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Li Z, Wang XQ. Clinical effect and biological mechanism of exercise for rheumatoid arthritis: A mini review. Front Immunol 2023; 13:1089621. [PMID: 36685485 PMCID: PMC9852831 DOI: 10.3389/fimmu.2022.1089621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/16/2022] [Indexed: 01/09/2023] Open
Abstract
Rheumatoid arthritis (RA) is a common systematic, chronic inflammatory, autoimmune, and polyarticular disease, causing a range of clinical manifestations, including joint swelling, redness, pain, stiffness, fatigue, decreased quality of life, progressive disability, cardiovascular problems, and other comorbidities. Strong evidence has shown that exercise is effective for RA treatment in various clinical domains. Exercise training for relatively longer periods (e.g., ≥ 12 weeks) can decrease disease activity of RA. However, the mechanism underlying the effectiveness of exercise in reducing RA disease activity remains unclear. This review first summarizes and highlights the effectiveness of exercise in RA treatment. Then, we integrate current evidence and propose biological mechanisms responsible for the potential effects of exercise on immune cells and immunity, inflammatory response, matrix metalloproteinases, oxidative stress, and epigenetic regulation. However, a large body of evidence was obtained from the non-RA populations. Future studies are needed to further examine the proposed biological mechanisms responsible for the effectiveness of exercise in decreasing disease activity in RA populations. Such knowledge will contribute to the basic science and strengthen the scientific basis of the prescription of exercise therapy for RA in the clinical routine.
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Affiliation(s)
- Zongpan Li
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China,Department of Sport Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China,Department of Sport Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China,*Correspondence: Xue-Qiang Wang,
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Gwinnutt JM, Wieczorek M, Cavalli G, Balanescu A, Bischoff-Ferrari HA, Boonen A, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm T, Walker-Bone K, Welling J, Zlatković-Švenda MI, Guillemin F, Verstappen SMM. Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 2022; 8:rmdopen-2021-002168. [PMID: 35361692 PMCID: PMC8971792 DOI: 10.1136/rmdopen-2021-002168] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A European League Against Rheumatism (EULAR) taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). This paper reviews the literature on the effects of physical exercise and body weight on disease-specific outcomes of people with RMDs. METHODS Three systematic reviews were conducted to summarise evidence related to exercise and weight in seven RMDs: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis, systemic sclerosis and gout. Systematic reviews and original studies were included if they assessed exercise or weight in one of the above RMDs, and reported results regarding disease-specific outcomes (eg, pain, function, joint damage). Systematic reviews were only included if published between 2013-2018. Search strategies were implemented in the Medline, Embase, Cochrane Library of systematic reviews and CENTRAL databases. RESULTS 236 articles on exercise and 181 articles on weight were included. Exercise interventions resulted in improvements in outcomes such as pain and function across all the RMDs, although the size of the effect varied by RMD and intervention. Disease activity was not influenced by exercise, other than in axSpA. Increased body weight was associated with worse outcomes for the majority of RMDs and outcomes assessed. In general, study quality was moderate for the literature on exercise and body weight in RMDs, although there was large heterogeneity between studies. CONCLUSION The current literature supports recommending exercise and the maintenance of a healthy body weight for people with RMDs.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Maud Wieczorek
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, “Sf. Maria” Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland,Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland,University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas E Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria,Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria,Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain,Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana I Zlatković-Švenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia,Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
| | - Francis Guillemin
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Inserm, CHRU Nancy, CIC-1433 Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Sieczkowska SM, Smaira FI, Mazzolani BC, Gualano B, Roschel H, Peçanha T. Efficacy of home-based physical activity interventions in patients with autoimmune rheumatic diseases: A systematic review and meta-analysis. Semin Arthritis Rheum 2021; 51:576-587. [PMID: 33945907 DOI: 10.1016/j.semarthrit.2021.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Physical activity (PA) has been receiving increasing interest in recent years as an adjuvant therapy for autoimmune rheumatic disease (ARDs), but there is scarce information about the efficacy of home-based PA for patients with ARDs. OBJECTIVE To perform a systematic review and meta-analysis on the efficacy of home-based physical activity (PA) interventions in improving health-related quality of life, functional capacity, pain, and disease activity in patients with ARDs. METHODS Searches were performed in PubMed, Web of Science, Scopus, Cochrane, CINAHL database and Sport Discus. Trials were considered eligible if they included a home-based physical activity intervention. The population included adults with autoimmune rheumatic diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus, idiopathic inflammatory myopathies, systemic sclerosis and ankylosing spondylitis), comparisons included non-physical activity control or centre-based interventions (i.e., interventions performed on a specialized exercise centre) and the outcomes were quality of life, pain, functional capacity, disease activity and inflammation. RESULTS Home-based physical activity improved quality of life (p<0.01; g = 0.69; IC95%, 0.61 to 1.07) and functional capacity (p = 0.04; g = - 0.51; IC95%, -0.86; -0.16), and reduced disease activity (p = 0.03; g = - 0.60; IC95%, -1.16; -0.04) and pain (p = 0.01; g = -1.62; IC95%, -2.94 to -0.31) compared to the non-physical activity control condition. Additionally, home-based physical activity interventions were as effective as centre-based interventions for all investigated outcomes. CONCLUSION Home-based PA is an efficacious strategy to improve disease control and aleviate symptoms in ARD.
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Affiliation(s)
- Sofia Mendes Sieczkowska
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil. Laboratory of Assessment and Conditioning in Rhematology, Faculdade de Medicina FMUSP, Disciplina de Reumatologia, Universidade de Sao Paulo, Sao Paulo, SP, Brazil Av. Dr. Arnaldo, 455, ZIP code: 01246-903, Sao Paulo-SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fabiana Infante Smaira
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil. Laboratory of Assessment and Conditioning in Rhematology, Faculdade de Medicina FMUSP, Disciplina de Reumatologia, Universidade de Sao Paulo, Sao Paulo, SP, Brazil Av. Dr. Arnaldo, 455, ZIP code: 01246-903, Sao Paulo-SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bruna Caruso Mazzolani
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil. Laboratory of Assessment and Conditioning in Rhematology, Faculdade de Medicina FMUSP, Disciplina de Reumatologia, Universidade de Sao Paulo, Sao Paulo, SP, Brazil Av. Dr. Arnaldo, 455, ZIP code: 01246-903, Sao Paulo-SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil. Laboratory of Assessment and Conditioning in Rhematology, Faculdade de Medicina FMUSP, Disciplina de Reumatologia, Universidade de Sao Paulo, Sao Paulo, SP, Brazil Av. Dr. Arnaldo, 455, ZIP code: 01246-903, Sao Paulo-SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil. Laboratory of Assessment and Conditioning in Rhematology, Faculdade de Medicina FMUSP, Disciplina de Reumatologia, Universidade de Sao Paulo, Sao Paulo, SP, Brazil Av. Dr. Arnaldo, 455, ZIP code: 01246-903, Sao Paulo-SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Tiago Peçanha
- Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, SP, Brazil. Laboratory of Assessment and Conditioning in Rhematology, Faculdade de Medicina FMUSP, Disciplina de Reumatologia, Universidade de Sao Paulo, Sao Paulo, SP, Brazil Av. Dr. Arnaldo, 455, ZIP code: 01246-903, Sao Paulo-SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Sieczkowska SM, Coimbra DR, Vilarino GT, Andrade A. Effects of resistance training on the health-related quality of life of patients with rheumatic diseases: Systematic review with meta-analysis and meta-regression. Semin Arthritis Rheum 2020; 50:342-353. [DOI: 10.1016/j.semarthrit.2019.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/19/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022]
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Kamruzzaman AKM, Chowdhury MR, Islam MN, Sultan I, Ahmed S, Shahin A, Alam MM, Azad MA, Hassan MM, Amin MZ, Sinha S, Ahmad HI, Shazzad MN, Ahmad SN, Haq SA, Rasker JJ. The knowledge level of rheumatoid arthritis patients about their disease in a developing country. A study in 168 Bangladeshi RA patients. Clin Rheumatol 2019; 39:1315-1323. [PMID: 31828544 DOI: 10.1007/s10067-019-04859-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/29/2019] [Accepted: 11/14/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess disease-related knowledge of rheumatoid arthritis (RA) patients PATIENTS AND METHODS: Consecutive RA patients were invited from the rheumatology departments of BSMM University, Dhaka, Bangladesh. The Bangla version of the Patient Knowledge Questionnaire (B-PKQ) was used. Correlations between the B-PKQ scores and clinical-demographic data were measured using Pearson's correlation coefficient. Impact of independent variables on the level of knowledge about RA was analyzed through multiple regression analysis. Possible explanatory variables included the following: age, disease duration, formal education level, and Bangla Health Assessment Questionnaire (B-HAQ) score. Analysis of variance (ANOVA) was used to test the difference between demographical, clinical, and socioeconomic variables. For statistical analysis, SPSS statistics version 20 was used. RESULTS A total of 168 RA patients could be included. The mean B-PKQ score was 9.84 (range 1-20) from a possible maximum of 30. The mean time for answering the questionnaire was 24.3 min (range 15-34). Low scores were observed in all domains but the lowest were in medications and joint protection/energy conservation. Knowledge level was higher (15.5) in 6 patients who had RA education before enrollment. B-PKQ showed positive correlation with education level (r = 0.338) and negative correlation with HAQ (r = -0.169). The B-PKQ showed no correlation with age, disease duration, having first degree family member with RA, education from other sources (neighbor, RA patient, nurses), or information from mass media. CONCLUSIONS Disease-related knowledge of Bangladeshi RA patients was poor in all domains. Using these findings, improved education and knowledge will result in better disease control.Key Points• Little is known about the knowledge of RA patients regarding their disease and its treatment in Bangladesh and in developing countries in general.• We found that the knowledge of Bangladeshi RA patients regarding their disease was poor in all domains; it correlated positive with education level and negative with function (HAQ), but showed no correlation with age or disease duration.• The findings of this study can be used for improving current patient education programs by health professionals and through mass media.• Better disease control of RA may be achieved by improving patient knowledge in a developing country like Bangladesh, but also in other parts of the world.
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Affiliation(s)
- A K M Kamruzzaman
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Minhaj Rahim Chowdhury
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Md Nazrul Islam
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Imtiaz Sultan
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Shamim Ahmed
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Abu Shahin
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Mohammad Mahbubul Alam
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Md Ak Azad
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - M Masudul Hassan
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Md Zahid Amin
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Sudeshna Sinha
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Habib Imtiaz Ahmad
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Md Nahiduzzamane Shazzad
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Sonia Nasreen Ahmad
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Syed Atiqul Haq
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Johannes Jacobus Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.
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Ritschl V, Lackner A, Boström C, Mosor E, Lehner M, Omara M, Ramos R, Studenic P, Smolen JS, Stamm TA. I do not want to suppress the natural process of inflammation: new insights on factors associated with non-adherence in rheumatoid arthritis. Arthritis Res Ther 2018; 20:234. [PMID: 30340628 PMCID: PMC6235214 DOI: 10.1186/s13075-018-1732-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/25/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is estimated that 50-70% of patients with rheumatoid arthritis (RA) are non-adherent to their recommended treatment. Non-adherent patients have a higher risk of not reaching an optimal clinical outcome. We explored factors associated with nonadherence from the patient's perspective. METHODS Four hundred and fifty-nine RA patients (346 (75.4%) females; mean age 63.0 ± 14.8 years) who failed to attend follow-up visits in two rheumatology centres were eligible to participate in a qualitative interview study. We used this strategy to identify patients who were potentially non-adherent to medicines and/or non-pharmacological interventions. By means of meaning condensation analysis, we identified new and some already well known insights to factors associated with non-adherence. We used the capability, opportunity, and motivation model of behaviour (COM-B) model as a frame of reference to classify the factors. RESULTS Forty-three of 131 patients (32.8%) who agreed to participate in the qualitative interviews were found to be non-adherent. New insights on factors associated with non-adherence included strong opinions of patients, such as pain being considered as an indicator of hard work and something to be proud of, or inflammation being a natural process that should not be suppressed; feeling not to be in expert's hands when being treated by a physician/health professional; the experience of excessive self-control over the treatment; and rheumatologists addressing only drugs and omitting non-pharmacological aspects. The COM-B model comprehensively covered the range of our findings. CONCLUSIONS The new insights on factors associated with non-adherence allow a better understanding of this phenomenon and can substantially enhance patient care by helping to develop targeted interventions.
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Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
- Division of Occupational Therapy, University of Applied Sciences FH Campus Wien, Vienna, Austria
| | - Angelika Lackner
- Department of Rheumatology, Medical University of Graz, Styria, Austria
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Karolinska Institute, Care Sciences and Society (NVS), Huddinge, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - Erika Mosor
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Michaela Lehner
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Maisa Omara
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Romualdo Ramos
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Paul Studenic
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Josef Sebastian Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine, Centre for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
| | - Tanja Alexandra Stamm
- Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
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Hernández-Hernández MV, Díaz-González F. Role of physical activity in the management and assessment of rheumatoid arthritis patients. ACTA ACUST UNITED AC 2016; 13:214-220. [PMID: 27263964 DOI: 10.1016/j.reuma.2016.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/18/2016] [Accepted: 04/04/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting diarthrodial joints, in which patients tend to perform less physical activity (PA) than recommended. This review focuses on the existing evidence about the relationship of PA and RA, specifically how the former influences joint inflammation, disability, quality of life and pain in RA patients, and also how disease activity potentially impacts PA in these patients. METHODS A literature search of EMBASE and MEDLINE databases from January 2000 to January 2015. RESULTS The evidence indicating that PA in RA patients is safe and the benefits from regularly performing, both aerobic and resistance exercises, in these patients include improvement in: quality of life, functionality, pain and number of swollen joints. Interestingly, recent studies suggest that changes in disease activity in RA patients inversely correlate with variations in PA, as assessed by accelerometry. CONCLUSIONS The regular monitoring of PA in RA patients might facilitate a more objective evaluation of variations in disease activity, helping physicians to make general and therapeutic recommendations that will improve both the health status and the joint functionality of these patients.
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Affiliation(s)
| | - Federico Díaz-González
- Servicio de Reumatología, Hospital Universitario de Canarias, La Laguna, Spain; Departamento de Medicina Interna, Facultad de Medicina, Universidad de La Laguna, La Laguna, Spain.
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van Erp SJ, Brakenhoff LK, van Gaalen FA, van den Berg R, Fidder HH, Verspaget HW, Huizinga TW, Veenendaal RA, Wolterbeek R, van der Heijde D, van der Meulen-de Jong AE, Hommes DW. Classifying Back Pain and Peripheral Joint Complaints in Inflammatory Bowel Disease Patients: A Prospective Longitudinal Follow-up Study. J Crohns Colitis 2016; 10:166-75. [PMID: 26512134 DOI: 10.1093/ecco-jcc/jjv195] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/13/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Peripheral joint complaints [pJTC] and chronic back pain [CBP] are the most common extra-intestinal manifestations in patients with inflammatory bowel disease [IBD]. This prospective study evaluates variables associated with joint/back pain, including IBD disease activity. METHODS IBD patients with back pain ≥ 3 months and/or peripheral joint pain/swelling [n = 155], and IBD patients without joint complaints [n = 100; controls], were followed for a period of 1 year. Patients were classified as having SpondyloArthritis [SpA] according to several sets of criteria. Statistical analysis included logistic regression models and linear mixed model analysis. RESULTS Of the 155 patients with joint/back pain, 13 had chronic back pain, 80 peripheral joint complaints, and 62 axial and peripheral joint complaints. Smoking, female gender, and IBD disease activity were independently associated with IBD joint/back pain. The Assessment in Spondyloarthritis International Society criteria for axial and peripheral SpA were fulfilled in 12.3% of patients, with 9.7% [n = 15] receiving a rheumatological diagnosis of arthritis. During the 12-month follow-up, the majority of the patients reporting joint/back pain remained stable. CONCLUSIONS In our cohort, the majority of IBD patients reported joint/back pain and SpA was relatively common. To facilitate effective care, gastroenterologists should be aware of the various features of SpA to classify joint complaints and, by making use of an efficient referral algorithm, to refer CBP patients to the rheumatologist.
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Affiliation(s)
- S J van Erp
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - L K Brakenhoff
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - F A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - R van den Berg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - H H Fidder
- Department of Gastroenterology and Hepatology , University Medical Center Utrecht, Utrecht, The Netherlands
| | - H W Verspaget
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - T W Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - R A Veenendaal
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - R Wolterbeek
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - D van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - A E van der Meulen-de Jong
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - D W Hommes
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands Center for Inflammatory Bowel Diseases, University of California Los Angeles, Los Angeles, CA, USA
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Metsios GS, Lemmey A. Exercise as Medicine in Rheumatoid Arthritis: Effects on Function, Body Composition, and Cardiovascular Disease Risk. ACTA ACUST UNITED AC 2015. [DOI: 10.31189/2165-6193-4.1.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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10
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Kjeken I, Dagfinrud H, Heiberg T, Kvien TK. Multidisciplinary approach to rheumatoid arthritis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00098-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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11
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Nolte K, Janse van Rensburg DC. Exercise prescription in the management of rheumatoid arthritis. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2013.10874374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- K Nolte
- Department of Biokinetics, Sport and Leisure Sciences, University of Pretoria
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12
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Effectiveness of sensorimotor training in patients with rheumatoid arthritis: a randomized controlled trial. Rheumatol Int 2013; 33:2269-75. [DOI: 10.1007/s00296-013-2706-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
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13
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Vervloesem N, Van Gils N, Ovaere L, Westhovens R, Van Assche D. Are personal characteristics associated with exercise participation in patients with rheumatoid arthritis? A cross-sectional explorative survey. Musculoskeletal Care 2012; 10:90-100. [PMID: 22351523 DOI: 10.1002/msc.1003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Organized exercise programs for patients with rheumatoid arthritis (RA) are useful to enhance physical activity and fitness. However, participation and adherence rates of these programs are low. This study aimed to identify demographic, personal and disease-related factors interfering with implementing an exercise program for RA. METHODS A random sample of ambulatory RA patients from a single centre was divided into two groups, depending on their willingness to participate in an exercise program. Subsequently, demographic data (gender, age, disease duration and educational level) and disease-related and personal factors were obtained (Disease Activity Score; Short Form 36 [SF-36]; Health Assessment Questionnaire; Global Disease Activity; and also the Utrecht Coping List [UCL], Illness Cognition Questionnaire; TAMPA scale and modified Baecke questionnaire). RESULTS Of the 154 people completing the survey, 113 (73%) indicated that they were willing to participate in an exercise program. These positive responders (PR) were more often female (p<0.05), and had a higher educational level (p<0.05). In the negative responders (NR), higher scores were found in the general health perception (54.7; [SD 18.3] versus 47.4; [SD 20.8]) and vitality (61.6 [SD 19.8] versus 53.7 [SD 20.1] sections of the SF-36, and a lower score was found on the reassuring thoughts subscale of the UCL (11.9 [SD 2.7] versus 12.9 [SD 2.7]) compared with the PR (all p<0.05). CONCLUSIONS Although few differences were found between the groups, some insights regarding pitfalls in implementing an exercise program were highlighted. Further insights into external and personal motivators for patients are needed.
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Affiliation(s)
- Nele Vervloesem
- Department of Rheumatology, University Hospital Leuven, Leuven, Belgium
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Lemmey AB, Williams SL, Marcora SM, Jones J, Maddison PJ. Are the benefits of a high-intensity progressive resistance training program sustained in rheumatoid arthritis patients? A 3-year followup study. Arthritis Care Res (Hoboken) 2012; 64:71-5. [PMID: 21671413 DOI: 10.1002/acr.20523] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) patients were reassessed for body composition and physical function mean ± SD 39 ± 6 months after commencing a randomized controlled trial involving 24 weeks of either high-intensity progressive resistance training (PRT) or low-intensity range of movement exercise (control) to determine whether the benefits of PRT (i.e., reduced fat mass [FM], increased lean mass [LM], and improved function) were retained. METHODS Nine PRT and 9 control subjects were reassessed for body composition (dual x-ray absorptiometry) and function (knee extensor strength, chair test, arm curl test, 50-foot walk) approximately 3 years after resuming normal activity following the exercise intervention. RESULTS At followup, PRT subjects remained significantly leaner than control subjects (P = 0.03), who conversely had accumulated considerable FM during the study period (approximately -1.0 kg versus +2.4 kg, PRT versus controls). PRT subjects also retained most of the improvement in walking speed gained from training (P = 0.03 versus controls at followup). In contrast, the PRT-induced gains in LM and strength-related function were completely lost. Data from the controls suggest that established and stable RA patients have similar rates of LM loss but elevated rates of FM accretion relative to age-matched sedentary non-RA controls. CONCLUSION We found that long-term resumption of normal activity resulted in loss of PRT-induced improvements in LM and strength-related function, but substantial retention of the benefits in FM reduction and walking ability. The relatively long-term benefit of reduced adiposity, in particular, is likely to be clinically significant, as obesity is very prevalent among RA patients and is associated with their disability and exacerbated cardiovascular disease risk.
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Affiliation(s)
- Andrew B Lemmey
- School of Sport, Health and Exercise Sciences, Bangor University, UK.
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Baillet A, Vaillant M, Guinot M, Juvin R, Gaudin P. Efficacy of resistance exercises in rheumatoid arthritis: meta-analysis of randomized controlled trials. Rheumatology (Oxford) 2011; 51:519-27. [PMID: 22120463 DOI: 10.1093/rheumatology/ker330] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of resistance exercises in RA patients. METHODS A systematic literature search was done using Pubmed, Embase and Cochrane databases through November 2009 and in abstracts presented at rheumatology scientific meetings over the past 3 years. Randomized controlled trials (RCTs) comparing resistance exercise based therapy with interventions without resistance exercise for the treatment of RA patients were included. Outcomes studied were post-intervention disability on the HAQ, functional capacity assessed by walking speed, pain on the visual analogue scale (VAS), joint count, isometric, isokinetic and grip strength. Efficacy was assessed by weighted mean differences (WMDs) and tolerance was assessed by relative risk (RR). Data were pooled using the inverse of variance model, and heterogeneity was tested. RESULTS Ten RCTs, including 547 patients, met the study inclusion criteria. The mean (S.D.) Jadad score was 2.3 (0.6). Resistance exercises significantly improved isokinetic strength (WMD = 23.7%, P < 0.001), isometric strength (WMD = 35.8%, P < 0.001), grip strength (WMD = 26.4%, P < 0.001) and HAQ (WMD = -0.22, P < 0.001). Exercise also had a positive impact on the 50-foot walking test (WMD = -1.90 s, P < 0.001) and ESR (WMD = -5.17, P = 0.005). Withdrawals [RR = 0.95, 95% confidence interval (CI) 0.61, 1.48] and adverse events (RR = 1.08, 95% CI 0.72, 1.63) were well balanced in both groups. Patient and exercise characteristics did not influence the results. Subgroup analysis revealed a trend towards higher efficacy associated with high-intensity programmes. CONCLUSION Resistance exercise in RA is safe, and the improvement in most outcomes was statistically significant and possibly clinically relevant for RA disability.
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Affiliation(s)
- Athan Baillet
- Hôpital Sud, Grenoble Teaching Hospital, Echirolles Cedex, France.
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Stuifbergen AK, Morris M, Jung JH, Pierini D, Morgan S. Benefits of wellness interventions for persons with chronic and disabling conditions: a review of the evidence. Disabil Health J 2011; 3:133-45. [PMID: 20628583 DOI: 10.1016/j.dhjo.2009.10.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persons living with the effects of chronic and disabling conditions are often at increased risk for the development of secondary conditions and disabilities that can lead to further decline in health status, independence, functional status, life satisfaction, and overall quality of life. OBJECTIVE The purpose of this study was to review the evidence for the benefits of wellness/health promotion interventions for persons with chronic and disabling conditions. METHODS The authors conducted a Medline search (1990-2007) using terms related to wellness and health promotion cross-referenced with general terms for chronic and disabling conditions, as well as 15 specific chronic and/or disabling conditions (e.g., multiple sclerosis, spinal cord injury). Selection of studies was limited to those published in English that reported randomized controlled trails or prospective studies that involved adult human subjects with a chronic and/or disabling condition. All selected studies focused on some aspect of a wellness or health promotion intervention and involved a comparison or control group. Of the 5,847 studies initially identified in the search using medical subject heading terms, 190 met the criteria for full review. Data were extracted from these publications and summarized using descriptive statistics. RESULTS Almost all studies (95%) explored the effects of wellness intervention in a sample diagnosed with a single condition (e.g., cancer, stroke, arthritis). Although the mean sample size was 100, the range in sample size varied widely (6-688); 25% of the studies had sample of 30 or fewer. Almost all studies (89.5%) reported positive effects of the wellness intervention, although the delivery and content of interventions as well as the measurement of outcomes, varied greatly. CONCLUSIONS Our findings support an immediate post-intervention positive impact of wellness interventions across persons with a wide variety of chronic and disabling conditions. Future research that clearly specifies primary study outcomes and follows the CONSORT guidelines will strengthen future reviews of the evidence and facilitate application of the evidence of practice.
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Affiliation(s)
- Alexa K Stuifbergen
- The University of Texas at Austin School of Nursing, Center for Health Promotion and Disease Prevention Research in Underserved Populations, 1700 Red River, Austin, Texas 78701, USA.
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Lemmey AB. Efficacy of progressive resistance training for patients with rheumatoid arthritis and recommendations regarding its prescription. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ijr.11.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Reid A, Brady A, Blake C, Mongey AB, Veale DJ, FitzGerald O, Cusack T. Randomised controlled trial examining the effect of exercise in people with rheumatoid arthritis taking anti-TNFα therapy medication. BMC Musculoskelet Disord 2011; 12:11. [PMID: 21232112 PMCID: PMC3024271 DOI: 10.1186/1471-2474-12-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 01/13/2011] [Indexed: 12/31/2022] Open
Abstract
Abstract Methods/Design Six hundred and eighteen individuals with RA, on anti-TNFα therapy medication, will be randomised into one of 3 groups: a land-based exercise group; a water-based exercise group or a control group. The land and water-based groups will exercise for one hour, twice a week for eight weeks. The control group will receive no intervention and will be asked not to alter their exercise habits for the duration of the study. The primary outcome measure, the Stanford Health Assessment Questionnaire Disability Index (HAQ-DI) which measures functional ability, and secondary measures of pain, fatigue and quality of life, will be assessed at baseline, eight and 24 weeks by an independent assessor unaware of group allocation. Changes in outcome from 0 to 8 weeks and 0 to 24 weeks in the 'land-based exercise group versus control group' and the 'water-based exercise group versus control group' will be examined. Analysis will be conducted on an intention to treat basis. Discussion This trial will evaluate the effectiveness of group exercise therapy on land or in water, for people with RA taking anti-TNFα therapy medication. If these exercise groups are found to be beneficial, they could be conducted in local community facilities thus making these forms of exercise more easily accessible for individuals and potentially reduce the burden on health services. Trial Registration This trial is registered with ClinicalTrials.gov (a service of the United States National Institutes of Health) identifier: NCT00855322.
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Affiliation(s)
- Angela Reid
- Physiotherapy Department, Our Lady's Hospice and Care Services, Harold's Cross, Dublin, Ireland.
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Multidisciplinary approach to rheumatoid arthritis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00095-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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20
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The effects of strength and endurance training in patients with rheumatoid arthritis. Clin Rheumatol 2010; 30:623-32. [DOI: 10.1007/s10067-010-1584-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 07/21/2010] [Accepted: 09/20/2010] [Indexed: 10/19/2022]
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Lemmey AB, Marcora SM, Chester K, Wilson S, Casanova F, Maddison PJ. Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. ACTA ACUST UNITED AC 2010; 61:1726-34. [PMID: 19950325 DOI: 10.1002/art.24891] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To confirm, in a randomized controlled trial (RCT), the efficacy of high-intensity progressive resistance training (PRT) in restoring muscle mass and function in patients with rheumatoid arthritis (RA). Additionally, to investigate the role of the insulin-like growth factor (IGF) system in exercise-induced muscle hypertrophy in the context of RA. METHODS Twenty-eight patients with established, controlled RA were randomized to either 24 weeks of twice-weekly PRT (n = 13) or a range of movement home exercise control group (n = 15). Dual x-ray absorptiometry-assessed body composition (including lean body mass [LBM], appendicular lean mass [ALM], and fat mass); objective physical function; disease activity; and muscle IGFs were assessed at weeks 0 and 24. RESULTS Analyses of variance revealed that PRT increased LBM and ALM (P < 0.01); reduced trunk fat mass by 2.5 kg (not significant); and improved training-specific strength by 119%, chair stands by 30%, knee extensor strength by 25%, arm curls by 23%, and walk time by 17% (for objective function tests, P values ranged from 0.027 to 0.001 versus controls). In contrast, body composition and physical function remained unchanged in control patients. Changes in LBM and regional lean mass were associated with changes in objective function (P values ranged from 0.126 to <0.0001). Coinciding with muscle hypertrophy, previously diminished muscle levels of IGF-1 and IGF binding protein 3 both increased following PRT (P < 0.05). CONCLUSION In an RCT, 24 weeks of PRT proved safe and effective in restoring lean mass and function in patients with RA. Muscle hypertrophy coincided with significant elevations of attenuated muscle IGF levels, revealing a possible contributory mechanism for rheumatoid cachexia. PRT should feature in disease management.
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Göksel Karatepe A, Günaydin R, Türkmen G, Kaya T. Effects of home-based exercise program on the functional status and the quality of life in patients with rheumatoid arthritis: 1-year follow-up study. Rheumatol Int 2009; 31:171-6. [DOI: 10.1007/s00296-009-1242-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 10/21/2009] [Indexed: 11/28/2022]
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Hurkmans E, van der Giesen FJ, Vliet Vlieland TPM, Schoones J, Van den Ende ECHM. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev 2009; 2009:CD006853. [PMID: 19821388 PMCID: PMC6769170 DOI: 10.1002/14651858.cd006853.pub2] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND An up-to-date overview of the effectiveness and safety of dynamic exercise therapy (exercise therapy with a sufficient intensity, duration, and frequency to establish improvement in aerobic capacity and/or muscle strength) is lacking. OBJECTIVES To assess the effectiveness and safety of short-term (< three months) and long-term (> three months) dynamic exercise therapy programs (aerobic capacity and/or muscle strength training), either land or water-based, for people with RA. To do this we updated a previous Cochrane review (van den Ende 1998) and made categories for the different forms of dynamic exercise programs. SEARCH STRATEGY A literature search (to December 2008) within various databases was performed in order to identify randomised controlled trials (RCTs). SELECTION CRITERIA RCTs that included an exercise program fulfilling the following criteria were selected: a) frequency at least twice weekly for > 20 minutes; b) duration > 6 weeks; c) aerobic exercise intensity > 55% of the maximum heart rate and/or muscle strengthening exercises starting at 30% to 50% of one repetition maximum; and d) performed under supervision. Moreover, the RCT included one or more of the following outcome measures: functional ability, aerobic capacity, muscle strength, pain, disease activity or radiological damage. DATA COLLECTION AND ANALYSIS Two review authors independently selected eligible studies, rated the methodological quality, and extracted data. A qualitative analysis (best-evidence synthesis) was performed and, where appropriate, a quantitative data analysis (pooled effect sizes). MAIN RESULTS In total, eight studies were included in this updated review (two additional studies). Four of the eight studies fulfilled at least 8/10 methodological criteria. In this updated review four different dynamic exercise programs were found: (1) short-term, land-based aerobic capacity training, which results show moderate evidence for a positive effect on aerobic capacity (pooled effect size 0.99 (95% CI 0.29 to 1.68). (2) short-term, land-based aerobic capacity and muscle strength training, which results show moderate evidence for a positive effect on aerobic capacity and muscle strength (pooled effect size 0.47 (95% CI 0.01 to 0.93). (3) short-term, water-based aerobic capacity training, which results show limited evidence for a positive effect on functional ability and aerobic capacity. (4) long-term, land-based aerobic capacity and muscle strength training, which results show moderate evidence for a positive effect on aerobic capacity and muscle strength. With respect to safety, no deleterious effects were found in any of the included studies. AUTHORS' CONCLUSIONS Based on the evidence, aerobic capacity training combined with muscle strength training is recommended as routine practice in patients with RA.
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Affiliation(s)
- Emalie Hurkmans
- Leiden University Medical CenterDepartment of RheumatologyAlbinusdreef 2LeidenZuid‐HollandNetherlands2333 ZA
| | - Florus J van der Giesen
- Leiden University Medical CenterDepartment of Physical TherapyAlbinusdreef 2LeidenNetherlands2333 ZA
| | - Thea PM Vliet Vlieland
- Leiden University Medical CenterDepartment of RheumatologyAlbinusdreef 2LeidenZuid‐HollandNetherlands2333 ZA
| | - Jan Schoones
- Leiden University Medical CenterWalaeus LibraryLeidenNetherlands
| | - Els CHM Van den Ende
- Sint MaartenskliniekDepartment of RheumatologyHengstdal 3NijmegenNetherlands6522 JV
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Cairns AP, McVeigh JG. A systematic review of the effects of dynamic exercise in rheumatoid arthritis. Rheumatol Int 2009; 30:147-58. [DOI: 10.1007/s00296-009-1090-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 08/07/2009] [Indexed: 01/08/2023]
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Assessment of a Sixteen-Week Training Program on Strength, Pain, and Function in Rheumatoid Arthritis Patients. J Clin Rheumatol 2009; 15:165-71. [DOI: 10.1097/rhu.0b013e318190f95f] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vliet Vlieland TPM, Pattison D. Non-drug therapies in early rheumatoid arthritis. Best Pract Res Clin Rheumatol 2009; 23:103-16. [PMID: 19233050 DOI: 10.1016/j.berh.2008.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Non-pharmacological treatment modalities are often used as an adjunct to drug therapy in patients with rheumatoid arthritis (RA). The aim of this overview is to summarize the available evidence on the effectiveness of these modalities in early RA. The few available randomized controlled trials that have specifically investigated patients with early RA support the effectiveness of dynamic exercise and cognitive behavioural interventions, and to a lesser extent of joint protection programmes and foot orthoses. The effectiveness of multidisciplinary team-care programmes, specialist nurse care, electro-physical modalities (including passive hydrotherapy), wrist orthoses, and dietary interventions have not been studied in patients with early RA. Current recommendations on the usage of non-pharmacological treatment modalities in sets of guidelines on the management of early RA vary with respect to their scope, strength and level of detail. The results of this review indicate a need for further investigation into the most clinically effective and cost-effective strategies to deliver non-pharmacological treatment modalities as well as comprehensive arthritis care models in early RA.
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Affiliation(s)
- Theodora P M Vliet Vlieland
- Leiden University Medical Center, Department of Orthopaedics and Department of Rheumatology, Leiden, The Netherlands.
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Hammond A, Bryan J, Hardy A. Effects of a modular behavioural arthritis education programme: a pragmatic parallel-group randomized controlled trial. Rheumatology (Oxford) 2008; 47:1712-8. [DOI: 10.1093/rheumatology/ken380] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Silva EGD, Dourado VZ. Treinamento de força para pacientes com doença pulmonar obstrutiva crônica. REV BRAS MED ESPORTE 2008. [DOI: 10.1590/s1517-86922008000300014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pacientes com doença pulmonar obstrutiva crônica apresentam comumente fraqueza muscular periférica associada à intolerância ao exercício. Embora efetivo, o exercício aeróbio apresenta pouco ou nenhum efeito na fraqueza e atrofia muscular, além de não ser tolerado pela maioria dos pacientes com DPOC. Nesse sentido, o treinamento de força é opção racional para aumentar a força muscular, além de já ter se mostrado mais tolerável que o exercício aeróbio. O aumento de força muscular periférica é o benefício mais consistente do treinamento de força e, quando este é associado ao exercício aeróbio, não resulta em melhora adicional da capacidade de exercício, da dispnéia e da qualidade de vida. Contudo, observa-se que o treinamento combinado é fisiologicamente mais completo e pode ser uma opção de condicionamento físico mais diversificado. O treinamento de moderada a alta intensidade resulta em maiores adaptações fisiológicas, entretanto o exercício de baixa intensidade é tolerável, simples, de fácil execução domiciliar, não requer equipamentos sofisticados e resulta em benefícios significativos. Este exercício é indicado, sobretudo, para os pacientes com DPOC mais avançada. Finalmente, há evidências recentes de que o treinamento de força para os músculos do tronco é alternativa válida para melhorar a capacidade funcional de exercício e a função pulmonar em pacientes com DPOC. A presente revisão de literatura sugere a incorporação do treinamento de força como estratégia de rotina nos programas de reabilitação pulmonar. Pesquisas futuras são necessárias para avaliar os efeitos do treinamento de força na saúde mental, no desempenho em atividades de vida diária, na saúde osteoarticular, no risco de quedas e na função pulmonar, entre outros.
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Conn VS, Hafdahl AR, Brown SA, Brown LM. Meta-analysis of patient education interventions to increase physical activity among chronically ill adults. PATIENT EDUCATION AND COUNSELING 2008; 70:157-72. [PMID: 18023128 PMCID: PMC2324068 DOI: 10.1016/j.pec.2007.10.004] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 09/24/2007] [Accepted: 10/06/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This meta-analysis integrates primary research testing the effect of patient education to increase physical activity (PA) on behavior outcomes among adults with diverse chronic illnesses. METHODS Extensive literature searching strategies located published and unpublished intervention studies that measured PA behavior outcomes. Primary study results were coded. Fixed- and random-effects meta-analytic procedures included moderator analyses. RESULTS Data were synthesized across 22,527 subjects from 213 samples in 163 reports. The overall mean weighted effect size for two-group comparisons was 0.45 (higher mean for treatment than control). This effect size is consistent with a difference of 48 min of PA per week or 945 steps per day. Preliminary moderator analyses suggest interventions were most effective when they targeted only PA behavior, used behavioral strategies (versus cognitive strategies), and encouraged PA self-monitoring. Differences among chronic illnesses were documented. Individual strategies unrelated to PA outcomes included supervised exercise sessions, exercise prescription, fitness testing, goal setting, contracting, problem solving, barriers management, and stimulus/cues. PA outcomes were unrelated to gender, age, ethnicity, or socioeconomic distribution among samples. CONCLUSION These findings suggest that some patient education interventions to increase PA are effective, despite considerable heterogeneity in the magnitude of intervention effect. PRACTICE IMPLICATIONS Moderator analyses are preliminary and provide suggestive evidence for further testing of interventions to inform practice.
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Affiliation(s)
- Vicki S Conn
- S317 School of Nursing, University of Missouri, Columbia, MO 65211, USA.
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The role of physical activity in rheumatoid arthritis. Physiol Behav 2008; 94:270-5. [PMID: 18234247 DOI: 10.1016/j.physbeh.2007.12.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 12/18/2007] [Accepted: 12/18/2007] [Indexed: 11/22/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory auto-immune disease, causing progressive damage to the musculoskeletal system. Many patients with RA also suffer from accelerated muscle loss or cachexia, which contributes to the loss of physical function and quality of life. Physical activity plays a central role in the management of the disease as it is essential to maintain muscle strength and endurance, range of motion and the ability to perform activities of daily life. On the other hand, given the nature of the disease, there is always an increased risk for injury. There is a large amount of literature investigating the effect of exercise interventions on muscle function and disease activity. These studies show that exercise clearly improves muscle function without affecting disease activity. Studies including radiographic evaluation of joint damage as an endpoint also show that there is no evidence that exercise, even high-intensity exercise, increases inflammation or joint damage, although care should be taken with patients with severe baseline damage. Regarding daily physical activity (exercise is only one component of physical activity) there is hardly any research done showing either that physical activity is indeed decreased in patients or whether or not there is a relation between daily physical activity and disease activity. The results from studies looking at the effect of exercise on muscle mass or the ability to prevent or reverse cachexia are somewhat contradictory, but it seems that when the training dose is sufficiently large, gains in muscle mass can be achieved.
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Conn VS, Hafdahl AR, Minor MA, Nielsen PJ. Physical activity interventions among adults with arthritis: meta-analysis of outcomes. Semin Arthritis Rheum 2007; 37:307-16. [PMID: 17888500 DOI: 10.1016/j.semarthrit.2007.07.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Revised: 06/19/2007] [Accepted: 07/17/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Due to reduced physical activity, adults with arthritis experience significant disability and comorbidities including cardiovascular disease. This meta-analytic review integrates results from primary research studies testing interventions to increase physical activity in arthritis patients. METHODS Extensive literature searching strategies were employed to locate published and unpublished empirical studies testing physical activity interventions. Results were coded for studies that had at least 5 participants. Effect sizes (ESs) were calculated for measures of physical activity, pain, and objective and subjective measures of functional ability. RESULTS Twenty-eight research studies with 4111 subjects were synthesized. The mean ES for 2-group comparisons (treatment versus control) was 0.69 for physical activity, 0.21 for pain, 0.49 for objectively measured function, and 0.14 for subjectively measured function. This average effect on subjective function is consistent with a Health Assessment Questionnaire mean of 0.64 for treatment subjects as compared with 0.70 for control subjects. For pain assessed using the 0 to 10 visual analog scale, the average effect amounts to a mean of 3.78 for treatment subjects versus 4.33 for control subjects. Control group subjects experienced statistically significant improvements in pain and, to a lesser extent, objectively measured functional ability during study participation. CONCLUSIONS Physical activity interventions resulted in moderate positive effects on physical activity behavior and small positive effects on pain and physical function outcomes. Future research should examine specific intervention characteristics that result in optimal results, such as frequency, type, and intensity of exercise.
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Affiliation(s)
- Vicki S Conn
- Professor of Nursing, University of Missouri, University of Missouri-Columbia, Columbia, St. Louis, MO 65211, USA.
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Gossec L, Pavy S, Pham T, Constantin A, Poiraudeau S, Combe B, Flipo RM, Goupille P, Le Loët X, Mariette X, Puéchal X, Wendling D, Schaeverbeke T, Sibilia J, Tebib J, Cantagrel A, Dougados M. Nonpharmacological treatments in early rheumatoid arthritis: clinical practice guidelines based on published evidence and expert opinion. Joint Bone Spine 2006; 73:396-402. [PMID: 16626995 DOI: 10.1016/j.jbspin.2006.01.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Accepted: 01/25/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To develop clinical practice guidelines for the use of nonpharmacological treatments in patients with early rheumatoid arthritis (RA), using the evidence-based approach and expert opinion. METHODS A scientific committee used a Delphi prioritization procedure to select five questions. Evidence providing answers to the five questions was sought in the literature and presented to a panel of rheumatologists. The panel developed five detailed recommendations, filling gaps in evidence with their expert opinion. The strength of each recommendation was determined. RESULTS Of the 565 publications retrieved by the literature review, 198 were included in the analysis. The five recommendations on nonpharmacological treatments for early RA were validated by a final vote among all participants. The recommendations are as follows: (1) physicians may decide to provide joint protection education to patients with potentially severe early RA, with the knowledge that structured joint protection programs have not been found effective; (2) physical exercise and sports can be recommended to patients with early RA; muscle strength exercises are advisable; (3) in patients with early RA, metatarsal pain and/or foot alignment abnormalities should be looked for regularly, and appropriate insoles should be prescribed if needed; (4) dietary measures and nutritional supplements are not indicated as part of the treatment of early RA; (5) elimination diets, particularly those with low intakes of dairy products, should be discouraged in patients with early RA. CONCLUSION These recommendations should help to improve practice uniformity and, ultimately, to improve the management of RA.
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Affiliation(s)
- Laure Gossec
- Service de rhumatologie B, CHU de Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
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Khanna D, Arnold EL, Pencharz JN, Grossman JM, Traina SB, Lal A, MacLean CH. Measuring Process of Arthritis Care: The Arthritis Foundation’s Quality Indicator Set for Rheumatoid Arthritis. Semin Arthritis Rheum 2006; 35:211-37. [PMID: 16461068 DOI: 10.1016/j.semarthrit.2005.08.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe the scientific evidence that supports each of the explicit process measures in the Arthritis Foundation's Quality Indicator Set for Rheumatoid Arthritis. METHODS For each of the 27 measures in the Arthritis Foundation's Quality Indicator set, a comprehensive literature review was performed for evidence that linked the process of care defined in the indicator with relevant clinical outcomes and to summarize practice guidelines relevant to the indicators. RESULTS Over 7500 titles were identified and reviewed. For each of the indicators the scientific evidence to support or refute the quality indicator was summarized. We found direct evidence that supported a process-outcome link for 15 of the indicators, an indirect link for 7 of the indicators, and no evidence to support or refute a link for 5. The processes of care described in the indicators for which no supporting/refuting data were found have been assumed to be so essential to care that clinical trails assessing their importance have not, and probably never will be, performed. The process of care described in all but 2 of the indicators is recommended in 1 or more practice guidelines. CONCLUSION There are sufficient scientific evidence and expert consensus to support the Arthritis Foundation's Quality Indicator Set for Rheumatoid Arthritis, which defines a minimal standard of care that can be used to assess health care quality for patients with rheumatoid arthritis.
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Affiliation(s)
- Dinesh Khanna
- Division of Immunology, University of Cincinnati and VAMC, OH, USA
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Sokka T, Hannonen P, Möttönen T. Conventional Disease-Modifying Antirheumatic Drugs in Early Arthritis. Rheum Dis Clin North Am 2005; 31:729-44. [PMID: 16287594 DOI: 10.1016/j.rdc.2005.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article reviews the use of conventional disease-modifying antirheumatic drugs (DMARDs) in the treatment of early rheumatoid arthritis (RA). The Finnish early RA cohorts are used as examples of how early and active treatment strategies have improved over time with increasing variety of available DMARDs. Therapy goals of early RA include remission to prevent severe long-term outcomes of RA. Remission can be achieved in a third of patients with early RA using a combination of conventional DMARDs, including methotrexate, sulfasalazine, hydroxychloroquine, and prednisolone. Of patients with early RA, 20% to 30% do not improve enough with conventional treatments and should be identified at early phases to consider institution of biologic agents.
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Affiliation(s)
- Tuulikki Sokka
- Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland
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