The Effects of Resistance Exercises on the Nitrogen, Phosphorus, and Calcium Metabolism of Patients With Rheumatoid Arthritis 12

Abstract

Muscle weakness and atrophy are common and disabling manifestations of rheumatoid arthritis for which various types of active exercises are usually prescribed. It is well known that active exercises result in substantial increases in muscle mass and power only when performed repeatedly against resistance with considerable physical effort (1). Although physical activity has been reported to have a protein-anabolic effect and cause calcium retention in normal subjects (2, 3), the metabolic responses to exhaustive physical exertion during active rheumatoid arthritis have not been investigated. These studies were undertaken to determine the effects of heavy resistance exercises on nitrogen, phosphorus, and calcium metabolism in patients experiencing exacerbations of this disease. Laboratory studies revealed a normal urine, a corrected sedimentation rate of 1.38 mm. per minute, and a hemoglobin of 12.5 grams per cent. Urinary 17-ketosteroids were 10.8 mg. in twenty-four hours.X-ray studies revealed minimal osteoporosis of the carpal bones and slight spur formation at the margins of the coronoid processes and olecranons. There was marked osteoporosis of the tarsals and metatarsals.2. J. W., a 47-year-old white male, developed rheumatoid arthritis three years before admission with swelling, aching, redness, and heat in the second and third metacarpophalangeal and mid-phalangeal joints of both hands, subsiding in three weeks. Nine months before admission, he developed pain and swelling in the left wrist. This pain subsided within three months but slight swelling remained. Two months before admission he developed pain and swelling in both ankles, the right large toe, right elbow, and left knee. During the two months before admission, he experienced marked fatigue and anorexia and lost twenty-seven pounds.His height was 178.7 cm., weight, 80 Kg., blood pressure, 125/70, and temperature 98.6°F. There was soft tissue swelling of the midphalangeal joints, wrists, left knee, and both ankles. A small effusion was present in the left knee. Motion was limited in the right hand, both wrists, right elbow, and both ankles.Laboratory studies revealed a normal urine, a corrected erythrocyte sedimentation rate of 1.55 mm. per minute, and a hemoglobin of 12.5 grams.X-ray studies revealed considerable osteoporosis of the ends of the long bones of both hands and narrowing of the joint spaces of the right fourth metacarpophalangeal joint and several interphalangeal joints. PROCEDUREThree balance studies were performed in accordance with methods described by Reifenstein, Albright, and Wells (4). Stools were collected in six-day periods and urines in three and six-day periods. Diets, urines, and stools 505

Metabolic Studies in Paralytic Acute Anterior Poliomyelitis. Ii. Alterations in Calcium and Phosphorus Metabolism 1

“…In other studies some influence of exertion on calcium excretion has been noted. Heavy resistance exercises reduced calcium loss in one of two patients with rheumatoid arthritis (51). A definite reductive influence of ambulation on excessive mineral loss was seen in the recovery phase of the immobilization study of normal men (2) in which ambulation was rapid, but in this study also return of calcium excretion to control levels was sluggish.…”

History of Strength Training Research in Man: An Inventory and Quantitative Overview of Studies Published in English Between 1894 and 1979

“…*Journals that published 1 strength training study were Acta Orthopaedica Scandinavica (47), Acta Paediatr Scand (105), Am J Phys Anthropol (353), Am J Sports Med (106), Am Phys Educ Rev (7), Am Pract Dig Treat (317), Aust J Physiother (340), Aviat Space Environ Med (126), BMJ (114), Bull Br Assoc Sport Med (343), Bull NY Acad Med (344), Electroencephalogr Clin Neurophysiol (243), Electromyography (63), Hum Biol (61), Hum Factors (337), Int J Aging Hum Develop (204), J Clin Invest (69), J Neurol Neurosurg Psychiatr (200), J Phys Educ Recr (354), Jap J Rehabil Med (2), Medical Arts and Sciences (83), Metabolism (38), Physical Educator (86), Physician and Sportsmedicine (77), Physiother Rev (169), Proc Hum Factors Soc Ann Meet (152), Psychol Rev (391), Rheumatol Rehabil (80), Science (168), and Studies from Yale Psychol Lab (324). †Some journals changed names throughout the era examined.…”

“…Three hundred thirty-nine strength training studies were published between 1894 and 1979 (1–4,7–19,22–45) (47–50,53–70,72–78) (80,82–92,94–107,110,111) (113–130,132–138,140–146) (149,150,152–157,159–170) (173–179,182,183,186–206,208) (210–233,235,237–244) (246–254,259–267) (271–280,282–288,295) (298–319,321–328) (330–359) (367–379,382) (383,385–394,396–399) (Figure 1). Three articles (0.9%) were published before 1940, 14 (4.1%) were published in the 1940s, 52 (15.3%) in the 1950s, 142 (41.9%) in the 1960s, and 128 (37.8%) in the 1970s.…”

“…Approximately, 1 in 5 articles included patient groups. Patient impairments included poliomyelitis (190,240,276,318,345), cerebral palsy (138), limb paralysis from stroke or spinal cord injury (105,121,160), low back pain (87,111), and joint and bone disabilities (69,77,80,90,94,95,174,(176)(177)(178)(179)312). Medical and rehabilitation journals, such as Archives of Physical Medicine and Rehabilitation, were common outlets for this research.…”

“…Future injury incidence 1 0.3 (24) Clinical symptoms 23 6.8 (69,90,91,94,95,103,104,111,137,169,173,194,195,200,253,261,275,312,317,342,371,398) Psychological outcome 13 3.8 (41,49,68,87,103,104,252,264,265,298,313,339,394) (199) reported 8 weeks of various types of strength training had no impact on ROM at the elbow, hip, and knee. Thus, this early era of research debunked the notion of "muscle boundness."…”