Strength at home
Hand exercises for rheumatoid arthritis (the SARAH programme)
A daily routine for rheumatoid arthritis in the hands and wrists, from the SARAH trial, which improved hand function in 490 people. NICE recommends considering a programme like this once your medicines have been stable for 3 months, taught by a hand therapist: use this to remember the moves. Move up a level only if there is no increase in pain.
Stretches
- Tendon glides (hand tendon gliding exercises)5 of each position, 5 s holdsBeginner · Forearms · 3D demoFinger bends and knuckle bends. Build to 10 reps, then 10-second holdsHarder: Ball squeeze
- Finger walking (SARAH hand stretch)5 with each handBeginner · ForearmsBuild to 10, then 10-second holdsHarder: Overhead lat stretch at a bench
- Wrist circles5 each wayBeginner · Forearms · 3D demoKeep the forearm still, resting on the table if that's easier; build to 10Harder: Wrist flexor stretch
- Wrist & forearm flow5 finger spreads and 5 palm turnsBeginner · Forearms · 3D demoSpread the fingers as far as is comfortable while keeping them straight; build to 10Harder: Wrist flexor stretch
Strengthening
- Reverse wrist curl10 repsBeginner · Forearms · 3D demoSARAH uses an elastic band held in both hands: bend the wrists back against it, pause for 2 seconds, then lower very slowlyEasier: Wrist-extensor eccentricsHarder: Plate pinch
- Ball squeeze10 squeezes of 2 sBeginner · Forearms · 3D demoPutty or a soft ball, as hard as you comfortably canHarder: Band finger extension
- Thumb lifts and O-sign (thumb base exercises)10 with each fingerBeginner · ForearmsPinch a putty sausage between the thumb tip and each fingertip in turnHarder: Band finger extension
Tips
- Do it every day. Move up only if there's no increase in pain or other difficulties: stretches from 5 to 10 reps, then 10-second holds; strengthening from 1 set of 10 to 2, then 3 sets.
- If a joint is hot and swollen, do the stretches only, gently, until it settles.
- The programme also includes reaching a hand behind your head and behind your back, and squeezing your fingers together on a putty sausage: your hand therapist can show you.
- Keep going: in the trial, the benefit faded over 2 years as people stopped doing the exercises.
- Numbness or tingling in the thumb and fingers can be carpal tunnel syndrome, which is common with rheumatoid arthritis: tell your team.
The doses are suggested starting points, not a prescription. Choose a range you can control and stop for sharp or increasing pain, numbness or tingling. Get individual advice after an injury or surgery, or if you are pregnant or managing a health condition.
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How long does the hand exercises for rheumatoid arthritis (the sarah programme) take?
About 15 minutes, including any warm-up and cool-down listed. Shorten it by doing fewer rounds; lengthen it by adding one.
What equipment do I need?
You need: A dumbbell, A bench or box, Other / check instructions. Each move links to its guide, where you can find an alternative if you are missing something.
Is it suitable for beginners?
It is written for beginners. 1 of its 7 moves have an easier option listed beside them if you need one.
How do I make it easier or harder?
Use the easier or harder option listed under each move, change the number of rounds, or adjust the rest. Progress one change at a time.