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Story at-a-glance

• Blood flow restriction (BFR) training allows people with rheumatoid arthritis (RA) to build muscle, improve mobility, and reduce pain using very light resistance, avoiding the joint stress of heavy lifting
• Eccentric exercises — the slow “lowering” phase of movements — help increase muscle mass, lower blood pressure, reduce body fat, and restore daily function without triggering flare-ups
• In studies, RA patients who followed structured BFR or eccentric training programs reported higher strength, better endurance, and greater ease in performing everyday activities
• The Arthritis Foundation emphasizes gentle, consistent movement such as stretching, swimming, walking, and balance training as key to protecting joints and slowing disease progression
• Combining light-load eccentric exercise with BFR offers a safe, effective way to rebuild strength, stability, and independence while keeping inflammation and discomfort in check

Most people with rheumatoid arthritis (RA) want to stay active and strong, but conventional strength training often feels like too much. When your joints are already inflamed, the idea of lifting heavy weights sounds like a fast track to pain, not progress. That’s the dilemma facing many with RA: movement is necessary for preserving mobility and muscle, but the wrong kind of movement makes things worse.

As joints weaken and muscles waste away, daily tasks — like standing up, reaching overhead, or simply walking — become harder and riskier. But what if you could build strength without loading your joints? What if there were a way to stimulate muscle growth using just light weights, or even bodyweight — no pain, no flare-ups?

That’s exactly what researchers set out to test with a method known as blood flow restriction (BFR) training.1 Instead of pushing heavier loads, this technique uses gentle resistance paired with a cuff that lightly restricts blood flow to the working muscles. In Japan, it’s known as KAATSU, meaning “training with added pressure.” The results are surprising — and promising.

BFR Strength Training Works Better Than You Think

In a study published in Disability and Rehabilitation, researchers from the University of South Australia designed an eight-week intervention to evaluate whether BFR resistance training was safe, tolerable, and effective for people with RA, a chronic autoimmune disease that attacks the lining of your joints.2

This training method involves applying inflatable cuffs to your upper or lower limbs during exercise to limit blood flow return. The goal was to simulate the muscle-building effects of heavy lifting without overloading the joints — a key advantage for people with inflammatory joint disease.

• Researchers recruited 20 adults with longstanding RA who had no prior experience with this training style — All participants were over age 45, diagnosed with rheumatoid arthritis, and sedentary at the time of the study. Each participant performed supervised strength training two times per week using light weights (20% to 40% of their one-rep maximum) with intermittent blood flow restriction.

• Participants gained measurable strength, improved function, and reported less pain, without needing high resistance — The researchers tracked performance on leg presses, arm curls, and triceps pushdowns. By the end of the study, participants significantly increased their strength across all movements.

They also performed better on walking tests, which measured mobility and lower-body power. Despite using light loads, participants gained functional strength that helped them move through daily life more easily.

• Pain scores dropped, and patients reported better overall well-being — On a standard tool used to measure pain, participants experienced meaningful improvements. Some even said the gains in strength made them feel more motivated. No serious side effects or injuries occurred, and nearly all participants completed the full eight-week program.

• Adherence to the training was high when the format matched individual preferences — The researchers emphasized how patient preference played a key role in adherence. Participants responded best to sessions that were short (around 40 minutes), supervised by knowledgeable staff, and included a variety of exercises rather than just machine-based work. This highlights the importance of personalization when designing movement plans for chronic illness.

BFR Resistance Training Produced Strength Gains with Light Loads

Typically, strength training requires loads of 60% to 80% of your maximum effort to stimulate muscle growth. But with BFR resistance training, participants used as little as 20% of their max effort and still experienced substantial gains. This is because restricting blood flow during exercise creates a low-oxygen environment in your muscle, triggering stress signals that tell your body to build more muscle, even without heavy resistance.

• Light resistance combined with BFR tricks your body into working harder — When muscles are deprived of oxygen due to restricted venous blood flow, it causes an increase in metabolites like lactate, which in turn stimulates the release of growth hormone and other muscle-building signals. At the same time, this low-load approach reduces mechanical stress on joints, which is important for people with fragile cartilage and inflammation.

• This training method targets both strength and metabolic health, making it especially useful for RA patients at risk of frailty — The researchers noted that muscle weakness in RA contributes to disability, falls, and even cardiovascular disease risk. By improving muscular strength and endurance with minimal joint stress, BFR resistance training addresses these risks head-on. It’s not just about lifting weights — it’s about restoring function and independence with a smarter approach.

Whether you're elderly, recovering from an injury, or struggling with RA, BFR training/KAATSU can be a real game changer. To learn more, check out my previous article, “How to Stay Fit for Life,” in which I review the science behind KAATSU and explain in greater detail how to use it.

The main difference between KAATSU and BFR is the tool you're using. BFR can be done with restriction bands, but KAATSU uses a device that also provides intermittent and not just constant pressure. The KAATSU set is ideal as it is far easier to dial in to the correct pressures. You also get the benefit of intermittent pressure automatically, without having to adjust the bands yourself.

I recommend the C4 model, because the C-series doesn’t have Bluetooth (which emits harmful electromagnetic fields). For a limited time, you can get 10% off any KAATSU equipment by using the promo code DRM.

Eccentric Exercise Builds Strength, Lowers Blood Pressure, and Restores Function in RA

Eccentric exercises are another way to help manage RA, as evidenced in a randomized controlled trial published in Health Science Reports.3 Unlike generic fitness advice, this study focused on a specific, underused technique that delivers impressive benefits without stressing vulnerable joints.

Participants were between ages 30 and 65 and were randomly assigned to either a control group (usual care) or an eccentric training group. The exercise group did three 40-minute sessions per week, using movements like forward lunges, bicep curls, leg curls, chest flys, and calf raises — all performed with slow, deliberate motion during the lengthening phase. Each rep took four to six seconds, focusing on muscle control rather than speed or weight.

• Eccentric exercise involves the “lowering” or lengthening phase of a movement, when your muscle resists as it slowly stretches — For example, when you lower a dumbbell during a bicep curl, that’s the eccentric phase. You’re still working the muscle but in a gentler, more controlled way. This study tested whether focusing on that part of the motion could help people with RA build strength, improve function, and feel better — all without needing to lift heavy weights or risk joint flare-ups.

• The results were dramatic: muscle mass increased, body fat decreased, and blood pressure went down — After just 12 weeks, participants in the eccentric group gained more lean muscle and lost excess body fat. Both systolic and diastolic blood pressure dropped — an important benefit given the elevated cardiovascular risk in RA. These changes occurred without pain or injury, even among people who had previously struggled to stay active.

• Work productivity and daily function also improved significantly — RA often leads to fatigue, reduced mobility, and difficulty performing job tasks. In this study, people following the eccentric training plan reported feeling more capable, more active, and less limited by their symptoms — both at home and at work.

• This type of training is ideal for those who feel too weak or inflamed for conventional strength workouts — Eccentric movements deliver powerful results with less effort and lower joint stress than conventional lifting. The body responds by building muscle and improving function, even with modest resistance and a lower overall energy cost. For people with RA, that means they gain strength without triggering pain or flares.

• The researchers recommend these new guidelines be added to official RA exercise protocols — They suggest starting with two sets of 15 reps at 50% effort, progressing to three sets at up to 75% effort over 12 weeks. Each session includes a warm-up, eccentric training, and a cooldown. Simple recovery tools — like foam rolling and ice — help ease any delayed soreness.

The goal is steady, sustainable progress that supports better health without fear of injury. These guidelines offer something RA patients often lack: a clear, safe, and effective way to regain control over their bodies and lives. By focusing on the “easy-looking” half of a movement, eccentric exercise quietly delivers big gains.

Simple Daily Movements That Protect Your Joints

The Arthritis Foundation published a comprehensive overview focused on safe and effective movement strategies for people with RA. Their guide outlines which types of exercises provide benefits without triggering flare-ups, and why consistency — not intensity — is the key to long-term success.4

RA causes swelling, joint deformation, fatigue, and sometimes even damage to internal organs. For many, this leads to movement avoidance, which only worsens stiffness and weakens muscles. The Arthritis Foundation emphasizes that even small amounts of movement help preserve mobility, relieve tension, and slow the disease process over time.

• Five exercise categories work especially well for people with RA — The Arthritis Foundation recommends the following exercises to not only ease symptoms but help you regain confidence in your body:

◦Stretching to reduce stiffness and improve flexibility

◦Strengthening exercises (like resistance bands or light weights) to support joints

◦Aerobic conditioning such as walking or swimming to boost circulation and energy

◦Balance and body awareness training like yoga or tai chi to prevent falls

◦Functional movements that mimic daily tasks to make real-life activities easier

• Gentle stretching routines are safe to perform daily and can be modified for any level — Stretching helps keep joints lubricated and muscles from shortening. The Arthritis Foundation suggests holding each stretch for 20 to 30 seconds and focusing on large muscle groups around affected joints. If you're flaring or feeling stiff in the morning, even a five-minute routine will help start your day with less discomfort.

• Water-based exercises are strongly recommended for people with joint pain and swelling — Aquatic workouts, especially in warm water, allow your body to move without the weight of gravity compressing your joints. Activities like water aerobics or swimming are easier on painful areas while still building strength and cardiovascular fitness. The Arthritis Foundation describes water as a “natural resistance” that helps you strengthen muscles without overdoing it.

• Strength training is key, even with RA, but it needs to be done thoughtfully — Lifting weights doesn’t damage joints if done correctly. In fact, it stabilizes them. The Arthritis Foundation recommends two sessions per week focused on low resistance and higher repetitions. The goal isn’t bulk — it's joint protection and injury prevention through muscle support.

• Rest is important, but too much inactivity weakens your muscles and limits your motion — The guide warns that inactivity accelerates joint deterioration and leads to greater disability over time. Instead of long rest periods, aim to break up sedentary time with short bursts of movement, such as a few stretches at your desk or a walk around the block.

Most importantly, listen to your body and modify activity based on how you feel. Track your energy levels and joint responses. If a movement causes sharp pain or leads to worsening symptoms the next day, it's a sign to adjust. But gentle, regular activity, even during flares, helps prevent long-term damage. Exercise isn’t just safe for RA — it’s foundational to your recovery and resilience.5

Start with Gentle Movement and Build from There

If you’re living with joint pain, stiffness, or the fatigue of RA, the thought of exercising might feel overwhelming or even impossible. But avoiding movement altogether makes things worse over time. Your joints depend on circulation and muscular support to stay functional — and both of those rely on movement.

The key is to start small, keep it gentle, and be consistent. You don’t need intense workouts or long gym sessions to see results. In fact, short daily movements are more effective than occasional hard efforts. Think of exercise not as punishment, but as nourishment for your joints, muscles, and nervous system. Here’s how to get started in a way that supports your body, not strains it:

1. Ease in with flexibility and range-of-motion work — Begin each day with five to 10 minutes of gentle stretches, focusing on your shoulders, hips, knees, and wrists. Hold each stretch for 20 to 30 seconds without bouncing. These light movements help lubricate joints, reduce morning stiffness, and prepare your body for more targeted exercise.

2. Incorporate low-impact aerobic activity — Walking on flat ground, cycling on a stationary bike, or doing gentle water exercises boosts circulation, reduces inflammation, and lifts energy levels. Start with 10 minutes and increase as you’re able. If you have access to a heated pool, warm-water exercise eases pain while improving mobility.

3. Follow a progressive eccentric exercise program — Eccentric training focuses on the “lowering” or lengthening phase of a movement, such as slowly lowering a weight or descending into a squat. For RA-friendly eccentric moves, try forward lunges, banded leg curls, bicep curls, and calf raises. Begin at low intensity and progress gradually, allowing four to six seconds for the lowering phase of each repetition.

4. Add BFR for strength gains with less joint stress — BFR uses a specialized cuff or elastic band to gently limit blood flow to a limb during light exercise. This amplifies the muscle-building effect of low-resistance movements, making it possible to gain strength without heavy lifting. For RA patients, pairing BFR with light eccentric training helps preserve muscle and support joint stability. Work with a trained therapist to ensure safe technique and appropriate pressure.

5. Break up sedentary time with micro-movement breaks — Sitting for long stretches stiffens joints and slows circulation. Set a reminder at least every hour to stand, stretch, or walk briefly — even a lap around the room counts. These small, consistent bursts of movement help maintain mobility and reduce fatigue over the day.

You don’t have to start with all five steps. Choose the one that feels most manageable and build from there. What matters most is that you keep moving, because movement is what keeps your joints functional and your strength intact.

FAQs About BFR and Other Exercise for RA

Q: What is BFR training and why is it helpful for RA?

A: BFR training uses a specialized cuff or elastic band to gently limit blood flow to a limb while you perform light-resistance exercises. This creates a low-oxygen environment in your muscles, which triggers muscle-building signals similar to heavy lifting — but without the joint stress. For people with RA, it helps increase strength, mobility, and function while reducing pain risk.

Q: How does eccentric exercise benefit people with RA?

A: Eccentric exercise focuses on the “lowering” or lengthening phase of a movement, such as lowering a dumbbell during a curl. This type of training builds strength, increases muscle mass, reduces body fat, lowers blood pressure, and improves daily function — all with less joint strain than conventional lifting. It’s especially useful for people who feel too weak or inflamed for conventional strength workouts.

Q: What daily exercises does the Arthritis Foundation recommend for RA?

A: The Arthritis Foundation suggests five main exercise types: stretching, strengthening, aerobic conditioning, balance training, and functional movements. Activities like gentle stretching, resistance band work, walking, swimming, tai chi, and practicing movements that mimic daily tasks help maintain mobility, reduce stiffness, and protect joints.

Q: How do I start exercising if I have joint pain or stiffness?

A: Start small and be consistent. Begin with five to 10 minutes of gentle stretching in the morning, add low-impact aerobic activity like walking or water exercise, and gradually introduce BFR strength training. You can also break up long periods of sitting with short movement breaks. The goal is steady progress without triggering pain or flare-ups.

Q: Can BFR and eccentric training be combined for better results?

A: Yes. Combining light-load eccentric training with BFR maximizes muscle gains while minimizing joint stress. This approach is ideal for RA patients who want to improve strength and stability without heavy lifting. It’s important to learn safe techniques and use proper equipment, ideally under the guidance of a trained professional.

Sources and References

• 1, 2 Disability and Rehabilitation February 13, 2025
• 3 Health Science Reports April 21, 2025;8(4):e70731
• 4 Arthritis Foundation, Best Exercises for Rheumatoid Arthritis
• 5 J Aging Res. 2011 Feb 13;2011:681640