Maximal strength training in patients with inflammatory rheumatic disease: implications for physical function and quality of life

Abstract

Purpose Patients with inflammatory rheumatic disease (IRD) have attenuated muscle strength in the lower extremities, resulting in impaired physical function and quality of life. Although maximal strength training (MST), applying heavy resistance, is documented to be a potent countermeasure for such attenuation, it is uncertain if it is feasible in IRD given the pain, stiffness, and joint swelling that characterize the population. Methods 23 patients with IRD (49 ± 13 years; 20 females/3 males), diagnosed with spondyloarthritis, rheumatoid arthritis, or systemic lupus erythematosus, were randomized to MST or a control group (CG). The MST group performed four × four repetitions dynamic leg press two times per week for 10 weeks at ~ 90% of one repetition maximum (1RM). Before and after training 1RM, rate of force development (RFD), and health-related quality of life (HRQoL) were measured. Results Session attendance in the MST group was 95%, of which 95% conducted according to MST protocol. Furthermore, MST increased 1RM (29 ± 12%, p = 0.001) and early and late phase RFD (33–76%, p < 0.05). All improvements were different from the CG (p < 0.05). MST also resulted in HRQoL improvements in the dimensions; physical functioning, general health, and vitality (p < 0.05). Physical functioning was associated with 1RM (rho = 0.55, p < 0.01) and early phase RFD (rho = 0.53–0.71, p < 0.01; different from CG p < 0.05). Conclusions Despite being characterized by pain, stiffness, and joint swelling, patients with IRD appear to tolerate MST well. Given the improvements in 1RM, RFD, and HRQoL MST should be considered as a treatment strategy to counteract attenuated muscle strength, physical function, and HRQoL. Trial registration: ClinicalTrials.gov, NCT04998955, retrospectively registered.

Effects of a self‐determination theory‐based physical activity programme for postmenopausal women with rheumatoid arthritis: A randomized controlled trial

“…This study's 16‐week SDT‐based physical activity programme showed that the intervention group improved more in psychosocial aspects than the control group, specifically regarding the HRQoL and physical indicators. This finding is consistent with a previous RCT that investigated the effects of maximal strength training in patients with inflammatory rheumatic diseases (Haglo et al, 2022), showing that the intervention significantly improved the participants' physical functioning as well as HRQoL. Perceived change in the quality of life is an important factor in maintaining the physical activity of a health intervention (Salemonsen et al, 2018); thus, future physical activity intervention studies must incorporate methods for improving psychosocial factors as well as promoting physical activity in individuals with RA.…”

“…This study's 16-week SDT-based physical activity programme showed that the intervention group improved more in psychosocial aspects than the control group, specifically regarding the HRQoL and physical indicators. This finding is consistent with a previous RCT that investigated the effects of maximal strength training in patients with inflammatory rheumatic diseases (Haglo et al, 2022), showing that the intervention significantly improved the participants' physical T A B L E 3 Group-by-time effects of the programme using repeated measures analysis of variance. (Fenton et al, 2021).…”

Aerobic high‐intensity interval training and maximal strength training in patients with unspecific musculoskeletal disorders improve V̇O2peak and maximal strength more than moderate training

“…This is in accordance with our hypothesis and several studies describing their experimental group as "high-intensity" (Cerini et al, 2022;Verbrugghe et al, 2019). In fact, recent studies in patients with inflammatory rheumatic disease, which, in a similar fashion to the current study population, are characterized by pain and stiffness, also reported that high-intensity training was feasible (Haglo et al, 2021(Haglo et al, , 2022. These observations contrast a recent meta-analysis that reported an increased dropout from highintensity compared to lower-intensity exercise in patients with fibromyalgia (Vancampfort et al, 2023)…”

“…The strength training in the horizontal leg press consisted of 4 sets of 4 repetitions at ∼90% of 1RM and is referred to as maximal strength training; MST. Emphasis was placed on maximal intended velocity and mobilization in the concentric phase (Behm et al., 1993), and the eccentric phase was performed with relatively slow velocity to minimize eccentric forces (Haglo et al., 2022). When a patient was able to conduct more than four repetitions in the last set, the load was increased by 4.5 kg in the following session.…”

“…Similarly, maximal strength training (MST), carried out as few repetitions with heavy loads at ∼90% of 1 repetition maximum (1RM), with maximal intended velocity in the concentric phase, is shown to induce greater increases in maximal strength compared to conventional strength training at low or moderate intensity (∼70% of 1RM) in healthy (Heggelund et al., 2013) and diseased individuals, for example, peripheral arterial disease (Wang et al., 2010), schizophrenia (Nygård et al., 2021), and Parkinson's disease (Helgerud et al., 2020). In addition to being crucial for primary prevention of lifestyle‐related diseases (Booth et al., 2012), aerobic power and muscle strength are often positively associated with self‐reported quality of life (Haglo et al., 2022; Oscar García López et al., 2016), suggesting that these factors are of both objective and subjective importance for most patient populations.…”