Illustration of woman getting ready to exercise

Fatigue often comes with the territory of rheumatoid arthritis (and other autoimmune diseases), but you may find yourself in a catch-22 situation when it comes to exercise.  

On one hand, you know that physical activity is key for managing your disease. Exercise can lower your pain, morning stiffness, and even reduce fatigue in rheumatoid arthritis — all while improving functional ability and psychological well-being, per a classic study in the Journal of Aging Research

On the other hand, you may feel so fatigued that the thought of exercise feels out-of-reach. Rheumatoid arthritis is responsible for a marked decrease in physical activity, per a 2016 study in Joint Bone Spine. 

Here’s how to navigate this, with insight from a rheumatologist and personal trainer.  

Are You Too Exhausted to Work Out?

This is a key question, but one that’s difficult even for experts to answer — since graded, aerobic exercise actually helps to improve fatigue.  

“Fatigue is omnipresent and likely a consequence of RA-related inflammation, but even after good disease control, fatigue might persist — lowering the quality of life and the motivation of patients with RA,” says Elena Schiopu, MD, Director of Clinical Trials for the Division of Rheumatology at Augusta University Health. “I am a big cheerleader for daily baseline exercise, with additional pushes throughout the week to get more conditioned.” 

However, if you’re experiencing a viral infection, RA flares, or swelling of the knees or toes, it may be reasonable to skip the daily exercise.  

“Exercise is super important for people with rheumatoid arthritis, since staying active helps strengthen the muscles, improve flexibility, support joints, and even plays a role in reducing the pain,” says John Gardner, a NASM certified personal trainer and the CEO and Cofounder of Kickoff, a remote personal training platform. “However, when your joints are swollen and stiff, it is important to rest to reduce the inflammation and reduce the risk of injury.” 

When Is It Safe to Push Through?

If you’re otherwise feeling healthy, you can most likely stick to your daily workout schedule (even if you don’t initially feel like it!).  

“If no upper respiratory viral infection or swelling of the lower body joints, I think it is safe to at least get the daily workout,” says Dr. Schiopu. “There are infinite advantages to exercise, from preventing heart attacks and strokes to lowering the overall inflammatory burden and preventing dementia. And in the end, the daily baseline effort does lower your overall fatigue.” 

However, that doesn’t mean you have to navigate the complex machines at the gym. It can be as simple as getting your heart rate up through a brisk walk or stretching outside — and you may find that fresh air and sunshine motivate you to get moving.  

“Both exercises are low-impact, do not require a lot of energy, and are easy on the joints,” says Gardner. “Also, stretching can help relieve the tension, stiffness, and improve the range of motion that can help improve your functionality.” 

Also, think about how your daily activity is building muscle. Rheumatoid arthritis accelerates the loss of muscle mass that typically occurs as people get older, so it’s important to do muscle-building routines — along with aerobic exercises, which strengthen your heart and lungs, per the Mayo Clinic 

Meanwhile, weight-bearing exercises like walking help prevent the loss of bone density (osteoporosis), which can also occur from rheumatoid arthritis.  

If you’re experiencing pain, activities like matt exercises, chair exercises, or walking can be less impactful on the lower body. Practicing tai chi is also a gentle way to get moving and can also reduce stress, which may be contributing to your fatigue. 

To maximize the benefits of exercise while minimizing risks:

  • Listen to your body: Always pay attention to how your body feels during and after workouts. If you feel pain (different from typical muscle soreness) or excessive fatigue, it’s a sign that you might be overdoing it.
  • Start slow: Especially if you’re new to exercise or returning after a break. Gradually increase the intensity.
  • Stay Hydrated: Drink water before, during, and after exercise.
  • Rest and Recover: Allow your muscles time to heal and recover. This is when they grow and strengthen.
  • Seek expert advice: Work with your rheumatologist or a physical therapist to create an appropriate exercise regimen.

Remember, exercise should make you feel good, both mentally and physically. If it’s causing prolonged pain or signs of fatigue, it’s essential to reach out to your health care provider.

When to Discuss Fatigue with Your Rheumatologist

Over half of people with rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis were fatigued in a 2019 study published in PLoS One, even though they had low disease activity and few treatment changes. 

“As a rheumatologist, fatigue is a very reported symptom, sometimes the only symptom patients bring up — even more than pain,” says Dr. Schiopu. “It is important to bring it up when it feels truly impairing, like losing days of work or family gatherings due to fatigue.”  Get tips on talking to your doctor about fatigue.

While there isn’t medication to combat fatigue, your doctor may check for abnormal thyroid function, anemia, or lack of vitamins to rule out any treatable reasons for fatigue. High levels of stress and depression can also commonly trigger fatigue. 

“It is always interesting to me how patients describe their fatigue: Is it more like falling asleep in the morning, or more like not feeling like getting out of bed?” says Dr. Schiopu. “Everyone has a different personal take on fatigue and exhaustion, but the way patients describe it sometimes helps us narrow down the treatable causes.” Read more about how CreakyJoint members describe their fatigue.

Be a More Proactive Patient with ArthritisPower

ArthritisPower is a patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. You can participate in voluntary research studies about your health conditions and use the app to track your symptoms, disease activity, and medications — and share with your doctor. Learn more and sign up here.

Cooney JK, et al. Benefits of Exercise in Rheumatoid Arthritis. Journal of Aging Research. February 13, 2011. 

Interview with Elena Schiopu, MD, Director of Clinical Trials for the Division of Rheumatology at Augusta University Health. 

Interview with John Gardner, a NASM certified personal trainer and the CEO and cofounder of Kickoff, a remote personal training platform. 

Rheumatoid arthritis: Is exercise important? Mayo Clinic. July 22, 2022. 

Severity of fatigue in people with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis – Results of a cross-sectional study. Pilgaard T, et al. PLoS One. doi:   

Verhoeven F, et al. Physical activity in patients with rheumatoid arthritis. Joint Bone Spine. May 3, 2016. doi:  




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