Slowing of bone loss in patients with rheumatoid arthritis by long‐term high‐intensity exercise: Results of a randomized, controlled trial

Abstract

Objective. Patients with rheumatoid arthritis (RA) are more at risk for the development of osteoporosis and osteoporotic fractures than are their healthy peers. In this randomized, controlled, multicenter trial, the effectiveness of a 2-year high-intensity weight-bearing exercise program (the RheumatoidArthritis-Patients-In-Training [RAPIT] program) on bone mineral density (BMD) was compared with usual care physical therapy, and the exercise modalities associated with changes in BMD were determined.Methods. Three hundred nine patients with RA were assigned to an intervention group, either the RAPIT program or usual care physical therapy. The primary end points were BMD of the hip and spine. The exercise modalities examined were aerobic fitness, muscle strength, and, as a surrogate for those effects not directly measured by the RAPIT program, attendance rate.Results. The data on the 136 RAPIT participants and 145 usual care participants who completed the study were analyzed. The mean rate of decrease in hip BMD, but not in lumbar spine BMD, was smaller in patients participating in the RAPIT program when compared with that in the usual care group, with a mean decrease of 1.6% (95% confidence interval [95% CI] 0.8-2.5) over the first year and 0.5% (95% CI 1.1-2.0) over the second year. The change in hip BMD was significantly and independently associated with changes in both muscle strength (multivariate odds ratio [OR] 1.75, 95% CI 1.07-2.86) and aerobic fitness (OR 1.79, 95% CI 1.10-2.90), but not with the attendance rate (OR 1.00, 95% CI 0.99-1.00).Conclusion. A long-term high-intensity weightbearing exercise program for RA patients is effective in slowing down the loss of BMD at the hip. The exercise modalities associated with this effect are muscle strength and aerobic fitness.

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

“…13 There was a non-significant trend to less bone loss at the hip in the RAPIT group versus usual care (-1.1% versus -1.9%, p=0.06), and no difference between the groups for bone density in the spine (+0.9% versus +0.9%, p=0.697). However when analysed by mixed-effect ANOVA, the mean between-group difference in change of hip BMD over the 2 years was statistically significant (p=0.026) in favour of the RAPIT group.…”

“…Some studies also reported improvements in disease activity measures 15,19,20,25 , and small improvements in hip bone mineral density. 13,16 One study reported significantly less progression of small joint radiographic damage of the feet in the dynamic exercise group.…”

“…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.…”

Consenso 2012 da Sociedade Brasileira de Reumatologia sobre o manejo de comorbidades em pacientes com artrite reumatoide

“…Beginning physical activity can also reduce the risk of osteopenia and bone mass loss. [111][112][113] Brazilian guidelines for assessment, prevention and treatment of osteoporosis in patients with RA are urgently needed. In the initial assessment, bone densitometry should be indicated for all patients over the age of 50 years.…”