A group of 120 patients with rheumatoid arthritis or osteoarthritis volunteered to be subjects for this study of aerobic versus nonaerobic exercise. Patients were stratified by diagnosis and randomized into an exercise program of aerobic walking, aerobic aquatics, or nonaerobic range of motion (controls). The retention rate for the 12-week program was 83%. Exercise tolerance, disease-related measures, and self-reported health status were assessed. The aquatics and walking exercise groups showed significant improvement over the control group in aerobic capacity, 50-foot walking time, depression, anxiety, and physical activity after the 12-week exercise program. There were no significant betweengroup differences in the change scores for flexibility, number of clinically active joints, duration of morning stiffness, or grip strength. Our findings document the feasibility and efficacy of conditioning exercise for people who have rheumatoid arthritis or osteoarthritis.Physical inactivity is associated with increased risk for developing any of a number of degenerative and chronic conditions, the symptoms and findings of From the Departments of Medicine and Statistics, University of Missouri, Columbia.

Though simple and attractive, the role of hydration for the prophylaxis of contrast nephrotoxicity has not been definitively established. We prospectively evaluated the role of deliberate saline hydration in patients undergoing nonemergency cardiac catheterization. Patients (n = 53) were randomized on the day prior to scheduled catheterization to one of two groups – group 1 (n = 27) received normal saline for 24 h (at a rate of 1 ml/kg/h) beginning 12 h prior to scheduled catheterization, and group 2 (n = 26) were allowed unrestricted oral fluids. Serum creatinine measured 24 and 48 h postcardiac catheterization was compared to the pre-randomization baseline value. The mean baseline calculated creatinine clearance was 79.6 ± 31.9 ml/min and the mean baseline creatinine was 106 ± 28 µmol/l. An increase in serum creatinine by at least 44.2 µmol/l (0.5 mg/dl), within 48 h of contrast exposure, was considered to represent clinically significant acute renal insufficiency. Ten subjects (18.9%) developed acute renal insufficiency. The incidence of acute renal insufficiency was significantly lower in group 1 (1 out of 27) as compared to group 2 (9 out of 26; p = 0.005 for comparison between groups; relative risk 0.11, 95% confidence interval 0.015 to 0.79). Twenty-four hours after contrast exposure, the mean increase in creatinine was less in group 1 vs. group 2 (8 ± 11 vs. 20 ± 21 µmol/l, p = 0.02). The increase in creatinine was not significantly different in group 1 vs. group 2 48 h after contrast exposure (12 ± 21 vs. 29 ± 40 µmol/l, p = 0.17). Deliberate saline hydration decreases the incidence of contrast-related acute renal failure and the severity of contrast-induced renal dysfunction in patients undergoing non-emergency cardiac catheterization.

The optimal intervention for FMS would include nonpharmacological treatments, specifically exercise and cognitive-behavioral therapy, in addition to appropriate medication management as needed for sleep and pain symptoms.

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Objective. To examine the effects of stressmanagement training on clinical outcomes in persons with rheumatoid arthritis (RA). Methods.Patients with RA (n = 141) were randomly assigned to 1 of 3 groups: a stress management group, an attention control group, or a standard care control group. The stress management and the attention control groups received a 10-week intervention followed by an additional 15-month maintenance phase.Results. The stress management group showed statistically significant improvements on measures of helplessness, self-efficacy, coping, pain, and health status. Selected beneficial effects were still detectable at the 15-month followup evaluation.Conclusion. The data indicated that stress management interventions are capable of producing important clinical benefits for persons with RA.