Rheumatoid arthritis (RA) is an inflammatory disease characterised by the presence of synovial inflammation and destruction of bone and cartilage. This matrix degradation leads to reduced physical function. Indeed, up to 50% of patients display a decreased range of movement at initial presentation to a rheumatologist.¹ The presence of widespread synovial inflammation, coupled with impaired mobility and function, results in a low bone mass.

Two distinct forms of bone loss—localised and generalised—have been described.² Localised bone loss in the form of bone erosions and periarticular osteopenia is an important component of the radiographic criteria for the diagnosis of RA.³ More severe disease activity is usually associated with the presence of extensive erosions. Erosions typically develop within the first 2 years of diagnosis of RA.⁴ The rate of progression of these erosions is, however, less clear. Whereas some studies suggest that radiographic progression continues at a constant rate throughout the disease,⁵ others report a variable course.^6,7 Synovial inflammation is an important determinant of progression of erosive changes in RA; however, radiological progression does not strongly correlate with other clinical measures.⁸

“Rheumatologists often recommend non-weightbearing exercise”

Exercise is an essential component of medical and surgical management of inflammatory joint diseases. Nevertheless, rheumatologists traditionally have recommended exercise restriction or exercise programmes limited to non-weightbearing isometric exercises and range of motion exercises owing to concerns about aggravating joint inflammation and accelerating joint damage in patients with RA.^9–11 In contrast with the standard regimens, dynamic exercises promote muscle movement during joint motion or aerobic activities, or both. Examples of dynamic exercise activities include swimming, walking, cross-country skiing, bicycling, weight training, and house cleaning.

Several studies have demonstrated that dynamic exercises improve muscle function and aerobic capacity^12–16 without negatively …