Does Exercise Help Gout?

'A Quick Readers Question From A Gout Sufferer'

Bland, unhelpful advice would suggest exercise is very good for gout. The truth for gout however is much more complicated. Does exercise help gout? Not always, sometimes ‘gouty arthritis’ is better left alone and when you do exercise, what types of activity really help gout and which make it worse?

In this article, we answer a question from one of readers on the subject of ‘does exercise help gout’?

Picture of a man swimmer with the slogan 'swimming is great for gout'

Does Exercise Help Gout.. A Background In Understanding Arthritis

Most arthritis patients are told it is very important to get exercise. Often it is vital to keep joints supple and maintain the original range of movement. Now gout is a form of arthritis (often referred to as ‘gouty arthritis’), but it behaves very differently to many of the ‘standard’ forms of arthritis such as rheumatoid or osteoarthritis.

Unlike many types of arthritis, gout is neither an auto-immune disease or formed around the concept of cartilage wearing down. Gouty arthritis is formed instead by a build up of uric acid.

Your body produces uric acid in response to certain foods/ drinks that you consume.

Normally, your kidneys excrete his uric acid (get rid of it) at approximately the same rate and everything is fine.

Sometimes however, uric acid builds up faster than your kidneys can get rid of it. Uric acid starts to build up in your body in what is known as hyperuricemia.

Sometimes (though not always) this uric acid forms into urate crystals that travel around your body looking for a joint to attach themselves too.

This may be a joint that has suffered trauma or simply one that is further from the heart (and therefore cooler). There are many reasons why the crystals may pick one joint over another.

However, once those urate crystals start attacking your joint, they are likely to eventually form tophi that attach directly to your joints.

All of this creates inflammation, considerable swelling and pain during what we call a gout flare up.

While untreated gout can cause damage to your joints in the long-term, it’s mode of action is completely different to any other arthritis. And yet still, in every article or video on ‘treating gout’, you’ll see reference to exercise as one of the leading treatments.

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But Does Exercise Help Gout?

Well, the answer is ‘a yes and a no’.

The correct type of exercise definitely helps prevent gout attacks from reoccurring in the future, but in the middle of a gout attack – definitely no.

During a gout flare up, the last thing you want to be doing is imposing further stress on a painful joint.

What you need to be thinking about is actually quite the opposite – resting and keeping weight off the joint. Similarly, the absolute worst mistake you could make is to bang the joint and cause it further trauma.

So, in terms of surviving a gout attack and providing pain relief, does exercise help gout?

Definitely not.

However, when it comes to preventative steps to create longer periods between attacks and reduce the severity of your next attack, then yes – exercise is helpful in combatting gout.

But why? As we all know, exercise helps to strengthen muscles and lose weight.

Excess weight is a key protagonist for gout – the excess weight encouraging the over-production and under-clearance of uric acid.

Is Gout Affected By Weight?

Reductions in gout flare frequency has been linked to potential weight loss in quite a few trials as reviewed by Nielsen et al in the Annals Of The Rheumatic Diseases 

Technically however, exercise in isolation does nothing to help gout, it’s the results of getting regular exercise on your body that, with a reasonable diet, helps to prevent gout.

So does exercise help gout? Yes – in the long-term and with some significant reservations.

Significant reservations because it’s still not quite as simple as that.

Firstly, there are still some question marks over why weight loss helps and if it is just weight loss or weight loss with exercise (ie being fitter) that helps prevent gout.

Indeed, in The British Medical Journal’s ‘Latest Guidance On The Management Of Gout’ it openly acknowledges a limited amount of evidence.

“Despite limited evidence, patients should be encouraged to manage their weight, increase exercise…..”

A major part of the problem also lies in the type of exercise undertaken….

Push ups are not good for gout as trauma is inflicted on your wrists and toes

Does Exercise Really Help Gout – The Evidence Is Not So Clear…

It has long been considered that the benefit of weight loss/ exercise is that it will slow down the rate at which your body produces uric acid. A slower rate of production means less chance of a build up.

However, while lower levels of uric acid have been linked to slimmer, fitter individuals, there is little data to directly back up this exact theory as to why (hence the admission above).

What has been observed though in certain cases of trialed exercise is quite the opposite – that ‘strenuous’ exercise can actually cause your kidneys to slow down the rate of uric acid excretion.

A reduced rate of excretion of uric acid (the rate your body gets rid of it) means a much higher likelihood of a build-up.

This was backed up by Green et al In Medicine and Science In Sports and Exercise.

The potential reasons for this are many and still not fully understood. However, several trials have now shown that vigorous exercise, especially from a position of very little exercise causes a state of shock and uric acid retention.

This is also true to some extent with weight loss – extremely fast weight loss or crash diets having also been shown to cause a reduction in the bodies desire to clear uric acid, leading quickly to a build up and gout.

For proof of this we need only look as far as a review published by The American Journal Of Lifestyle Medicine 

Why Not All Exercise Helps Gout

The other significant consideration when exercising is the type of exercise undertaken.

Playing football or ice hockey for example, if you are a regular gout sufferer, is likely to cause more problems than it solves.

You may well feel fine while playing – but all the time you are engaging in contact sports, you’ll be picking up minor trauma’s. These may be so small you’d never notice them – most won’t even bruise, but they will form perfect areas for urate crystals to form (and therefore gout to begin).

As much as the exercise will do you good, the regular trauma will actually increase your likelihood of suffering future gout attacks.

Even within normal, controlled exercise in a gym, certain actions are much more dangerous for gout sufferers (by which I mean they are much more likely to trigger a gout attack).

An image showing how to use an exercise ball under your legs to alleviate the pressure on your ankles

Running for example, involves impact on your feet and knees. If you tend to suffer first with gout in your big toe (like many people do), then running is only likely to make gout attacks all the more frequent – the impact forcing your toes into the end of your shoes.

The type and size of shoe you are wearing will also have some impact, but it’s fair to assume the net balance is negative.

The impact or ‘trauma’ created is, as mentioned, a well-known trigger for gout. The same is true of rowing machines on the knees, where the jolt of changing stroke, can trigger future gout attacks in the knees.

Given this risk of trauma to gout-vulnerable joints, it is perhaps no surprise then that swimming is one of the best possible exercises if you suffer with gout.

Exercises That Can Help Gout…

Not only is it great for your joints because the water takes up most of your weight, but the water itself can also have a massaging impact on surrounding muscles and ligaments. There is a reason hydrotherapy is frequently used for rehabilitation.

However, if swimming is not your ‘thing’, that’s fine – depending on which parts of your body tend to suffer most with gout, you can always come up with a custom exercise routine.

Even just altering some of your common exercises can have the desired result. For example, if you like doing sit-ups, then as long as you consider ‘how’ you execute them will define whether they trigger gout or help you to avoid it.

Jam your feet under one of the sit-up bars that you attach to doors for example or get someone to hold your feet down, and you are on a potential loser.

Lift your feet and knees in the air and do a normal abdominal crunch however and, not only are you elevating your feet/ knees (if you suffer with gout that’s no bad thing), but you are also ensuring no impact while you work out.

Even something as basic as a push-up will cause tension on your big toes as they take the brunt of your weight if you use the traditional stance. Doing a reduced push-up on your knees and hands can be a better option if you typically suffer with gout in your toes, but be careful that you don’t just start getting gout in your knees.

The Final Word –

In summary, exercise and weight loss are always listed under any ‘guide to treating gout’, but the case for both is less clear cut than expected.

Answering the question does exercise help gout is not nearly as straight forward as many sources would have us believe.

Why?

Well in the first instance, it is rarely pointed out that exercise is only ever to be done after gout attacks and never around them.

Then when it comes to long-term ‘gouty arthritis’ prevention, the changes must be gradual, or the positive effect on your uric acid (gout) will fast become negative actually increasing the frequency and severity of your attacks.

Crash dieting has at times been linked with increases of gout, but crash exercising is just as bad.

And then finally, there is the type of exercise you undertake – any that involves impact or may cause even minor trauma can give the urate crystals that create gout a perfect homing target.

So how does exercise help gout – well gradual increases in exercise, with swimming and lots of low impact activities included will lower your uric acid retention and see your gout attacks diminish.

Other factors like changing the type of foods you eat however, may have far more impact than either a strict general diet or specifically for this report – exercise.

The real take home message is ‘just exercising without a lot of consideration, will not help gout, but if done carefully, then yes it can help to prevent it.

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References –

1.Sabrina M Nielsen, Else M Bartels, Marius Henriksen, Eva E Wæhrens, Henrik Gudbergsen, Henning Bliddal, Arne Astrup, Filip K Knop, Loreto Carmona, William J Taylor, Jasvinder A Singh, Fernando Perez-Ruiz, Lars E Kristensen, Robin Christensen  (2017). Weight Loss For Overweight And Obese Individuals With Gout: a Systematic Review Of Longitudinal Studies. Annals Of The Rheumatic Diseases.
2. From Drugs And Therapeutics Bulletin. (July 2018)
Latest Guidance On The Management Of Gout. The British Medical Journal
3. Green HJ, Fraser IG. (Feb 1988). Differential Effects Of Exercise Intensity On Serum Uric Acid Concentration. Medicine And Science In Sports And Exercise.
4. Miki Kakutani-Hatayama, MD, PhD, Manabu Kadoya, MD, PhD, Hirokazu Okazaki, MD, PhD, Masafumi Kurajoh, MD, PhD, Takuhito Shoji, MD, PhD, Hidenori Koyama, MD, PhD, Zenta Tsutsumi, MD, PhD, Yuji Moriwaki, MD, PhD, Mitsuyoshi Namba, MD, PhD, and Tetsuya Yamamoto, MD, PhD. (July 2017). Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. American Journal Of Lifestyle Medicine.

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