Re: Strength training benefits maintained in early RA patients

[Guest guest]

I started strength training this past January. I go to the gym and

use the weight machines. I used a trainer at first to ensure I could

use the equipment properly. I was surprised to learn that most

weight machines do not require tight hand gripping (something that

would be hard for most of us). There have only been two machines so

far that I cannot do. The two I had a problem with were a tricep

machine because it hurt my elbow and a hip flexer because it required

me to lay on my side and that hurt my hip. Basically, if it hurts

any joint I don't do it.

I cannot tell you how much better I feel from exercising. I can

really tell when I skip it for a week. I do avoid going if I feel

really bad of if I'm having a flare. Or sometimes I'll go and just

do a little less than I would. But if I don't go regularly, I am

more tired and have more pain. I also do the eleptical machine and

sometimes the stair master, but I cannot do the treadmill. It hurts

my feet to walk very much.

As most of you know, my mom has very severe joint destruction (from

having RA for over 20 years) and is on disability. If she goes

anywhere in the car, she has to take the next day off to rest. Her

hands, feet, and wrists are extremely disfigured due to the lack of

joints there. This summer when I was visiting her, we went to the

gym together. We were both skeptical and just thought, we'll see

what if anything she can do. We were amazed at how many of the

machines she could operate. She didn't use very heavy weights, but

she could do most things. One thing she couldn't do is the chin up,

because her wrists are collapsing. But most things she could do

fine. And now she will not stop going because of the difference it

makes in how she feels. She has always done stretching exercises,

yoga and her stationary bike, but strength training is different.

I personnally believe that by having stronger muscles, they will be

better able to protect my joints and that it helps keep my health in

balance, which is good for my immune system. Not scientific I

know. But in know for a fact that I feel better when I go, and

worse when I don't.

I hope some of you will give it a try. Certainly getting your RA

under control with medication is key, becuase you can't do much if

you can't function well, and you don't want to injure an inflamed

joint further. But if you are feeling good on your current

medication, talk to your doctor and look into this.

Jennie

> Strength training benefits maintained in early RA patients

>

> Rheumawire

> Aug 10, 2004

> Mann

>

> Jyvaskyla, Finland - Regular strength-building exercise provides

greater

> long-term benefits for patients with early rheumatoid arthritis (RA)

> than range-of-motion exercise, according to a new study in the

August

> 2004 issue of the ls of the Rheumatic Diseases [1].

>

> " Individually tailored and regularly conducted physical exercises

> provide long-term benefits for patients with early RA, " conclude the

> researchers, led by Dr A Häkkinen (Jyvaskyla Central Hospital,

Finland).

> " Structural joint damage remained low and clinical disease activity

> decreased during the whole 5-year follow-up, indicating that

patients

> actively treated with disease-modifying antirheumatic drugs

(DMARDs) can

> safely carry out the applied individually tailored, moderate-

intensity

> physical activity. "

>

> The 5-year study of 70 patients looked at whether an initial 2-year

> home-based, strength-training program had sustained effects on

muscle

> strength, bone-mineral density (BMD), structural joint damage, and

> disease activity in patients with early RA. To this end, patients

either

> participated in a home-based strength training with weights loaded

to

> 50% to 70% of the patient's repetition maximum (experimental group

[EG])

> or range-of-motion exercises (control group [CG]). The strength

training

> included exercises for all groups: biceps curl, lateral pull-down,

and

> forward single up-rise for the arms/knee extension; flexion, hip

> extension and abduction, and squats for the legs; abdominal

crunches and

> leg lifts while patients lay on their backs; and back

hyperextensions in

> prone position for the back. These were done using rubber bands and

> dumbbells as resistance. Subjects exercised twice a week, doing 2

sets

> for each exercise and 8 to 12 repetitions for each set. Both groups

were

> also encouraged to take part in aerobic activities 2 to 3 times a

week.

> Exercise training by both groups was monitored over the first 24

months

> of the study, and patients were again assessed at the 5-year mark.

> Maximal muscle strength of different muscle groups was measured by

> dynamometers. BMD at the femoral neck and lumbar spine were

measured by

> dual x-ray densitometry. Disease activity was assessed by the 28-

joint

> disease activity score (DAS28), and joint damage by x-ray findings.

> Of the patients, 62 completed 2 years of training (31 in each

group) and

> 59 completed the trial to 5 years (29 in EG, 30 in CG). Of the 29 EG

> patients, 10 continued their strength training during the entire 5

> years. None of the 30 control-group patients continued their

> range-of-motion exercises beyond the first 2 years.

>

> In the first 2 years, maximum muscle strength increased by a mean

68 kg

> in EG patients vs 35 kg in controls. At 5 years, these gains were

> largely maintained: 59 kg in EG vs 30 kg in controls.

>

> Patients in the resistance-training group also used strikingly less

> prednisolone over the 5-year period than those in the control

group. EG

> patients used prednisolone for an average of 8.0 months vs 30.2

months

> for control patients, for a cumulative prednisolone dosage of 0.76

g vs

> 3.25 g (p=0.0005.)

>

> Despite substantial training effects in muscle strength, BMD values

> remained relatively constant. Femoral and spinal BMD both increased

in

> the EG group at 2 years while decreasing in the control group, but

these

> differences were not significant when corrected for age, sex, DAS,

use

> of prednisolone, and drug treatment for osteoporosis and were not

> significant at 5 years.

>

> To address concerns that this type of exercise might increase

damage to

> inflamed joints, the investigators compared changes in DAS, Larsen

> scores, pain scores, and health-assessment questionnaire (HAQ)

scores at

> 2 and 5 years. These measures showed not only that patients in the

> strength-training group did not have faster joint deterioration but

also

> that they had significant improvements in disease activity, pain,

and

> quality of life during the 2-year monitored training period.

> Mean DAS scores improved by about 2 points in both groups at 2

years and

> remained about the same or improved slightly at the 5-year point.

Pain

> scores improved at the 2-year point by 67% in the EG group and by

3% in

> the control group (p=0.03) but were not significantly different at 5

> years. Similarly, HAQ scores improved significantly more in the EG

group

> at 2 years than in the control group but were not significantly

> different at 5 years. Radiographic damage remained low even at 5

years,

> the researchers concluded.

>

> Study participants had RA lasting for <24 months at inclusion and

had

> not been treated with prednisolone or DMARDs before inclusion in the

> study. After initial assessment, patients were put on sulfasalazine

as

> the first drug (with a few exceptions). At the 6-month and 2-year

visit,

> 24% and 50% were taking MTX or a combination of DMARDS including

MTX,

> respectively. At the 5-year visit, 70% were taking DMARDs.

>

> " The effect of exercise on the outcome of patients with rheumatoid

> arthritis has always been debated, and all of the studies have been

> short term, " Dr Jan Bergman ( Hospital, Ridley Park,

PA)

> tells rheumawire. " In general, most rheumatologists probably use the

> same rules today that I was taught 20 years ago: 'if it is hot and

> angry, rest it . . . if it's stiff, move it,' but there is no basis

for

> this other than 'that's the way it was done.' "

>

> Bergman says that with regard to RA, there has been a concern that

> vigorous strength-training exercise might lead to increased damage

of

> the already-inflamed joint. " In this paper, despite the fact that

there

> ultimately was little difference between the 2 treatment arms,

there was

> convincing evidence that having patients exercise, including

> strengthening exercise, did not cause any increased harm. This

should be

> reassuring both to physicians who encourage exercise and to

patients who

> are concerned about the exercise hurting and doing damage, " Bergman

> says. " This finding is the most important point of the study. "

>

>

> Source

>

> Häkkinen A, Sokka T, Kautiainen H, Kotaniemi A, and

> Hannonen P. Sustained maintenance of exercise induced muscle

strength

> gains and normal bone mineral density in patients with early

rheumatoid

> arthritis: a 5-year follow-up. Ann Rheum Dis 2004; 63:910-916.

>

>

>

>

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org