RESEARCH - Intensive exercise helpful in rheumatoid arthritis

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Intensive Exercise Helpful in Rheumatoid Arthritis

Laurie Barclay, MD

Sept. 10, 2003 - Intensive exercise improves functional ability in

rheumatoid arthritis (RA) better than does usual care, according to the

results of a randomized trial published in the September issue of Arthritis

& Rheumatism.

" This study demonstrates that participation in long-term high-intensity

exercise classes decreases the level of psychological distress in RA

patients, " lead author Zuzana de Jong, MD, from Leiden University Medical

Center in the Netherlands, says in a news release.

Although the benefits of regular exercise with a moderate-to-high level of

intensity are well recognized to promote muscle strength and cardiovascular

fitness, physicians have traditionally warned patients with RA against

weight-bearing workouts due to fear of stress and damage to inflamed joints.

Of 300 subjects with RA enrolled in this study, 79% were women. Median age

was 54 years. Half of the subjects received an intensive exercise program,

Rheumatoid Arthritis Patients In Training (RAPIT), consisting of biweekly

one-hour sessions including 20 minutes of bicycling, 20 minutes of an

exercise circuit to build muscle strength and endurance as well as joint

mobility, and 20 minutes of high impact sports activities such as badminton,

volleyball, soccer, and basketball. Each session was preceded and followed

by 15 minutes of warm-up and cool-down exercises. The remaining 150 subjects

received usual care for RA, including physical therapy at the discretion of

their treating physician.

At study initiation, both groups were similar in most clinical parameters,

but average duration of disease was 7.5 years in the physical therapy group

and 5 years in the RAPIT group. There were also differences in use of

disease-modifying antirheumatic drugs and in baseline radiographic damage of

the hands and feet. During the two-year study, there were no significant

differences between groups in disease activity markers, including joint

swelling or joint pain, or in use of antirheumatic drugs and analgesics.

Of 150 subjects enrolled in RAPIT, 136 regularly participated in their

training sessions for the full two years. After correction for baseline

differences, the RAPIT group had greater improvement than did the usual care

group in functional ability, including climbing stairs as well as repetitive

and complex tasks, measured with the McMaster Toronto Arthritis Patient

Preference Disability Questionnaire.

The RAPIT group also fared better than the usual care group in physical

capacity, determined by aerobic fitness and muscle strength, and in feeling

more optimistic and capable of coping. Although functional ability for the

RAPIT group improved by nearly the same extent in each of the study years,

physical capacity plateaued after the first year.

Median radiographic damage of the large joints did not increase in either

group during the study, but subjects in both groups with greater joint

damage at study entry had slightly more progression in damage, and this was

more pronounced in the RAPIT group.

" In early RA, functional ability and physical capacity deteriorate quickly,

while the large joints are still relatively spared. The cost-benefit ratio

is probably most favorable in these patients, " Dr. de Jong says. " Until more

research is done, it seems wise to offer individually designed exercises

that spare the damaged joints to RA patients with considerable damage of the

large joints who wish to participate in long-term intensive programs. "

The Dutch Health Care Insurance Board supported this study.

Arthritis Rheum. 2003;48(9):2415-2424

Reviewed by D. Vogin, MD

http://www.medscape.com/viewarticle/461231

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