Strength training is essentially exercises that help build and strengthen muscles. For the purpose of improving muscular fitness, this includes push, pull, squat, and hinge exercises. A push would be something where we’re targeting our chest muscles and backs of our arms – for example, a chest press. A pull would be something where we’re targeting more back muscles – for example, our biceps in something like a row. Squats are a really important movement for getting in and out of a chair. So they are effective in strengthening the quadriceps and butt muscles. And then our hinge, which largely targets muscles in the backs of our legs like our hamstrings, can be something like a Romanian deadlift which kind of looks like picking something on and off the ground.

Strength training, even high intensity strength training, if it is prescribed appropriately, is safe for people with rheumatoid arthritis.

Strength training improves both strength and function, which is really important for maintaining independence and doing everyday activities. But strength training has many other benefits. For example, it can improve mental health and decrease a person’s risk for chronic diseases like cardiovascular disease and type 2 diabetes.

Specifically for people with rheumatoid arthritis, strength training has many benefits. It can help decrease pain, fatigue, as well as swelling. People with rheumatoid arthritis are also at an increased risk for accelerated loss of muscle strength and size. Strength training can help lower this risk. These benefits apply to other types of arthritis too – we see similar improvements in things like strength and function, as well as decreased risk for chronic diseases like cardiovascular disease, type 2 diabetes, etc.

There are limited strength training resources available for people with arthritis and that’s what we’re trying to address through our research. If someone wants to start strength training, there are some resources online. You don’t have to go to a gym to get started. You can even start by doing exercise classes or doing exercises at home with things like your own body weight or simple equipment like resistance bands.

We’re looking to find ways to support people with rheumatoid arthritis to participate in strength training. This includes the development of resources and training for people living with rheumatoid arthritis, as well as the health and exercise professionals who work with them to prescribe and promote strength training.

This research is called I START, which stands for Improving Strength Training and Tailoring Among People with Rheumatoid Arthritis. Our researchers are developing what’s called the I START Toolkit. It’s a complimentary tool for both practitioners, as well as patients. The purpose of this tool is to have a guided conversation where we can co-develop an approach to strength training.

The research team includes people with lived experience – people with rheumatoid arthritis, as well as clinicians. What we’ve been doing with this research is gaining an understanding of the things that make strength training challenging for someone with rheumatoid arthritis. We’ve summarized existing research to gain an understanding of how we tailor our approaches for someone with rheumatoid arthritis and what the guidelines and recommendations are for strength training. And what we are currently seeing, not just among people with rheumatoid arthritis, but more generally around how we support strength training as something that people do long term.

To our knowledge, there aren’t currently any tools specifically for prescribing strength training for people with rheumatoid arthritis. Our tool will be the first of its kind. The unique piece here is we’re not just talking about what we prescribe, but how we prescribe and seeing strength training as something that isn’t just the exercises that we do, but a lifelong behaviour that we support.

The benefits of strength training and aerobic exercise are actually pretty similar. To clarify, aerobic exercise includes activities like walking, running and swimming and can decrease the risk of cardiovascular disease, type 2 diabetes and stroke. But we’re also seeing that those similar health benefits result from strength training. In some cases, strength training even provides additional benefits – especially when we look at things like function and decreased risk for frailty.

Understanding how to do cardio exercise is sometimes a little bit easier. You can ask someone to go for a walk, wheel or run. But with strength training, it becomes a little bit more complicated. Asking someone to go to the gym and do a set number of repetitions or specific exercises requires more support. There really is a need for more resources and training – not just for people with arthritis, but also health and exercise professionals. There’s a big knowledge gap in how to prescribe strength training for people with rheumatoid arthritis.

Overall, strength training participation rates are low. In the general population, about a third of the population does strength training regularly (twice per week). Only about 14% of people with rheumatoid arthritis do regular strength training.

Through speaking with people living with rheumatoid arthritis, our researchers identified 50 different barriers to strength training. For example, disease-specific symptoms like pain and fatigue make it difficult to do strength training. Medication side effects – like brain fog – can also cause people to have trouble remembering a strength training program. These are a couple individual factors. But the barriers to strength training extend far beyond the individual. Many health and exercise professionals do not know how to provide support to help people strength train.