Rheumatoid arthritis (RA) is a systemic autoimmune disease that primarily affects the joints but can also involve the heart and lungs.

Medication is important—but it is not enough on its own. Long-term outcomes depend heavily on structured physical activity and personalized physiotherapy.

This guide explains how exercise therapy and treatment profiles work based on the 2021 clinical practice guideline—and how you can apply them safely and effectively.

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Why Physical Therapy Is Essential in Rheumatoid Arthritis

If you live with RA, your biggest challenges likely include joint pain, stiffness, fatigue, and reduced mobility. Over time, inactivity increases cardiovascular risk and worsens functional decline.

Structured exercise improves:

• Muscle strength

• Aerobic capacity

• Daily function

• Disease activity

• Mental health

Patients with RA also face higher cardiovascular risk. Regular physical activity helps reduce that risk significantly.

Learn more about tailored care plans in our guide on Personalized Physiotherapy Plans in Kuwait.

When Should You Refer to Physical Therapy?

Use the ICF model to assess limitations in activity and participation. Refer to physiotherapy when the patient cannot achieve or maintain a healthy level of physical activity due to RA.

Consult a physician immediately if:

• Another diagnosis is suspected

• Red flags appear during assessment

Do NOT Start Physical Therapy If There Is:

• Fever

• Vertebral fractures

• Cervical spine instability

• Recent tendon rupture

Three Treatment Profiles in Rheumatoid Arthritis

Treatment must always be patient-specific, based on goals, limitations, and disease activity.

Profile 1 – Independent Exercisers

These patients require information and advice. They can exercise independently once given structured guidance.

Profile 2 – Short-Term Supervision

These patients need temporary supervision to learn proper exercise technique before transitioning to independent training.

Profile 3 – Long-Term Intensive Supervision

These patients often have:

• High disease activity

• Severe joint damage or deformities

• Major limitations in daily life

• Comorbidities

• Poor pain coping strategies

The goal is to guide them toward an active, self-managed lifestyle over time.

Core Education & Lifestyle Advice for All Profiles

Education is essential regardless of treatment profile.

• Spread load across multiple joints

• Use assistive devices when needed

• Plan activity throughout the day and week

• Reduce sedentary time

If posture or work setup contributes to discomfort, review our article on Improving Posture with Physiotherapy.

Exercise Therapy Guidelines for Rheumatoid Arthritis

A combination of functional strength training and moderate-to-high intensity aerobic training is recommended.

Session Structure

• Spend at least 75% of the session on one primary training type

• Assign the secondary training type as independent work

Strength Training

• Start at 50–60% of 1 repetition maximum (1RM)

• Progress to 60–80% of 1RM

• Frequency: Daily if possible, minimum twice per week

Aerobic Training

• Start at 40–60% of maximum heart rate or Borg scale 12–13

• Progress to >60% max heart rate or Borg 14–17

• Frequency: At least 5 days per week, 30 minutes per session

Consistency matters. Read why in Why Consistency in Physiotherapy Is Key.

Avoid Passive Treatments

Passive treatments do not replace active rehabilitation and should not be routinely offered.

• Low-level laser therapy

• Electrotherapy (including TENS)

• Ultrasound

• Massage

• Thermotherapy

• Medical taping

• Dry needling

Passive joint mobilization may be considered only in rare cases to improve specific joint mobility and must support exercise therapy—not replace it. It is contraindicated in cervical spine instability.

Frequently Asked Questions

Is exercise safe during active rheumatoid arthritis?

Yes—if tailored to disease activity and supervised when needed. Intensity should be progressed gradually.

Can exercise reduce RA flare-ups?

Individually tailored programs can help reduce disease activity and improve resilience.

Do I need long-term supervision?

Only patients in Profile 3 typically require extended supervision. The goal for all patients is independence.

Take Control of Your Rheumatoid Arthritis

The evidence is clear: active treatment works. Patient-specific strength, aerobic, and functional training should form the foundation of care. Supervision should gradually shift toward independence.

If you're ready to build a structured recovery plan, explore our Physiotherapy Services or read more on our Rehabilitation Blog.