your knees for an added challenge.

And if your RA makes your hips uncomfortable in this position, try rolling the top hip farther forward to alleviate any pressure on the lower hip, Mackay says. Or push your top hand into the floor (without lifting your upper body off the ground) to engage your abdominals and ease the strain on other parts of your body, she suggests.

Lie on one side on a mat or another comfortable surface. Use a pillow to support your head if that’s most comfortable for you. Stack your hips and knees on top of each other, and bend your knees level with your hips. Moving from your top hip, lift your entire leg toward the ceiling without moving your hips or back; keep your knees bent. Lower the top leg to the starting position. Complete two to three sets of 10 reps, then repeat on the other side.

Follow the modifications for the clamshell exercise above if you’re ready to make this move harder or need to make the position more comfortable.

Start on your hands and knees on a mat or another comfortable surface; stack your shoulders over your wrists and your hips over your knees. Gaze at the floor so your neck aligns with your spine, and press your hands into the floor to engage your abdominals. Keeping your arms straight and spine neutral, slowly squeeze your shoulder blades. Then, slowly draw your shoulder blades apart. That’s one repetition. Do 10 reps.

“Sometimes people with RA have wrist and hand pain,” Mackay says. If this position is uncomfortable, you can balance on fists instead of flat palms, or grip dumbbells on the floor instead, she suggests.

If this exercise feels too easy, walk your knees back and do the scapular squeeze from a modified plank position instead of on all fours. Or, you can lift up onto your toes and do the same squeeze from a full plank, Mackay says.

Start on your hands and knees on a mat or another comfortable surface. Be sure your shoulders are stacked over your wrists and your hips are over your knees. Gaze at the floor so your neck aligns with your spine. Engage your core and raise your left arm straight out in front of you while extending your right leg straight out behind you; reach both limbs away from the body, parallel to the floor. Hold briefly before returning your hand and knee to the floor. Repeat with the right arm and left leg. Do two sets of eight reps per side. Keep your spine neutral and focus on moving the limbs; keep your shoulders and pelvis still.

Balance on your fists instead of your palms if this position hurts your wrists.

• People with rheumatoid arthritis can try Pilates exercises to build strength, reduce inflammation, and ease pain.
• This 20-minute workout includes six Pilates movements that are gentle enough for most people with RA to try.
• Get cleared by your doctor before doing Pilates exercises for RA.