Hey friends,
Welcome back to How to Move With! In this (free!) series, I interview experts about the ins and outs of exercise when you’re dealing with various conditions. (If you have a special request for a condition you’d like me to cover, please feel free to say so in the comments, reply to this email if you’re getting this in your inbox, or send me a DM on Substack.)
How to Move with hypermobility and connective tissue disorders (including Ehlers-Danlos)
Hey everyone: I’m so excited to announce that I’m kicking off a new series called How to Move With. In this (free!) series, I’ll interview experts about the ins and outs of exercise when you’re dealing with various conditions. (If you have a special request for a condition you’d like me to cover, please feel free to say so in the comments, reply to this…
Before we start, a reminder that when I run interviews with experts, the optimal user experience tends to be audio. You can listen to it in the Substack app, or in your favorite podcast player: Here’s a link to learn more about making that happen.
However! For this interview, the incredible How to Move subscriber Katie Gresham (who also writes Stutter Over Silence) helped shape the transcript into something a whole lot more readable than the one my audio editing tool automatically generates. So if you prefer to read (or read while you listen!), you have Katie to thank for this one. You’re the best, Katie!
I’d also just like to say, I’m really proud of this initiative, and as a journalist and former editor, I’m so grateful to have my own outlet so that I can call the shots and just do stuff I think is helpful and important — these stories are not ones I’d be able to tell in traditional media outlets (I can just hear the editors saying “too niche!”), or at least certainly not with this much depth. If you’d like to support independent, inclusive, useful, anti-diet health journalism, please consider becoming a paid subscriber or share this work with a friend who might be interested.
Finally, just a reminder that registration for my May 30-day strength challenge is now open! Learn more here, including the discount code for paid subscribers, and register here.
Transcript:
A couple of months ago, I launched a new audio series here called How to Move With: It’s all conversations with experts about finding exercise that works for your body when you’re dealing with a chronic illness, a challenging life stage, or any of the other many situations that can make it tricky to figure out your relationship with movement. (The first one was about hypermobility and Ehlers Danlos.) I knew I wanted one of my first conversations to focus on rheumatoid arthritis, since several of you asked about it, and I’ve had clients with it in the past, and it’s SO HARD to find really good information about it. But I kept striking out! A prominent researcher wouldn’t speak with me, other experts seemed to be promoting scientifically questionable treatments and approaches.
And then I found Britany Williams. She’s a fitness trainer, a motivational speaker, a podcast host — and someone who’s lived with rheumatoid arthritis since she was a teenager. She’s worked with lots of clients with RA and speaks from deep experience about living, and moving, with this autoimmune disease. If you have RA, I’m willing to bet you’re going to learn something new and helpful from this conversation; if you don’t have RA, you’ll gain a deeper understanding of what loved ones and friends with the condition might be going through. And for anyone who could use some help navigating exercise modifications, the difference between pain and discomfort, and how to deal when your wrists hate push-ups and planks? This conversation is for you.
Of course, this interview, and any content on How to Move, is not medical advice and is not meant to diagnose or treat any medical condition. For personalized guidance and treatment, please consult a medical professional.
Okay, here’s Britany.
Anna: Let’s start with an introduction. I’d love to just know who you are, where you are, and what you do.
Britany: Yeah, so I’m Britany Williams. I am originally from San Antonio, Texas, but live in Portland, Oregon; but have lived East Coast, West Coast, done a bit of it all.
I am a fitness trainer, podcast host and content creator. But I didn’t–haven’t–done this for my entire life. I like to tell people that I worked for Under Armour for 12 years, was an Excel spreadsheet wizard, like PowerPoint presentation deck, all of the things. And then in my mid-thirties decided to pursue fitness training and content creation full-time.
I was diagnosed with arthritis, rheumatoid arthritis, when I was 13. So I’ve always kind of felt like I resonated with the story of you’re gonna have obstacles, but you have to find a way through. And that’s really been my kind of mantra as I now build workout programs for an app called Sweat.
I also help people on a one-on-one basis, and then hopefully educate out the masses via social media, just on how to exercise in a way that fits your schedule, your nuance. Is your, you know, maybe pains and injuries like rheumatoid, rheumatoid arthritis is not an injury, but your disorders, diseases, whatever you’re dealing with. And it’s just kind of created this community that blossomed into a podcast and different things of just helping motivate women specifically to feel their best via working out.
Anna: So can you walk us through what rheumatoid arthritis is and kind of tell us about your journey with it?
Britany: Yeah, so rheumatoid arthritis is different than many other arthritises and when a lot of people think of arthritis, they think of osteoarthritis, which is your more traditional wear and tear arthritis that you would get as you age. And most, a lot of people, not most, but a lot of people do get kind of traditional osteoarthritis as they age.
Rheumatoid arthritis is different in that it is an autoimmune disease. So this is an immune response that can kind of pop up at any time in your life and it is your own body attacking your own joints. So it is your own body kind of flagging the lining of your joints as kind of like a foreign body, I will say, to simplify it. And you begin to eat away at your own cartilage and lining of your joints, which leads to a lot of inflammation and pain, stiffness, lack of mobility but there’s also because it is more of a systematic issue and not just the pain in the joints, there’s also a lot of fatigue and full body kind of pain. And again, fatigue I think is the great best word for it that goes along with it.
So it’s not just like I have my rheumatoid arthritis worse from a pain perspective in my wrist, but there are some days that I’m just really tired because of my arthritis and you wouldn’t think that the whole body would get really tired from arthritis in your wrist.
But that is unfortunately the nuance of an autoimmune disease, that it is a systematic disease, not just a factor in one or two specific joints. Oh, and then my own joint journey as you asked. So yeah, I was diagnosed at a really early age, I was just dealing with a lot of what they thought because I was 12 at the time. Growing pains, right? Like when a 12 year old’s complaining of wrist pain. It kind of isn’t going away. That is lasting for months on end. That’s really what everyone thought it was. And I went through a battery of tests and I think that that’s what’s really hard for a lot of people dealing with rheumatoid arthritis is that it’s not the first thing that most doctors assume you have. So most people who are eventually diagnosed with, I think, any autoimmune disease have to go through this battery of tests and doctors and appointments to figure out what it is.
So it was about a year to kind of be able to get to the point where they did the test that confirmed that I have rheumatoid arthritis. It is hereditary. My dad eventually was diagnosed with rheumatoid arthritis as well as lupus later on in life. So like, we kind of knew one of my parents was probably gonna get it. We just kind of sat around waiting for which one it was. But I was diagnosed at an early age and I’m blessed. If I was going to get it, I am glad that I got it at an early age, which maybe sounds backwards, but because I grew up not knowing any better and I was a very athletic, um, child, I did a lot of sports.
You know, playing sports in college was my absolute dream, which I was able to do. And so it kind of from the very beginning had this mindset of, well, I’m gonna have to figure this out. Like I can’t. I’m only 13, I’ve got a lot of runway ahead of me. I’m gonna have to find a way to make this work. I think that if I was diagnosed today at 37, I would be like, woe is me.
Like this is awful. So I think there is some, well, you know, I never wish any child to go through any level of pain and certainly not an autoimmune disease. There, I think, is a lot of beauty in how it shaped my mindset around it. And I think I have a much healthier mindset around it because it’s always been here, it most likely will always be a part of my life. So I kind of had that, the hard part was. Up and over. I got over it much quicker, probably at 13 than I would have later on in life.
Anna: Hmm, that’s so interesting. But it makes sense. You kind of, you grew up with it. Yeah. You had time. So you said you were a very active kid, you loved sports. How does RA affect your workouts and is that like…?
Britany: Yeah, big time. Yeah.
Anna: Okay.
Britany: Yeah, it, it definitely does. Most rheumatoid arthritis is going to come across through stiffness in your joints. I have it in my, in most major joints at this point. So my wrist, my knees, my ankles, I have my fingers as well as my toes.
I do have some… It’s funny, I hesitate to say, do I have it in my jaw because, I haven’t actually gotten an x-ray of my jaw to confirm whether or not I have it or an MRI, but I have a lot of pain that feels like arthritis in my jaw. So me and my doctor are like, we’re just gonna assume that there’s something going on in the jaw region as well.
But it really presents itself as stiffness. And for me, I now, having this disease for 25 years, don’t have much active disease in the sense that I’m not fighting inflammation on a day-to-day basis. Mainly because I’ve been medicated now for 25 years. I’m under a kind of medication protocol that works for my body.
So what it looks like, what the disease looks like in my body right now at 37 is very different than what I look like at 13, which I can go through in a second. But today, not dealing with a lot of every single day pain. I don’t deal with a lot of flareups if I stay on top of my medications. But because I’ve had this disease for a long period of time, I went through a phase in my twenties where I was like, I don’t need to take medication.
I’m invincible. I’m, I’ll be fine. And that may be three or four years that I didn’t take medication really set me back from a range of motion perspective. So that’s really where I lack in my workouts right now is like I can’t put my right wrist flat on the ground. For example, if you imagine doing a plank, like a pushup position where your hand needs to be flat and your arm needs to be able to completely extend. I can either get my hand flat on the ground and then my arm is bent off in a weird position, or I can completely straighten my arm, but then my palm is lifted off the ground. Though that position’s by far the worst position. here’s also positions where if I’m holding a barbell and I have to kind of cock my wrist back, I get a lot of pain there. Again, it’s not because of this active disease, it’s more because over the years I have bone cartilage damage and I just don’t have that range. It certainly affects things like my grip, how heavy I can do things, when I need a break.
That’s really where I felt the most when I was younger and I was dealing with active pain and inflammation. That was more when I was like, I need to stop because I am in so much pain, so much fatigue. I have so much inflammation that my wrist is throbbing. I would say the first, let’s call it five years of the disease, was when I was having to take more rest breaks. There was just more active inflammation in the joint and so it just would get to a point where I had to stop. Whereas right now, I don’t get that as much, but it’s more like my wrist just doesn’t do that. Like I just can’t put my wrist in that position. So I have to make an adjustment. But once I find a position that works for me, I’m generally good.
Anna: Mm. And in your work with other folks who have RA, do you feel like your experience is kind of typical? Do you see a lot of variation in terms of what folks are experiencing when exercising?
Britany: Yeah, so I think mine is a little atypical, and I was funny. I was talking to my husband about this this morning. My superpower in this disease is that I’ve gotten so used to it. I’ve been able to adjust, but I have to, as a fitness trainer, almost put myself back in the lens of what I was going through when I was 13, 14, 15, because I think that is the more typical experience for people.
Most people who are coming to me with rheumatoid arthritis were more recently diagnosed. I think once someone has had this disease for 10 years, you learn to evolve. You learn to figure it out because you have to. This isn’t something that… It’s not like an injury where you will get to the other side where you’re no longer injured, no, you’re gonna have arthritis for the rest of your life.
It’s a very sobering fact, but I think the sooner people can recognize that, the better. So mostly I get approached by people who are early in their journey where active fatigue, inflammation, pain and stiffness are very prevalent and it almost feels like you’re walking into a forest and there’s 700 different paths you could take and you’re not sure what path to take because all you know is that the workouts that I used to be doing are now painful.
How do I adjust? And I think it’s, honestly, the hardest question I could possibly answer because it’s not like it shows up the exact same for every single person. And I say this with sarcasm, there’s a lot of joints in the body. Like there’s a lot of different places that arthritis can present itself. So it’s gonna be different for different people. Really is a lot of trial and error. But most people who come to me are feeling active inflammation. They’re feeling active stiffness, active pain, similar to where my experience was when I was younger.
Anna: Interesting. I mean, it also brings to mind just working as a trainer. Even people who don’t have chronic illness, there are so many ways that people experience pain and sensation and challenge.And so just navigating that with this extra, very big layer is a lot. I’m sure folks are very glad to find you.
Britany: Yeah, and I think it’s hard too, because, in my experience and most people that I have spoken to, it’s gonna take–and this is where I don’t know what the exact number is–two years, maybe three years to find, if you decide to go the medication route, a medication protocol that works for you. And that to me was the hardest part of the whole process that I didn’t anticipate, that I like to warn people about when they first get diagnosed, is that there’s a multitude of medications that you could take and you aren’t gonna know what your body responds to.
And sometimes the disease can respond really well to a medication, but your body doesn’t, right? Like either. You know, you’re getting poor kidney markers or liver markers or I took a medication that did wonders for my arthritis, but it would make me vomit and it was like I was having to take time off of work every time I had to take the drug and it was not worth it.
So it’s gonna take a little while to find what works for you. That process is years of process because any drug is not gonna just work the next week, right? You gotta stay on a drug for three to four months just to find out it doesn’t work for you. And then at three or four months, you may still be dealing with a lot of pain and then you have to start over, okay, we’re gonna try a new, new drug and that’s gonna take three or four months, that process.
I think staying positive and feeling like you can still be active and move your body during that process is probably the hardest and is not talked about enough. I think that once you, again, if you decide to take the medication route, once you have something that works for you, again generally, that is when I find people can breathe a little bit and they’re like, okay, I can figure this out.
Maybe I can’t do exercise X, Y, and Z that I love. But I have found other things that work for me. But that early process is so, no pun intended here, but inflammatory in a lot of different ways. Like it’s just, there’s so much going on and it feels like so much is out of control that that’s honestly where I think people come to me searching for an answer, like I can solve their problem with one gadget, one exercise, or some workout program. When in reality I think the only thing that’s gonna solve that is time, which is a hard pill for people to swallow. Myself included, I was the same way.
Anna: That’s so in, I mean, it makes a lot of sense that that would be a huge part of the journey, but that people don’t expect because you think there should just be:Okay, here’s the protocol. I take the medication it..
Britany: Yep. I take the medication and then in a couple weeks it starts to feel better. That is 0% what the… it couldn’t be further from the truth. It [is] just the number of labs and tests you have to take, like there’s such a startup process. And that’s where sometimes I, as a trainer, feel a little like I can’t help people because you’re gonna be in pain during that.
Like there, you’re, yes, you’re gonna have to stop. Sometimes the answer is, I can’t help you with that. That is something that you are going to have to just sit and understand that there’s going to be pain and there’s going to be discomfort. And that is such a hard thing to say because I think people don’t want to hear that.
But again, I clearly am a tough love type of person, but the sooner that you understand there is going to be a level of pain in this, and that is okay, and that is how you’re gonna get to the other end of it. I think the sooner people can get back to that positive mindset, that is absolutely possible.
Anna: So what kind of guidance do RA patients usually get for exercise? I’m curious, does a rheumatologist usually give any practical advice or are people just kind of like, Britany help me or frantically Googling for…
Britany: Yeah.
Anna: I mean, I can just say like I’ve been, I think I told you, I’ve been wanting to do an interview about exercise in RA for months now and just finding somebody who specializes in that.I was so grateful when I found you, but it’s not, yeah, it’s not a big, big field out there.
Britany: Mm-hmm. It’s not. So, my experience is that doctors are all over the place and I don’t say that negatively. There’s just gonna be a lot of different trains of thought, depending on your doctors. And one of the biggest tips that I can give anyone who is early in the process or even is later in the process but is with a doctor that maybe doesn’t align with them, keep searching for a doctor that aligns.. that you feel best with, that you feel like can support who you are. And I have had a slew of doctors over the past 25 years, and I have quit on doctors very early when their mindset around activity with rheumatoid arthritis is quite narrow-minded, in my opinion.
Generally the average, I think, rheumatologist is going to, would rightfully, say, that movement is medicine. The more active you can stay. With rheumatoid arthritis, the better you are going to be because stiffness, swelling in the joints will respond positively through movement. Being able to continuously move your joints through a range of motion is really, really important.
I think that is hard because there is going to be some discomfort there. And I think one of the important lessons to learn is the difference between discomfort and pain, which we can go through a little bit later. But for me, most doctors are gonna say, stay active. Now what that means to that rheumatologist is where the variance is wide.
And some doctors will just tell you that flippantly and then they’ll move on to the next patient. And you’re like, well, what, what does active really mean? And sometimes you can’t stay active despite how much you want to, and that in of itself can feel like that’s where the gap is, that the doctor is there to help you manage your pain.
The doctor is there to help you manage the activity of the disease and not let it continue to spread. The doctor is not there to make your life easygoing, if that makes sense. And so to me that’s where I find physical therapy. Finding a physical therapist that specializes, if not in rheumatoid arthritis, but in the joints in which you have arthritis, is where I think is the best approach, is the approach that I took.
So I have it worse in my hands. I have seen a hand specialist, I think three different times across the 25 years at times where I felt like I needed something extra that I couldn’t figure this out myself. I think that I would recommend going to a physical therapist before a fitness trainer like myself. A physical therapist is going to help you build a foundation, is going to help you improve a range of motion in a way that I can do, but it’s not what I was trained to do. What I’m trained to do is make you strong, make you gain muscle, and that hopefully is also gonna help make you happy, right? The physical therapist I think is there for the health of your joint itself, and so while I am certainly qualified to help do that, that’s like all they do.You know, and so I always recommend going to physical therapy first.
If you feel like you have a doctor that isn’t helping you bridge the gap because a doctor is rarely going to…you know, I asked my doctor for some exercises and she’s like, just push your hand back and hold it there for 30 seconds. Okay, like that’s it. And it’s like a sheet of paper that’s a picture of a little stick figure hand moving in all different directions. And it’s… there’s so much more that you can do.
So some doctors I think are going to meet you in the middle.They are gonna be able to provide more, but I think most doctors are gonna say, be active. They will not define what active is. Or they’ll say, go for walks. Okay, I can only walk so much. Or like, what if you are a gym girly and you wanna be able to get back in the gym? Like, how do I bridge the gap from walking to the gym. I think that’s where physical therapy gets you to a point where you have a foundation that you can jump off on with a trainer. Even if you’re not working one-on-one with a trainer, if you can find a workout program where it has exercise substitution.
So I work with a Sweat app and that’s what we do where I have a strength training program that yes,I built for the masses. Right., I did not build it with the arthritis community in mind. But every single exercise has countless substitutions that you can pick based off of what equipment you have.
You know, let’s say it’s a pushup. A lot of people with arthritis and their wrist can’t do pushups. Cool. You click, I need a substitution for this. And the next exercise it’s gonna show you is a chest press where you’re laying on your back and you’re pressing a dumbbell overhead, which is much more accessible for someone who has wrist pain.
So I think it’s building the foundation so that you can get to the point where you can move again with physical therapy and then choosing a trainer, whether it be digital or in person that is equipped to meet you where you are and give you the modifications that you need. But I think that doctors mean well.It’s just not… They’re not supposed to be able to give you a workout program. That’s just simply not their job. And I think that some people expect that. But I think it’s okay that they don’t. I have had, like in my time, I have been extremely athletic. I obviously work out to an extreme.It’s my job. Yeah and even when I was in high school, I was doing club soccer and running track and doing track. I was working out like four hours a day every single day. I had games and meets all weekend, and I went through a couple doctors who were like, you are working out too much. Or I’ve had doctors in my adult life who were like, you should not be a fitness trainer doing burpees and pushups.
Like, you’re gonna push your joints to the limit and that’s always been… but it’s not painful, as long as it’s not painful, you know, you’re not telling, we have no signs that the disease is getting worse. So my reality is very atypical that I’m able to work out this much. So I’ve always quit on a doctor if they’re like, you need to stop working out as much as you do until I find one who says, I understand that your job and your reality requires you to work out,o let’s find a protocol that works for you. That’s the mentality, a doctor that’s willing to work with you and what phase of life you’re in and work with your reality. I will always tell people, keep looking at different doctors until you find one that understands you and the intricacies of your personal life.
Anna: I love the word you used: substitutions, because sometimes I think people, especially who have more of an athlete mindset, can think of taking a modification as I’m not doing the real thing as
Britany: a weakness.
Anna: A weakness. So I think just… it’s such an important reframe for folks who have something like rheumatoid arthritis to say like, you’re still doing it. This is just the version that’s gonna work for you and it’s the same thing. Yes and it’s just gonna work better for what you have going on.
Britany: It really is. I tell people that all the time, even if they aren’t dealing with chronic illness, like, let’s say your goal was to gain muscle in your legs, right? And you can’t do a deadlift because it hurts your lower back. Like, okay, I might tell you to do a hip thrust. I might tell you to do a glute bridge, which is the same base movement pattern, but in a different way that is less load on the lower back. And people always feel like, again, that is weakness.They’re making it… it’s an easier exercise. And I was like, okay, well if you could do a deadlift, and let’s say I’m using arbitrary numbers here, you can, you do a deadlift with 20 pounds and that doesn’t hurt your back. Great. Okay. But the minute we go up to 30 pounds, it hurts your back a lot. But if you can do the hip thrust with 50 pounds, what part of that is a modification?
Like you actually are able to do a stronger, harder exercise with an additional load, just in a different position. So to me, I think of exercise substitutions as just different doors to open and once we open that door, you can find your strongest self in a different room. Like you just, yeah, all of these are all the same rooms in a house.We just need to find which room is most comfiest for you to sleep in. If we can get the right exercise, you can unlock a level of strength that you wouldn’t have had in that initial exercise. And like, it might actually be harder for you. It actually might be a more advanced exercise once we get you there.
That mindset shift is difficult for people. But once you can get that, I’m like, Ooh, we’re off to the races, because it’s not just about exercise is being in this hierarchy of what’s harder than something else, it’s, there’s so many different ways to make an exercise–push up versus a chest press.A pushup can be easy for someone, but if you increase the weight on a chest press enough, or if you slow down the tempo, meaning literally the pace at which you’re lowering or lifting that weight, or if you do enough volume, you can make a chest press significantly harder than a pushup. But everyone’s like, oh, the pushup is so hard.And like I’m like, but it’s not for some people. It really just depends on how you do it and I think that’s the beauty of exercise is that it can be tailored to where you are and that should be the approach that I think anyone should take. But certainly people with chronic illness is that… like take any workout as a template that is yours to adjust to make it work for your situation, which is gonna change day by day.
Anna: Yes, I love it. So I got a few questions from readers who have RA, so I wanna get into a couple of these. So first one is a question from a reader named Rachel. So she asks, what is recommended to aim for in terms of movement per week? I watched a presentation about dementia where the physician recommended 150 minutes per week of vigorous exercise to reduce risk.I enjoy Pilates and find it manageable within my limitations, but is that considered vigorous? It’s definitely challenging, but I’m not necessarily out of breath or sweating. I feel like the advice for RA is often to stop when it hurts, but that would be extremely limiting for me and probably most people with RA.
Britany: Yeah, this one is tough and I smile when I hear about Pilates. Pilates is always the… like, people want it to be the solve for everything and it is the solve for a lot of things, but not the solve for everything. Like nothing is the solve for everything, right? And I love Pilates.That’s not a dig on Pilates, but the general guidelines, whether you have a chronic illness or are healthy is, at least in the United States, 150 minutes of moderate intensity exercise. That is aerobic, that’s a fancy word for cardio. That does not mean it has to be super intense sweating out of breath.It is moderate and the way that you kind of know if you’re hitting that point is, are you breathing heavy? But you can still hold a conversation. So this doesn’t need to be, I am sprinting up a hill and I’m like huffing and puffing, but is your heart rate a little bit elevated?Are you having to really maybe stop and think, you can speak in short sentences, short bursts, but not like, you know, what did you have for breakfast today? Your answer is eggs and coffee, not eggs benedict with extra sauce on the side and a latte, right? You’re like… it’s really like short.
And then, so that 150 minutes per week of that moderate activity plus two strength training sessions per week. Now that is a lot, right? 150 minutes is, let’s say, what, five 30 minute sessions. Am I getting five 30 minute cardio sessions a week? No and I could not tell you the last time I was, but, so I think that people have to expand their horizons on what that means.A brisk walk is going to count. If you’re–again, not a leisurely, let’s stop and smell the roses–but if you’re moving at a decent pace, most people are going to check that box. The key here with that is going to be that increased heart rate. So that’s where Pilates, I think, doesn’t hit either of those two buckets.
The honest answer, most Pilates classes, I should say, are not increasing your heart rate enough to create that systematic metabolic stress that we’re looking for from that aerobic activity. They’re also not strength training. Pilates, barre, yoga. These are more endurance-based exercise, and I know that you hear endurance and you think cardio, but it’s more endurance for the muscle.So the capacity of the muscle to withstand effort versus your full body, your heart, your lungs, which is more cardio ability to withstand effort. Strength training typically is going to look like lifting heavy loads. That could be a resistant span. It does not have to be a machine.It does not have to be a barbell, it can be dumbbells. That is really where I would focus. So if you’re doing Pilates and you love Pilates, please don’t stop it. I absolutely believe enjoying your workout is so much more important than following some guideline that was built in a research lab.
With that being said, if you are trying to change something about your life, the way that your body feels, I do think that there is something to be said to following some guidelines because that is going to be more efficient for you to get there. So I would, if I love Pilates, I would probably go twice a week.I would start doing some strength training one or two times a week. I don’t think you have to just overnight, I’m gonna suddenly work out seven days a week and then I would start incorporating walks into my life. Again, brisk walks with intention. If you can run, if you can swim, if you can hike, if you can cycle, like that’s all wonderful.
But I think walking tends to be the most achievable for people. I think if you did 20 minutes a day, even 15 minutes a day. To start would be an excellent starting point. I don’t think you need to go up and strap out and get the gels and go for two hour walks. Like truly. If you have a more active job where you’re already walking, standing around, moving around, lifting heavy loads that does… the need to hit that 150 mark comes down. So that 150 mark is built with the typical American lifestyle, where you are sitting from nine to five, you’re probably doing some sort of activity beforehand, some sort of activity in the end at, in the evening. But generally the more you move around, I think the less you have to worry about hitting 150 minutes.
Anna: Yeah. I mean, I also teach Mat Pilates and I feel the exact same way about it. It can be an amazing form of mobility training and posture and alignment. And I would imagine some folks with RA may experience some, joint related benefits as well.
Britany: A hundred percent.
Anna: So it’s a great, like supplement to the other things that you’re doing.But you do have to have a little real talk about what you’re getting out of it.
Britany: It, yeah… I completely agree. And I, and I’m upset that I didn’t say that… I do think that. Exercises like Pilates, barre and yoga are extremely wonderful for the RA community because they work on mobility range of motion. I think [of] fitness like a menu, right? You’re gonna have, and maybe this is a three course meal, four course meal, right? You’re gonna have your appetizers, you’re gonna have your main, you’re gonna have your sides, and you’re gonna have your dessert. Aerobic activity and strength training should be your mainstay, but that does not mean every time I go to a restaurant, I’m asking for the dessert menu. My Pilates is my dessert, or it’s my appetizer. It’s still going to happen every single week, but it shouldn’t be the anchor or the beacon of your workout program.
I think a lot of people who don’t want to change anything and just wanna stay active, it makes ‘em feel good. They’re going for the endorphins, girl, do Pilates 12 days a week. You know, like that’s great. But if you’re looking for some sort of change, I do think taking that approach of anchoring your program with some sort of strength training or that aerobic activity, one of those being your anchor and then building a little bit of mobility work, a little bit of core work what those desserts and appetizers are gonna change based off of the phases of your life. If you are postpartum, you may not be doing any sort of Pilates, let’s say, and instead you have to do core restoration work, right?To work on your postpartum like AB separation and all of that, like your pelvic floor work. Like what those things are, are gonna change. But any workout program should have space for flexibility and what you just enjoy, not just what the research says you should do.
Anna: Yeah, absolutely. So one other thing in Rachel’s question was about the advice to stop when it hurts. So I’d love to talk a little bit about what you mentioned earlier, pain versus discomfort. I think, just as a trainer, I work with so many people who, any sensation comes across to them as pain because their brain is kind of stuck in that like self-protective mode, which we understand, but I’d love to know, just like, how do you help folks with RA kind of find that balance between we wanna push ourselves and challenge ourselves, but not, you know, cause harm.
Britany: Yeah. So I think that there is definitely [a] difference between pain and discomfort and with anyone, even a healthy body.Understanding the difference is very important. Your workout, if you, again, if you are looking to change the way your body feels, should be uncomfortable. If you finish a workout and you don’t feel like you actually pushed yourself or challenged yourself, that’s fine. Again, if the boxes were to check the endorphins, that’s great.
If the goal is to actually change something that most likely is not going to be enough, you’re going to have to challenge yourself. And that is why I love working out in the first place, ‘cause I think it is a testing ground to do that in a safe space and then be able to get better at doing it in your life, right?Like being uncomfortable is hard. The more you can practice it, the better you can be. Pain, if you have RA you probably understand pain. Like truly, just, I cannot continue on, I feel like I’m going to break something, like if I take this another step further, something is going to go wrong.If you’ve ever injured yourself, if you’ve ever tweaked, pulled a muscle, rolled an ankle, You understand that moment of pain where you go from everything is fine to suddenly everything is not fine, like this is a problem. There is a red light that is flashing somewhere in my body saying something is wrong.
Discomfort tends to be more building, it tends to be, Ooh, this is a little uncomfortable, Okay, I think I need to take a break. It tends to be, I’m slowing down. It tends to be, okay, I gotta stop and think about this. Like maybe you’re working out and suddenly you have to stop talking because it’s getting hard.Kind of like, you know, when you’re parallel parking in your car and you turn off the music even though it doesn’t actually help you, but like, I gotta concentrate on this. That’s kind of where I want you to be in your workout, where it’s like uncomfortable enough where you’re like, gotta stop talking to me, Sally ‘cause I need to, I need to focus on this. That’s the level of discomfort. Pain is like oh my God, something is wrong. There are two very different feelings and when it comes to rheumatoid arthritis, the feeling of stop when it’s painful. Well, first of all, I don’t ever want it to be painful. I want it to be uncomfortable.
I don’t ever want your workout to be painful. It’s just that pain is going to happen way more often for the RA community. And sometimes it’s gonna happen and you don’t expect it. So I wouldn’t fear pain. And this is the thing, I think with rheumatoid arthritis, it’s a little backwards. I don’t fear rheumatoid arthritis pain because this is not a wear and tear disease for the most part.
Working out in a healthy structured environment is not going to make your arthritis worse. Meaning you’re not gonna suddenly do something that unlocks the disease and it’s gonna go from your wrists to your knees because you did too deep of a squat. Like osteoarthritis, like wear and tear, where you literally do something too often and that creates osteoarthritis. That is simply not how autoimmune diseases work. This is a systematic thing, so to make it simple, you’re not gonna make it worse. Your working out is not gonna suddenly put you in this position where your arthritis was at a level three, and because you worked out, you’re suddenly gonna be at a level seven or a level eight.It just doesn’t work that way. It’s not what the disease responds to, so have permission to go out and experiment where your upper limits are in your workouts. You are going to have to try something that maybe is a little painful to see, can my body do this? Do you have to do it all the time? No, but I think that every few months, if you’ve been avoiding… we’ll say pushups ‘cause you have wrist pain, every three months, four months try to go in a plank position and try to do one pushup. Oh, oh my gosh. Absolutely not. That was really painful. Okay, we’re not gonna do pushups again. But then you might find if you’ve been working with physical therapy, if you’ve been working on your mobility, that you can eventually get there. But you have to be willing to put yourself in painful positions. Once you hit that pain, yes, again, please stop, but I think people fear pain too much, and in this case, specific to RA, the pain is the only way you’re gonna know where your upper limit is. So should you be uncomfortable? Yes. Should you be painful in every single workout? No. But every once in a while, you have to be willing to figure out what actually is painful for you, because that’s the only way that you’re gonna progress and that you’re gonna grow.
Uh, and that is, it sucks. I hate saying that to people. It’s like a burden that we have to hold onto that other people don’t have to deal with. But, you know, it’s like I don’t like ketchup and every three or four years, I’ll try ketchup just to make sure I don’t like it and then I’m like, nope, still doesn’t do it for me. Yeah. Still, still doesn’t do it for me. And that’s, that’s honestly, that’s honestly how I treat the exercises that I can do every… like once a year, I’ll just be like, okay, here are these exercises that I’ve been avoiding, like let’s try it. And you’ll surprise yourself like, oh wait, I’ve actually gotten strong enough to do this. But if you are never willing to be curious about that, you will continue to stay stuck. And the less stuck that you can be, the more you’re gonna enjoy your workout because you start to realize this isn’t the end of the world.Maybe I can’t do this, like, I, you know, hurt my back last week. So sure, maybe I’m not gonna be doing any deadlifts for the next few months, but like I’ll work on something else and then in a few months I’ll try my deadlifts and I’ll be back and then it’ll be fine. It’s not the end of the world.
But I recognize that it’s easy for me to sit here and say that, it’s another thing to go out and do it, but anticipate discomfort. Even if you don’t have RA, discomfort should be the name of the game and the workout. That is why you were there in the first place.
Anna: Mm. Those are such helpful distinctions and just the idea of checking and not assuming that the pain is gonna stay exactly the same way or show up with the same movements forever.Yes. So.
Britany: And I should say also check in when you’re in a good space, like even when you’re in the middle of a flareup, which is something that happens a lot in rheumatoid arthritis, like you can be fine and then suddenly one week the weather might change or it can be really cold. What causes flareups for people is going to be different.
Hopefully it goes without saying, but don’t test anything during a flareup. I think during flareups, which tend for most people to last, you know, some people, they have really bad flareups for a couple days. That’s how it is for me. Some people have just like moderate flareups.They last for weeks. Have whatever your plan B workout program is during those days, don’t feel like you have to push through a flareup, but I would have some sort of movement plan during a flareup because just sitting on the couch doing nothing is not going to be helpful for that flareup.
Anna: So another reader question. This one is from Mary and I know you’re gonna have thoughts here because of your wrist situation. So she says, how can we manage lifting and gripping heavier and heavier weights if we have arthritis in our hands? I feel like that must be such a common place for it to show up. I would love your advice. It’s the…
Britany: biggest one.
Anna: Yeah.
Britany: Yeah, that’s by far the most common question that I get. So there’s two things, two ways I think to approach arthritic hands. One is to,how do we adjust exercises to make them accessible? And then two, how do we actually improve the condition of your hand and your fingers so that you improve your grip strength?
I’ll start with the more complicated one, which is actually adjusting the workouts using things like hooks, lifting straps. There are just accessory things that you can buy. These are relatively cheap things. They’re not super expensive. They don’t take up a lot of space, but lifting straps and hooks are two things that can really help take off some of the load, so your body is still lifting the 30 pound dumbbell or whatever it is, but your wrist does not take on all of the load. So you’re still able to get the same amount of effort and against the muscle that you are targeting but it’s not going to all come through the wrist. If you have this sort of pain, like I do, where you can’t flatten your wrist, you cannot hold a plank position, elevating your hands on a bench or a chair, any sort of surface is going to make it easier because you’re not having to get to that 90 degree angle with your wrist.
Also things like machines. So at a gym, a cable machine is going to generally be much easier on the wrist, as well as generally all joints, compared to doing free weights, like a dumbbell or a barbell. There is a stability factor with barbells and dumbbells because they’re literally what the word free weight means they’re free, you, they can move in any direction if you let it. Right and that requires a lot of stability through the wrist joint. And if you instead do a machine that is almost in a locked, fixed position, your wrist does not have to move through as it does not have to work through that stability piece.
That can be, I think, intimidating for people if you haven’t ever gone to a gym before or used a machine before. But I just got a cable machine installed at my house and there’s so many things where I’m like, oh my God, this is just so much easier on my wrist. I knew it as a trainer, but then as I experience it now on a day-to-day basis, I’m like, wait, this is so much better on my wrist because I’m not having to stabilize through the joint.I can just focus on whatever the movement is. So that…those are a few things that might help you adjust the exercise so that you can do it, but then also just improving your grip strength is gonna help.
Farmer’s carries are easily, probably the best way of doing it. They’re also an excellent exercise for your core, which everyone can do.You just hold onto a heavy load, kettlebell, dumbbell, and you hold for as long as you can. Like it literally sounds silly. You also can work on grip strength by hanging from something, or if you have a pull up bar or any sort of bar in your house, you can just hang, literally just hang from it. Anything where you’re having to hold onto a surface for a longer period of time, work up to, as long as you can. I mean, not like… I mean a couple minutes here.I would say eventually if you can hold onto something for a minute or plus, you can go heavier.
Think of it like taking groceries, you know, from your car to your house in one trip. Working on that grip strength is going to help translate over time, but know that if you’re already dealing with arthritis, you might have to start small and then build up slowly over time, either by extending the amount of time that you hold or by increasing the amount of weight that you are holding.
Also just like working out more with dumbbells and barbells is going to also help you improve your grip strength because as you do the workout, your body will have to adjust to the stimulus that you’re giving it. I think working out with dumbbells is probably just in general a great way to improve grip strength, but I recognize that’s what she’s struggling with. So for me to suggest like, Hey, you should just keep working out. Like it’s not what she wants to hear, but it does help if you just continue to do that.
And the last thing that I didn’t mention that I also think is a good adjustment is always work on positioning of the wrist. So if you think of a traditional bicep curl, palms facing forward tends to be hard for people rotating them. So the palms face each other can be a lot easier on people and on people’s wrists.
If you are working on a certain exercise that feels uncomfortable maybe just [watch] a quick YouTube video or like literally do a quick Google search of what are alternative ways to literally hold the dumbbell for this exercise and that will help you maybe. Have a few more options if there’s a certain hand position that hurts with a dumbbell specifically.
Anna: Mm-hmm. And I’m curious, when it comes to things like planks and pushups, do you find that using like a dumbbell so that your wrist is straight is helpful?
Britany: Super helpful. Generally with wrist pain, getting the wrist to be in one straight line, so where your wrist is straight from, kind of like the knuckle to the forearm instead of having any sort of bend in it, is going to be beneficial.
So some people will like to put their hands on… literally hold dumbbells on the ground, so the dumbbells between you and the ground, but that allows you to have a straight line. That way you’re not having to cock the wrist forward or back, which is where that range of motion comes into play whereas staying neutral relatively feels better. I did pushups that way for years. Years on years and years and years and I still to this day, that is my preferred way to do a pushup on the ground. I think for most people, if you can’t do a pushup on your toes, I still think elevating your hands is the better option. It’s gonna allow you to get a better depth range of motion. It’s gonna allow you to come off your knees, which is gonna be more organic to what the exercise is. I think people progress on pushups better off of their knees, elevating your hands than they do on the ground on their knees. So if you can do pushups, or maybe if you’re just doing a plank position, let’s…even if you’re doing like a down dog, let’s say, it doesn’t have to be a pushup. Having dumbbells under your hands can help. I even have seen people in yoga classes, like roll up the end of their yoga mat so that their fingers are on the ground and then their palm is lifted up on the yoga mat, or they use a towel.That can be helpful as well.
I have some qualms about doing that every single time, long term, because you’re still not in a proper position and I wonder how that fatigues the shoulder. But I think like if you’re in a pinch, which we all are sometimes if you’re taking a yoga class a couple times a month, it’s not gonna hurt you.Getting it more into a neutral position is gonna help with that pain.
Anna: Nice. Okay. Question from Melissa who wants to get some support with the fatigue that she feels after a workout?Even just the next day, like feeling the need to take a nap, which, you know, people don’t always have time for.
Britany: Yeah. Yeah, for sure. So I think the fatigue is, again, a big piece of the autoimmune disease that people don’t see. So first of all, I wanna say that I see her and I feel her because I think that when you have arthritis and you tell people, oh, I have arthritis, they just think, okay, your joints hurt. They don’t think that, like you need to take a nap and that just feels almost silly to say like, oh, I’m fatigued because of my arthritis. Like, it just doesn’t, it doesn’t even sound right. So I hear her and I know how hard that is. Things I would recommend is probably doing shorter, more frequent workouts than doing longer workouts. So can you do 20 minutes, you know, four days a week instead of one hour or two days a week? That still counts. I think that’s important to tell people no matter who you are, like it’s about the amount of volume that you’re doing across the week, not about how long any one given session is.
I’ve even seen people. Split up their workout 10 minutes throughout the day, I’m gonna do 10 minutes before work, 10 minutes during lunchtime, 10 minutes after work like that. That absolutely still counts. That still counts as a workout.
I think shifting to more strength training versus cardio. Cardio is a systematic fatigue. Strength training is not as much as…you’re fatiguing the specific muscles, you’re not so much fatiguing your entire system. I find that while you might end up being really sore in your biceps after doing an arm workout, but you probably the next day can still do a lower body workout just fine because you’re working a completely different muscle group.
Her fatigue, you know, we’re not sure exactly what type of workouts she’s doing, but generally, when someone is systematically fatigued after their workout, that’s probably telling me that there’s too much like actual stress being placed on the full total body. So I would say a shift away from any exercise that does not have a lot of rest.So even in group fitness training, strength training classes that are using dumbbells like in my own group fitness classes. It’s circuit based. So there’s a timer you’re working for 40 seconds. You’ve got 20 seconds rest and you’re doing four rounds of that 20 seconds rest might not be enough for you.You may need 40 seconds on and 40 seconds rest. So you have to really look at, in your workout, is there enough time for rest in between the exercises that also can help. And the kind of… the more traditional strength training that you get, the more rest that’s gonna be built in. Generally like one to two minutes between exercises is kind of your typical amount of rest that I would recommend in a traditional strength training, unless you want your…unless you’re doing true, pure strength training, then it’s like three to five minutes.
But generally, for I think the average person, you know, 90 seconds to two minutes is good. I also think focusing on other factors that are in your control. So there’s a lot that’s not in your control,but the few things that are your diet, hydration, sleep at night, I mean like, duh.But it does all matter. I think that that can really help. I don’t think you need to overhaul any of those things, but you’ll know, oh yeah, no, I’m really bad at this. There’s something, we all have our vices, we all have those things that we’re not good at. Oh yeah. I stay up watching tiktoks till 2:00 AM in the morning.Whatever it is. Like you’ve gotta be honest with yourself about how you can improve your… I’ll call it, wellness routine and your health routine overall. And then the final thing that I’ll say is. Sometimes it just comes down to managing your RA itself. So if you are in those early phases, like I said, where you are bouncing between medications, trying to find your protocol, fatigue is going to be expected, and this may just be a phase that you’re in until you find what that protocol is that you can stick with longer term.
So managing the RA symptoms themselves, meaning finding some sort of solution that might be external to you is number one. And then number two would be adjusting your workout. And then number three would be fixing all the other things in life that you don’t wanna have to fix, but do unfortunately make an impact.
Anna: To wrap up, what do you wish you could tell folks with RA who wanna be active?
Britany: Yeah. I think the biggest thing I can give you is it sounds almost cliche, but don’t give up.I think that if I have learned anything over my 25 years of this disease is that at the beginning it feels like the end of your life. It feels like the end of the life that you know at least, and there’s so many unknowns. And the beginning is going to be hard. I’m not gonna sugarcoat that. I’m not gonna pretend like it’s gonna be easy.
I would say the first, again, it’s different for every person, but one to five years is quite difficult, especially from the lens of trying to move your body in a pain-free space. But you’ll absolutely, if you keep that North star in your mind of: I want to get to a place where movement is medicine and movement is not the problem.Movement is not evil. It is something that will help me. Like if you can continue to keep that North star and not push yourself to get there on a certain timeline and just know that you will get there over time, that this is a journey. I think that movement with arthritis can be a beautiful thing if you let it.
You just have to be patient in getting there. It is absolutely possible. I have seen it a thousand and a half times. It just does require some patience. And then I think that… what I like to tell people is that it’s your new normal, so don’t compare what you used to be able to do before your diagnosis, but before the pain started to now, treat this as a new phase of your life.
That does not mean you are weaker. That does not mean that you will never be able to do the things that you weren’t able to do beforehand. You might actually end up being stronger because of this, because maybe it forces you to slow down and actually learn the fundamentals and maybe it forces you to finally go get a coach, and that coach maybe is gonna inspire you to start running marathons.
I don’t know, you are capable of so much in this new normal, but you have to treat it as a new normal instead of constantly trying to get back to where you were. It is a new house, a new book, a new chapter. It is a new library, you know, and that shouldn’t scare you. It is a beautiful thing. But again, I think the beginning can be very hard.It will not stay hard forever.
Anna: So tell us where people can find you or follow you if they’d like to learn more about your work and make sure to tell us the name of your podcast too.
Britany: Sure. Absolutely. So, you can find kind of a little bit of everything, a resource for everything that I do on britanywilliams.com.
Britany is spelled B-R-I-T-A-N-Y. So Britanywilliams.com. I am probably most active on social media, so whether that be Instagram or TikTok or Facebook @BritanyWilliams is my handle for all of those. I have workout programs of all kinds on the Sweat app, which you can get a seven day free trial for just at sweat.com.
And then my podcast is called Filter Free Friday. It comes out every other Friday and you can find it [on] Spotify, apple, you know, wherever you listen to your podcasts, except for YouTube. I always say that, I’m like, you can get it wherever you want it and I was like, except it’s not on YouTube, and I should probably put it there.And that podcast is really, I call it banter between two girlfriends, even though it’s just me. So the other girlfriend is you listening, but you don’t get to talk back to me. I see it as everyday realistic fitness advice from the girl next door.
I truly believe in taking the expertise that I have in the fitness realm and digesting it in a way that is actually enjoyable for people and accessible for people. And I will complain and moan about how hard working out is. And I’m not gonna sit here and say, I have a beautiful six pack and I am perfect.It is more about me educating you on how to live a healthier life, but doing it in a way that feels like it’s just a voice note from your best friend who also is gonna complain about her three-year-old potty training at the same time. So I really hope to have, kind of, a laugh at yourself, a realistic approach to wellness, and that’s what the podcast is for.
Anna: Well, thank you so much. This has been such an incredibly informative conversation and I know that folks are gonna really appreciate hearing from you and learning from you. So thank you.
Britany: No, thank you. I appreciate it.
I hope you enjoyed and learned from that as much as I did. Please let me know what condition or situation you’d like me to explore next in this series. Thanks for listening, and remember that the best way to support this work is by sharing it with friends, and by signing up for a paid subscription — it’s just $7 per month or $70 per year, and you get access to special discounts and a huge library of workouts that are great for people at all levels who want to build strength, mobility, and energy.
Thanks again!
