Best Low-Impact Exercises for Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) can make everyday activities such as household chores, bathing, or going up the stairs feel difficult. The inflammatory condition is known for symptoms like muscle pain, stiffness, and reduced range of motion, especially in the shoulders, neck, and hips.

It’s no wonder why many people living with PMR instinctively pull back on physical activity. But avoiding movement can make symptoms worse over time.

The key is to choose exercises that are gentle on the body, sustainable in the long run, and tailored to how you feel and what you enjoy doing.

Walking is one of the simplest and most effective ways to stay active with PMR, according to Kimberly Steinbarger, an assistant professor in the school of physical therapy at Husson University in Bangor, Maine.

“It’s something you can do practically anywhere. Balance, mobility, flexibility, strength, conditioning — all those things can be incorporated into walking,” she says.

Physical activity can sound intimidating when you think of going to the gym to “work out," but taking a walk is a much more approachable way to exercise with PMR, she says. It can look like taking your dog for a walk around the block, walking to the mailbox, or even walking around the home, she says.

It can also provide some relief for an achy body, says Robyn Culbertson, DPT, a spokesperson for the American Physical Therapy Association and a geriatric physical therapist in Columbia, South Carolina.

“Walking helps increase circulation to stiff muscles,” she says. “It’s a way to get cardio without a huge impact on the joints, and you can adjust your pace and distance depending on how you’re feeling,” she says.

Water-based exercise, like going for a swim or taking an arthritic aquatic PT class, can be especially beneficial for people with PMR.

“Swimming is great because being in water increases buoyancy, putting almost no pressure on the joints,” Culbertson says.

Hydrotherapy — also known as water therapy or pool therapy — can offer a combination of gentle strength work, aerobic exercise, and flexibility training. Warm water may also help muscles feel looser and more comfortable, says Steinbarger. She suggests using a float for added resistance.

You don’t have to swim laps — it can be as straightforward as water walking and leg lifts to get your body warmed up and active, she says.

Be mindful of safety and accessibility, especially when mobility is limited. You can sign up for a supervised aquatic therapy class, or have a family member or friend spot you as you’re getting in and out of the pool, says Neal Birnbaum, MD, a rheumatologist and past president of the American College of Rheumatology who’s been practicing for 48 years in San Francisco.

Resistance exercise helps maintain the strength needed for daily tasks like getting out of bed, showering, and dressing, Culbertson says. It may also counter muscle loss and bone weakening linked to long-term steroid use.

And it doesn’t require heavy weights. In fact, a lighter approach is often safer, Birnbaum advises. “If you’re going to do anything with weights or machine resistance, increase the repetition more than the weight load. That way you don’t hurt yourself,” he says.

Consider your fluctuating symptoms first. If you’re in a flare and your joints are inflamed, scale back on resistance training and try out walking until you feel better, she says. As symptoms improve, you can add activity that’s a bit more strenuous.

If you’re not sure where to start with weight training, ask your rheumatologist for a referral to a physical therapist who can create an individualized workout plan that prioritizes your fitness level, goals, and preferences, she advises.

“I can’t stress enough [the importance of] seeing a physical therapist. We look at cardiovascular health, mobility, balance, fall risk, and we take into account chronic diseases, medications, sleep and diet,” she says.

Birnbaum, who was diagnosed with PMR in 2000, emphasizes consistency. He has worked with a personal trainer twice a week for more than 20 years.

Stretching ticks a lot of boxes for aiding people with PMR, Birnbaum says. Exercises like yoga and Pilates support flexibility and stiffness relief, boost mental health and mood and burns calories, if you’re worried about weight gain from steroid therapy, he says.

“If you’re doing yoga, you’ve got the mindfulness and breathwork. For some people, this is excellent for alleviating stress,” he says.

“There’s balance, mobility, weight shifting — it moves all the joints. And it’s great to decrease fall risk,” she says, noting stretching builds strength in a low-impact way.

“You can also do shoulder rolls to keep the muscles around the neck loose,” she suggests.

Having PMR and dealing with fatigue, stiffness, and steroid side effects can take a major toll on your quality of life, so doing any kind of activity that you enjoy, keeps you active, and that puts you in touch with people you like is going to have a therapeutic effect, Steinbarger says.

Take stock of your favorite hobbies and activities, like gardening or playing with your grandkids, she says. “It’s so much easier if you can find something that you love to do and then incorporate the physical activity. Because sometimes going to the gym is just too hard,” she says.

With PMR, the aim is to keep your body moving — even with gentle, limited movement, such as a short walk, Birnbaum says. “Once you settle into one position, it’s like Jell-O — you stiffen up and you’re not moving. As long you keep moving, things feel better,” he says.

• Low-impact exercise is essential for people with PMR, helping them to maintain mobility, muscle strength, and independence while also reducing the risk of falling and helping to offset steroid side effects like weight gain and bone loss.
• Examples of low-impact exercise include walking, swimming, resistance training, and stretching.
• Pay attention to your symptoms and adjust physical activity levels accordingly. If your symptoms are flaring, scale back and focus on gentle walking, then ramp up exercise as you feel better.
• Consult a physical therapist if you’re unsure of where to start; they’ll work with you to create a tailored exercise plan that matches your fitness level, goals, and physical activity preferences.