Long term high intensity exercise and damage of small joints in rheumatoid arthritis

Abstract

Objective: To investigate the effect of long term high intensity weightbearing exercises on radiological damage of the joints of the hands and feet in patients with rheumatoid arthritis (RA). Methods: Data of the 281 completers of a 2 year randomised controlled trial comparing the effects of usual care physical therapy (UC) with high intensity weightbearing exercises were analysed for the rate of radiological joint damage (Larsen score) of the hands and feet. Potential determinants of outcome were defined: disease activity, use of drugs, change in physical capacity and in bone mineral density, and attendance rate at exercise sessions. Results: After 2 years, the 136 participants in high intensity weightbearing exercises developed significantly less radiological damage than the 145 participants in UC. The mean (SD) increase in damage was 3.5 (7.9) in the exercise group and 5.7 (10.2) in the UC group, p = 0.045. Separate analysis of the damage to the hands and feet suggests that this difference in rate of increase of damage is more pronounced in the joints of the feet than in the hands. The rate of damage was independently associated with less disease activity, less frequent use of glucocorticoids, and with an improvement in aerobic fitness. Conclusion: The progression of radiological joint damage of the hands and feet in patients with RA is not increased by long term high intensity weightbearing exercises. These exercises may have a protective effect on the joints of the feet.

A systematic review of the effects of dynamic exercise in rheumatoid arthritis

“…It may be prudent to avoid sports and games involving twisting and rapid joint loading or unloading activities as described in the RAPIT programme [12][13][14] for patients with pre-existing large joint damage, pending further study. Exercise programmes should be individualised as much as possible taking into account individual patient and joint factors.…”

“…10,12,13,14 The mean difference in change in function as measured by the MACTAR score was significantly different and in favour of the exercise group at 12, 18 and 24 months (RAPIT 6.8% improvement v usual care 1.3% improvement, p=0.017 at 24 months). There was no significant difference in function as measured by the HAQ score.…”

“…Power calculations to determine sample size are only presented for the RAPIT study group of papers, [12][13][14] and for the two studies by Van den Ende et al 25,26 increasing the risk of statistical type two error in the other studies. Many of the papers included in this review present a large number of outcome variables.…”

The effect of rheumatoid arthritis and functional loading on the structure of the mandibular condyle in a transgenic mouse model: An FTIR study

“…[14][15][16] In addition, a number of studies have investigated the effects of functional loading, through physical exercise on bone structure alterations in particular within patients suffering from rheumatoid arthritis; available evidence from major joints (hip, spine) highlights the potential of long term, high intensity activity programs to decelerate mineral bone loss. 17,18 There is currently no evidence regarding the combined effect of functional loading and rheumatoid arthritis on the mandibular condyle.…”

Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation

“…Current evidence suggests that exercise does not appear to have a negative impact on the disease process and may in fact be beneficial, 68 including for the small joints of the hands and feet. 71 It should be noted that these studies were not specific to the hands; rather the hands were used during general upper limb exercise activity.…”