Exercise therapy for sarcopenia in rheumatoid arthritis: A meta-analysis and meta-regression of randomized controlled trials

Abstract

Objective: Rheumatoid arthritis and age are associated with high sarcopenia risk. Exercise is an effective treatment for preventing muscle mass loss in older adult populations. It remains unclear whether exercise affects muscle mass in people with rheumatoid arthritis. Thus, this meta-analysis investigated the effect of exercise on muscle mass gain in patients with rheumatoid arthritis. Data sources: PubMed, EMBASE, the Cochrane Library, the Physiotherapy Evidence Database (PEDro), the China Knowledge Resource Integrated Database, and Google Scholar were systematically searched until June 2021. Methods: The present study was conducted according to the guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Randomized controlled trials (RCTs) that reported the effects of exercise on muscle mass for rheumatoid arthritis were identified. The included RCTs were subject to meta-analysis and risk of bias assessment. Subgroup and random-effects meta-regression analyses were performed to identify any heterogeneity ( I2) of treatment effects across studies. Results: We included nine RCTs with a median PEDro score of 6/10 (range: 4/10–8/10). The weighted mean effect size for muscle mass was 0.77 (95% CI: 0.30–1.24; P = 0.001; I2 = 77%). Meta-regression analyses indicated that the disease duration significantly explained variance of treatment effects across studies (β = −0.006, R2 = 69.7%, P = 0.005). Conclusions: Exercise therapy effectively increased muscle mass in patients with rheumatoid arthritis. Treatment effects may be attenuated in those who have had rheumatoid arthritis for a relatively long time.

Efficacy of personalized exercise program on physical function in elderly patients with rheumatoid arthritis at high risk for sarcopenia: study protocol for a randomized controlled trial

“…To the best of our knowledge, this is the largest randomized controlled trial to examine the efficacy of a personalized exercise program on physical function in elderly patients with RA who are at a high risk for sarcopenia. Resistance training is considered as an effective exercise intervention to improve muscle strength and counteract muscle loss in RA [ 2 ]. Although the American College of Sports Medicine recommends that training loads corresponding to 60–70% of a repetition maximum are necessary to promote muscle strength and mass accrual [ 33 ], conventional high-load resistance training may not be feasible in all RA patients because of pain, fatigue, and joint limitations imposed by the disease [ 5 ].…”

“…Resistance training is effective and safe for reversing muscle atrophy in RA [ 2 ] whereas dietary protein supplementation and the combination with resistance exercise have shown an increase in muscle strength and physical performance in healthy elderly patients, but have not been completely examined in patients with RA [ 3 , 4 ]. However, some patients are unable to perform conventional high-load exercise programs because of disease-related limitations [ 5 ].…”

Non-pharmacological treatment in difficult-to-treat rheumatoid arthritis

“…Regarding mobilization and neural techniques in RA there are also some trials, mainly showing an effect on pain ( 23 , 24 ). As high load resistance training is not always feasible in active RA patients, low load or non-resistance training ( 25 ) or water-based exercises ( 26 , 27 ) appear to be good alternatives.…”

Evidence-based non-pharmacological treatment of inflammatory rheumatic diseases

“…i na kraju, nekoliko rečenica o nečemu što danas nije često spominjano u kontekstu nfl-a upalnih reumatskih bolesti, ali sama činjenica da u literaturi nalazimo sve više radova koji se bave problemom sarkopenije i upalnih reumatskih bolesti, poglavito ra, znak je da će o tome ubuduće biti mnogo više kvalitetnih radova (40,41). počelo je analizom sastava tijela u bolesnika s ra u Južnoafričkoj republici iz 2014. člankom lombarda i sur.…”

“…finally, we must discuss something that is rarely mentioned today in the context of npt of inflammatory rheumatic diseases. The very fact that in the literature we find an increasing number of papers dealing with the problem of sarcopenia and inflammatory rheumatic diseases, especially ra, is a sign that there will be many more quality papers on this topic in the future (40,41). it all started with an article authored by lombardo et al which was published in 2014, and which analysed the topic of body composition of ra patients in south africa (42).…”