Rheumatoid Arthritis/Osteoarthritis

Rheumatoid Arthritis/Osteoarthritis Exercise For Special Populations Richard Screnci, Fred Orchard, Chris Sanchez

Effects of Static and Dynamic Shoulder Rotator Exercises inWomen with Rheumatoid Arthritis • Authors- C. Bostrom, K. Harms-Ringdahl, H. Karreskog, R. Nordemar. • Scandinavian Journal of Rheumatology, 08/06/98, Vol. 27 Issue 4, p281-290.

Purpose • To compare static and dynamic shoulder rotator endurance in women with rheumatoid arthritis • See how training influences disability and handicap • Many studies only look at one type of exercise, do not compare the two

Methods • Subjects- looked for 63 women, age 20 or older, pain in shoulder region/functional limitations • Ended up with 45 participants, those who were younger declined to participate

Data Collection • 10 week program, measurements taken at beginning and after the program • Exercise 3 times a week using a pulley system, 30% 1 RM for shoulder internal and external rotation, 2 sets, 30 reps, 30 seconds rest • Static group-3 sec contraction, dynamic- 2 for concentric, 2 for eccentric

Results • Pain was not significant, but both groups experienced improvement in strength after 10 weeks • Dynamic group had greater gains in all variables • For all variables, from 10 to 20 weeks, minimal improvements

Results • Small population • Many participants only exercised 2 times a week • Static and dynamic both influence movements not stabilization • Overall, both static and dynamic influenced impairment of RA, but only dynamic impacted disabilities and handicap

Discussion • RA patients are not well suited for maximal endurance tests • The exercises were timed, 1 and 3 minute sessions. Pain and impairment did not vary largely during each • 4 seconds for dynamic group to simulate normal motions

Discussion • Regular exercise increases pain sensitivity, explains pain reduction • Swelling decreased to due increase in lymph fluid which decreases synovial fluid, more motion • Patient’s perceptions did not change due to still dealing with disease daily

Conclusion • Those with rheumatoid arthritis of the shoulders need to exercise regularly • Exercise decreases pain and swelling • Movements can be less painful and can cause less swelling • Exercising the shoulder three times a week of light resistance is beneficial

Investigation of Clinical Effects ofHigh- and Low-Resistance Training forPatients With Knee Osteoarthritis:A Randomized Controlled Trial • Authors- Mei-Hwa Jan, Jiu-Jeng Lin, Jiann-JongLiau, Yeong-Fwu Lin, Da-Hon Lin. • Physical Therapy; Apr2008, Vol. 88 Issue 4, p427-436.

Purpose • To compare high resistance and low resistance strength training in the elderly with knee osteoarthritis • Other studies show high intensity to be more beneficial for those suffering from the condition

Methods • 34 people per group, 3 groups, age 60 or older with osteoarthritis of the knee • High resistance group, low resistance group, and group who did not exercise • 10-60% 1 RM depending on which group patient was in • This was done due to previous studies that showed clients could not handle more than 80%

Methods • Used EN-Dynamic Track leg press machine • Repetitions were “until failure” • Tested in different positions including laying and seated • Exercise was stopped when client did not complete full range of motion or could not press the weight • Exercised 3 times a week for 8 weeks, 1 minute between sets • Every 2 weeks, 1 RM was tested

Methods • 10 minute cycling warm up • Clients were giving ice packs 10 minutes after exercise • Each session was 30 minutes long for high resistance groups, 50 for the low resistance • Subjects were asked to not do any other training during study

Results • The high resistance group experienced more improvements than the low resistance groups • There were not significant differences between the variables for either groups • Both experienced benefits from exercise • 70% 1 RM was the maximum for any subject

Results • Leg torque in knee extensors and flexors increased in all groups except for the control groups • Improvements in knee pain, functionality, speed, and strength • Both levels of resistance are advantageous to those suffering from the disease, but high resistance saw more gains

Discussion • Walking speed increase due to walking on uneven surfaces • Proprioception and balance were increased during study as well • Muscle weakness in those with knee OA is a symptom, weakness also makes patient vulnerable to joint displacement

Conclusion • Those with knee osteoarthritis can benefit from exercise, high and low resistance • Agility, balance, and proprioception should be incorporated into the exercise program • Time limitations must be considered when exercising • The differences in gains were not significant • 3 times a week, 30-50 minutes, up to 70% 1 RM

Effects of a Group-Based Exercise and Educational Program on Physical Performance and Disease Self- Management in Rheumatoid Arthritis: A Randomized Controlled Study • Authors: Martha Liejsma, Nienke P. Varheij-Jansen, Ellen van Weert • Physical Therapy; June 2011, Vol. 91, Issue 6, pg. 879-893

Purpose • To evaluate the effects of a group-based exercise and educational program on the physical performance and disease self-management of people with RA

Methods • 34 participants diagnosed with RA. Participants were randomly assigned to intervention group (19) or waiting list control group (15) • 8 week study consisting of physical exercise designed to increase aerobic capacity and muscle strength along with an educational program to improve health status and self-efficacy for RA self-management

Methods • Physical exercise conducted in group sessions and consisted of muscle exercise circuits, bicycle training, and various sports • Total amount of time spent exercising for each participant = 3 hours per week • VO2 max, muscular strength at knee and elbow flexors and extensors, health status, and self efficacy measured prior to study, immediately after study, and 13 weeks after study

Results • The intervention group showed significant improvement (12.1%) in VO2 max at week 9 compared with the control group (-1.7%) • Significant within-group changes were found over time for muscle strength of the upper and lower extremities and health status that favored the intervention group, however no between-group changes were found regarding these outcomes

Discussion • Although the control group showed no changes in VO2 max, upper and lower extremity muscle strength, or perceived health, the intervention group showed improvements in all these areas • Intervention group also showed small improvement in psychological health, self efficacy function, and handling pain • The relatively small amount of participants in study may have resulted in lack of statistical power

Conclusion • The present group-based exercise and educational program for people with RA had a beneficial effect on aerobic capacity but not on muscle strength, health status, or self-efficacy • This program had no negative impacts on disease activity

Is a Long-Term High-Intensity Exercise Program Effective and Safe in Patients with Rheumatoid Arthritis Zuzanade Jong, Marten Munneke, Aeilko H. Zwinderman, Herman M. Kroon, Annemarie Jansen, Karel H. Ronday, Dirkjan van Schaardenburg, Ben A. C. Dijkmans, Cornelia H. M. Van den Ende, Ferdinand C. Breedveld, Theodora P. M. VlietVlieland, and Johanna M. W. Hazes ARTHRITIS AND RHEUMATISM Vol. 48, No. 9, September 2003, pp 2415-2424

Purpose • Compare the effectiveness and safety of a 2-year intensive exercise program with those of typical physical therapy

Methods • 309 RA patients were assigned to either the RAPIT (Rheumatoid Arthritis Patients in Training) or the UC (Usual Care) programs • At the end of the 2-year program each patient had their functional ability tested and the effects on radiographic progression in large joints • Also assessed each patients emotional status and disease activity at the conclusion of the 2-year period

Results • After 2 years, the patients that participated in the RAPIT program showed greater improvement in functional ability than participants in the UC program • The radiographic damage of the large joints did not increase in either program over this period • In both groups, patients with considerable baseline damage upon entering the program showed slightly more progression in damage • The RAPIT program showed to be effective in improving emotional status, while there were no signs of detrimental effects on disease activity

Discussion • Patients in the RAPIT group showed a steep improvement in physical capacity during the first year of the program, followed by a more level rate of improvement in the second year • Results showed that participating in a long-term high-intensity exercise program decreases the amount of psychological stress in RA patients • The high rate of participation and low withdrawal rate suggests that participants in the RAPIT group perceived benefits from the program

Conclusion • A high-intensity exercise program has a greater effect on improving functional ability of RA patients than usual physical therapy • Intense exercise does not increase radiographic damage in large joints, except possibly in patients with considerable damage of the large joints

Effect of Intensive Exercise on Patients with Active Rheumatoid Arthritis: a randomized clinical trial C.H.M. van den Ende, F.C. Breedveld, S. le Cessie, B.A.C. Dijkmans, A.W. de Mug, J.M.W. Hazes BMJ Group Volume 59, February 9, 2000 Pages 615-621

Purpose • To study the effects of a dynamic, intense exercise program on pain, disease activity, and physical functioning in patients with active Rheumatoid Arthritis

Methods • 64 patients with RA with an average age of 60 and an average disease duration of 8 years were randomly assigned to either an intense exercise program or a conservative exercise program that lasted for 30 days • Intense exercise program consisted of strengthening exercises against resistance for the muscles involved in the functioning of the knee and shoulder joints five times a week. Also, included conditioning on a stationary bike three times a week • The conservative program consisted of range of motion and isometric exercises • Disease activity, pain, muscular strength and functional ability were assessed at 0, 3, 6, 12, and 24 weeks following completion of the program

Results • Physical functioning significantly improved for patients in the intense exercise group compared to the conservative group • Muscular strength also improved significantly in the intense group compared to the conservative group • No significant differences between groups when comparing disease activity

Discussion • Patients that participated in an intense program showed significant improvement in functional ability and muscular strength up to six months upon completion of program • Improved muscular function in the muscles stabilizing the joint has a positive effect on joint inflammation • Evidence that intermittent cycles of intra-articular pressure rise during intense exercise might increase the synovial blood flow and have a benefit on joint inflammation

Conclusion • A short term intense exercise program for RA patients is more effective in improving functional ability and muscular strength then a conservative program • A intense exercise program does not have any affect on disease activity

Overall Conclusion • Regular exercise is beneficial to those with OA and/or RA • Benefits obtained from low and high resistance training, as well as aerobic exercise • If done properly, exercise has little to no negative effects on disease activity • Exercise can decrease pain sensitivity in RA/OA patients, increase functional capability, and have positive effects on joint inflammation due to improved muscular function

Rheumatoid Arthritis/Osteoarthritis