People with arthritis have pain when they move, so many people with arthritis limit their movement. But this inactivity can be detrimental and lead to more crippling. More than 30 years ago, one of the accepted forms of treatment was bed rest. This was done to help patients with arthritis preserve their joints. It is now recognized that this type of treatment causes more harm than good, in many instances. Studies have revealed that people with arthritis who exercise regularly report less pain and joint swelling, improved functioning and increased strength, endurance and flexibility -- without harming their joints.

The psychological benefits are also important. People who exercise experience less depression and anxiety and greater feelings of control. Confidence in the ability to perform activities of daily living leads to a sense of well-being. There is less fear, particularly when it comes to things like falls. Patients with arthritis often worry about falling and being unable to get back up.

Since people with arthritis range in conditioning from very frail to those who are only slightly limited, the variety of exercises is enormous. There are two major areas to consider: Indoor and outdoor. This article will focus on indoor exercises.

Indoor exercises for people with arthritis fall into three major categories.

1. Range of motion exercises. These are exercises that help reduce the level of stiffness and keep the joints flexible. The term "range of motion" means the normal distance the joints can move in all directions. There are five primary targets... Shoulders. Slow easy arm circles. Starting with arms at the sides, bring them all the way up toward the ceiling and then as far behind the body as comfortable in a huge circle. Repeat 5-10 times. Hips. Lie on the back with knees bent, feet on the floor and arms down along the sides. Bring one knee to the chest and rotate the knee in an easy gentle circle. Repeat with other knee. Do this 5-10 times. Wrists. Make circles with the wrists, rotating hands in both directions. Ankles. Draw big circles in the air with the big toe in both clockwise and counterclockwise motion. Knees. Lie on the back and bring one knee to the chest. Straighten the leg, pointing the foot toward the ceiling and bend a few times. Repeat with the other leg.

2. Non-impact aerobic exercise. People with arthritis need to do 30 minutes a day of cardiovascular activity. In particular, conditioning large muscles, such as those in the legs, stimulates the healing of cartilage. When choosing an exercise, it's important to pick something that doesn't worsen arthritis. Walk on a flat even surface. Here is where indoor and outdoor can mix. For instance, a school track is a good choice. Remember to wear good, comfortable, supportive shoes. If there is no access to a track, consider a mall or a sidewalk. Avoid bumpy fields or gravel roads. Water exercise. For some people, walking is difficult. A good alternative is water exercise. The buoyancy of the water supports the body so there's less stress on the spine, hips and knees. The Arthritis Foundation sometimes sponsors water exercise classes at the YMCA. These classes are good because they allow a person to exercise in water at chest level. They provide good range of motion and aerobic conditioning.

3. Strengthening exercises. There are some excellent studies showing that weight training for people with arthritis is beneficial. Most of these will be done indoors.

When starting, it's best to begin with light weights such as Heavy Hands or dumbbells and work up from there. The goal is to work out with a weight that can be lifted at least 10 times without too much effort. If it is too difficult, then the weight is too heavy. Significant injury can result, so be careful! Resistance straps are also an option. Check with your physical therapist. Here are some good lower body strengthening exercises.

Leg extensions. Sit straight in a chair, knees bent 90 degrees, feet flat on floor. Then extend the leg straight out, hold it for 10 seconds, then bend it back down to the starting position. Start with 10 to 15 repetitions and increase to 50 over time. Toe raises. Work the calves by standing and raising the body up on tiptoes and back down. Do eight to 10 repetitions. Chair squats. Sit in a chair and practice standing straight up and sitting back down again, using the muscles of the legs. It strengthens the legs and also helps with balance.

Always check with your rheumatologist before starting this or any other exercise program.

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