Therefore, splints should be removed periodically for gentle ROM activities as previously described. Muscle atrophy can quickly occur in these patients because of disuse, splinting, or the inflammatory process. Loss of muscle bulk is correlated with loss of functional ability. The type and duration of exercise activity will vary from patient to patient, as determined by the practitioner's evaluation of the patient including available strength, functional needs, pain, fatigue, and degree of inflammation. As noted earlier in the discussion on preserving motion, exercise to preserve strength must be carefully monitored so that the patient does not over or under-exercise.
Isometric exercises are the best to use when the patient is experiencing a flare.
This type of exercise allows the patient the opportunity to exercise specific muscle groups while avoiding joint motion. Isotonic exercises with small weights may be used, as tolerated by the patient, in non-involved joints or joints with minimal inflammation. In most cases, it is not appropriate to have the patient with RA perform isokinetic exercises, especially at slower speeds which increase joint compression. No matter which type of exercise is selected by the practitioner, patients with RA should never be exercised to the point of fatigue.