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Improving Function Through Exercise in Rheumatoid Arthritis

Exercise can help those with rheumatoid arthritis.

Recent pharmacologic interventions for rheumatoid arthritis (RA) have significantly improved disease progression and prognosis.1However, even with effective drug therapy a substantial number of patients experience joint stiffness, muscle weakness, and deconditioning due to inactivity.2 The primary driver for inactivity is pain and fatigue,3 and inactive patients with RA are at increased risk for cardiovascular disease compared with patients with RA who are physically active.4

Two recent systematic reviews examined the effects of exercise on RA patients.5,6 Both reviews support the use of aerobic, resistive, and aquatic exercise to improve patient outcomes or fitness.

A review by Siegel and colleagues6 included 54 level 1 studies from 2000 to 2014 examining the effect of aerobic, resistive, dynamic (primarily body movements), home-based, and water-based exercise in addition to Tai Chi and yoga on adults with RA.

Research conducted by Swärdh and Brodin5 included 17 randomized controlled trials (RCTs) evaluating the effectiveness of land-based and water-based aerobic and land-based resistive exercise on cardiorespiratory conditioning, strength, activity limitations, and pain in individuals with RA.

Rheumatology Advisor talked with Nina Brodin, PT, PhD, of the Karolinska Institute, about her team’s review.5 “The most important takeaway from the study is that exercise should be recommended to all patients with RA and adjusted and supported if needed by physical therapists with knowledge of the disease.” Dr Broden and colleagues found that exercise has the potential to “improve body functions and reduce activity limitations independent of medical treatment.”

Bruno Gualano, PhD, associate professor at the University of São Paulo, Brazil, concurs with the importance of prescribing exercise. “The scientific evidence strongly supports physical activity promotion to mitigate symptoms and improve general health and well-being in rheumatologic diseases,” reports Dr Gualano. “Therefore, promoting physical activity becomes an important part of treatment in rheumatology.”

Aerobic Exercise

The research conducted by Siegel and colleagues6 included a meta-analysis of 14 RCTs comparing aerobic exercise (at 50% to 90% of maximal heart rate) with nonaerobic exercise (stretching, no attention, usual care, and relaxation). In an analysis of 5 studies with 586 patients, aerobic exercise had “a small beneficial effect” on quality of life (P <.0001).In an analysis of 6 studies involving 261 patients, pain measured by the visual analog scale (VAS) significantly improved (P =.02).7

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