Strength Training With Arthritis

[DiddlySquat]

Hey rip,

My girlfriend was diagnosed with lupus and rhematoid arthritis, and I want to have her slowly start training... she actually loves strength work because she hates any excercise that makes her work up a sweat or induce lactic acid burn... And she's seen the wonders barbell training has done for me and she's 100% sold

We tried the SS program after making sure her form was pretty much perfect with basically an empty bar.

A few times it would appear that the training may have precipitated flare ups with arthritis.. arthritis pain in elbows, ankle, etc...

I was just wondering if anyone here has any experience with barbell training someone with an autoimmune disorder, or arthritis and lupus in particular... Would higher reps with less weights be less stressful on the joints or more stressful?

[Mark Rippetoe]

I have had some experience with training people with autoimmune stuff, and I have found that the key is a submaximal start and smaller than normal jumps up the linear progression. But the reps are still 5s.

Think with me: she's not strong, so she can't stress herself with a weight that would constitute a heavy load because she's incapable of lifting it. But she can do lots of light reps at high volume -- because they're easier -- but something she's also not adapted to. Overstress is indeed the enemy here, but instead of using a manageable stress like 3 sets of 5 across that starts with an easy weight that increases gradually and eventually makes her stronger, you propose to stress her with a bunch of volume just because she's capable of doing a bunch of volume now if the weight is light enough. Remember that every rep has an eccentric component that makes you sore. More reps = more sore. Light weight = no strength adaptation. More sore = more inflammation, exactly what a person with an autoimmune disorder does NOT need. More importantly: More sore =/= stronger, because you don't stronger from getting sore; you get stronger from lifting heavier weights.

Training may indeed precipitate a flair-up. If they are small and manageable, they should actually help her adapt to living harder and better again, something I'm sure she'd like to do. If the workouts consist of 5s at a reasonable yet slowly increasing weight, she'll be better able to deal with them than if they consist of higher reps at a useless weight that makes her sore without making her get stronger. I occasionally see this high-rep approach advocated for older people who are detrained, under the guise of Lots Of Extra Warmup. If a person is detrained, high reps are much worse than low reps, for these same reasons.

Resist the temptation to assume that high reps/light weight = low reps/heavy weight, lest someone confuse you with an orthopedic surgeon or a CrossFit Level I Trainer.

[tnumrych]

I have had some experience with training people with autoimmune stuff, and I have found that the key is a submaximal start and smaller than normal jumps up the linear progression. But the reps are still 5s.

Think with me: she's not strong, so she can't stress herself with a weight that would constitute a heavy load because she's incapable of lifting it. But she can do lots of light reps at high volume -- because they're easier -- but something she's also not adapted to. Overstress is indeed the enemy here, but instead of using a manageable stress like 3 sets of 5 across that starts with an easy weight that increases gradually and eventually makes her stronger, you propose to stress her with a bunch of volume just because she's capable of doing a bunch of volume now if the weight is light enough. Remember that every rep has an eccentric component that makes you sore. More reps = more sore. Light weight = no strength adaptation. More sore = more inflammation, exactly what a person with an autoimmune disorder does NOT need. More importantly: More sore =/= stronger, because you don't stronger from getting sore; you get stronger from lifting heavier weights.

Training may indeed precipitate a flair-up. If they are small and manageable, they should actually help her adapt to living harder and better again, something I'm sure she'd like to do. If the workouts consist of 5s at a reasonable yet slowly increasing weight, she'll be better able to deal with them than if they consist of higher reps at a useless weight that makes her sore without making her get stronger. I occasionally see this high-rep approach advocated for older people who are detrained, under the guise of Lots Of Extra Warmup. If a person is detrained, high reps are much worse than low reps, for these same reasons.

Resist the temptation to assume that high reps/light weight = low reps/heavy weight, lest someone confuse you with an orthopedic surgeon or a CrossFit Level I Trainer.

This, ladies and gentlemen is IMO one of Rip's best posts.

[DiddlySquat]

Ahh... I see.. Yes what you're telling me is precisely what I had originally thought... I question my own instincts too much... Thanks for giving me a reality check rip...

I just began to second guess myself because I was upset that she was having flare ups, possibly due to something I told her to do...

We started with an empty bar and i told her to add weight extremely slowly.. but she didn't listen and in SS day # 3 made the jump from 55 to 75 pounds on her squat... because she knew she could do more weight....

It's not all bad news, though... She loves barbell training, can't get enough of the beef liver that i feed her and thinks she's really bad ass for getting stronger

Thanks rip..

[MikeS]

She IS really badass for strength training at all and doubly so for training with lupus and rheumatoid arthritis. Kudos to her.