Exercise is important for managing your axial SpA (AS) pain and fatigue, as well as improving your overall health and keeping your bones strong. We’ve put together the top tips from Andrew MacMillan’s Facebook Live session about weightlifting to help you get started, progress and stay safe while working out.
It’s important to remember that different things work for different people and when starting a new exercise regime, your rheumatology team can advise on what’s appropriate for you. One of the biggest things Andrew stressed is that there is no perfect exercise routine or amount, so experiment to find what works for you and be kind to yourself.
Getting started
When you’re starting a new exercise regime, make it as achievable as possible. Finding something you enjoy will make it much easier to start and, importantly, help you do it consistently over a long period of time.
- Are there different times of day that you prefer exercising?
- Do you prefer different types of exercise at different times of day?
- Do you prefer to exercise with others or on your own?
- Does music help motivate you?
As Andrew says, “the best exercise is the one you get done”.
Ideally you should aim for some moderate-intensity exercise. This means you get slightly out of breath, you’re a little sweaty and it will feel slightly challenging. This is a good way to judge the right level of workout and help you to increase the intensity over time safely.
Warming up
It’s important to warm up well before exercising to reduce the likelihood of injury.
- Some gentle cardio like cycling, cross trainer or brisk walking can help warm your muscles and joints.
- Try loosening your joints with swinging arm or leg movements and spinal twists.
- To help get your muscles fired up, try standing with your back against a wall and gently press into it. This will get the muscles warming up without moving your joints too much.
How much exercise should I do?
It depends on how much you currently do, how well your axial SpA (AS) is controlled and your general health. It’s worth checking with your healthcare team, but the general advice is 150 minutes of cardio exercise each week and strengthening exercises about three days a week.
Building up over time
To help you build up your exercise over time, think of FITT:
Frequency: exercising more often
Intensity: training a bit harder
Time: exercising for longer
Type: change the type of exercise
Make small increases and see how you feel in the days afterwards before increasing again.
Avoiding injury
The biggest advice for avoiding injury is to start with lower weights and repetitions, then increase this slowly over time as your strength and fitness increases.
Don’t worry about the ‘perfect posture’ too much, but be aware of your position and seek advice from a physiotherapist if you need to.
Injuries tend to happen when you’ve done too much too quickly, the weight is too heavy or you’re tired. If you feel tired, lighten the weight a little and concentrate on doing less repetitions really well.
Have a plan for flares
Flare ups of fatigue and pain are common in axial SpA (AS), even when your condition is generally well controlled. Sometimes it can physically stop you exercising, but it can also impact your motivation.
It’s important to keep moving when you’re flaring and there are some simple changes you can make if you want to weightlift during a flare:
- Do less repetitions of each exercise
- Use lower weights than usual
- Train different body areas to reduce strain on painful areas
- Do a shorter workout
- Try less impactful exercises e.g. exercise in water
- Exercise snacking: do small amounts of exercise throughout the day
- Have equipment at home: e.g. cables, bands, dumbbells, use a wall or the floor, or even tins of beans in a bag!
- Workout in water: use wrist/ankle weights, push a float into the water to add resistance or even hold a float between your knees for a good core workout
Positions to help weightlifting
As already mentioned, there is no perfect posture or alignment for anyone. Be guided by your healthcare professional’s advice and how things feel for you. There are some simple ways to adjust your position when lifting to find what’s right for you:
- Modify machines to find angles to suit you
- When using free weights, use a bench and alter your position/angle to make it more comfortable. For example, try leaning back to do a shoulder press, rather than sitting upright
- Dumbbells or cable machines can be easier than barbells. Sit on a bench when using these to keep yourself steady
- Use a hoodie/towel rolled up behind your head if you need extra neck and shoulder support
Squats
Before lifting, loosen up by doing small squats without weights or doing hip movements on machines.
If you find back squats uncomfortable on your spine, there are different types of squats that put pressure on your spine but still give your legs the same workout:
- Front squats: holding the bar on the front of your chest
- Goblet squats: holding a dumbbell or kettlebell in front of you
- Suitcase squats: holding weights in your hands
Use a deadlifting strap on a buffalo bar or safety bar if shoulder stiffness makes it difficult to hold the bar behind you.
Deadlifting
Commonly it can be difficult to deadlift with the bar on the ground, so try using bigger plates to raise the bar up or start with it on a bench.
Change your stance by having your feet wider or narrower to help with hip movements or discomfort.
Intense workouts
Sometimes you want an intense workout without putting pressure on your joints. There are a few ways to achieve this:
- Super sets: do back-to-back exercises where you work on one muscle group, followed by the opposite muscle group. For example, do bicep curls immediately followed by tricep pushdowns, or shoulder presses followed by lat raises
- Pre-fatigue muscles so you can use less weight. For example, do chest flies to tire the chest muscles before a bench press
- Drop sets: start with heaviest weight you can lift comfortably, then as your muscles fatigue move onto the next weight down and do as many reps as you can before dropping down again
- Lower the weight you’re using, but increase the repetitions
- Try High-Intensity Interval Training (HIIT)
Ideally the exercise should be difficult enough to challenge you, but not to the point where it’s really sore afterwards. As Andrew says, “stimulate, don’t annihilate. But remember that if it doesn’t challenge you, it doesn’t change you”.
Hand pain with holding weights
Top tips for reducing hand pain while holding weights:
- Use deadlifting grips or wrist straps that hook onto bar (these can be used for any exercise, not just deadlifting)
- Strengthen your hands: using hand putty, squishy ball, resistance tool…
- Compression gloves can be helpful
Remember…
There’s no perfect exercise, no ideal number of repetitions or intensity. It varies for each person and it varies depending on the day and how you’re feeling. Listen to your body and your healthcare professionals to find what’s right for you… most importantly, enjoy yourself!
Andrew is an osteopath, researcher and lecturer with a special interest in axial SpA (AS).
