Therapeutic exercise in rheumatoid arthritis

Abstract

Although about 80% of individuals with rheumatoid arthritis (RA) are functionally independent on any given occasion [1], substantial functional disability is often observed over time in the average patient [2]. One important goal in rehabilitation of individuals with RA is the prevention of functional decline, and therapeutic exercise is frequently used for this purpose. The target population for therapeutic exercise consists mainly of functionally independent persons with RA [3]. For these individuals, aerobic exercise seems superior to nonaerobic methods of exercise [4]. Likewise, dynamic exercise, requiring muscle work during joint motion, appears to be superior to static or isometric exercises [5].

Chronic Osteoarthritis and Adherence to Exercise: A Review of the Literature

“…Several authors currently agree on the importance of the role of cognitive beliefs, especially self-effi cacy beliefs, in the context of improving exercise adherence in those with osteoarthritis (Belza et al, 2002;Gecht, Connell, Sinacore, & Prochaska, 1996;Gyurcsik et al, 2003;Hughes et al, 2004; 06Marks (434) 444 9/14/05, 11:14:50 AM Jerome, Oliver & Cronan, 2002;Stenstrom, 1994). In earlier work, however, Sullivan et al (1998) concluded that interventions to promote selfeffi cacy and well-being among people with disabling osteoarthritis might require periodic booster sessions if initial positive effects are to be sustained.…”

A review of the history of hand exercises in rheumatoid arthritis

“…In tandem, the education of the patient in ways to protect and optimize use of the hand in everyday life, minimizing stresses on the small joints of the hand is also essential (Hammond and Lincoln, 1999). Additional aims may be to reduce pain, stiffness and swelling, to minimize deformity and guide the patient in maintaining a general level of physical fitness (Philips, 1989) as well as preventing general functional decline (Strenstrom, 1994a). Dellhag and Burckhardt (1995) investigated the relationship between joint range and both self-reported and actual hand function by studying 52 patients with RA.…”

Arthritis and exercise: The times they are a-changin'

“…Pumping iron and aerobic weight-bearing exercise performed by persons with arthritis are no longer radical notions. A number of events have led us to this point and challenge us to further explore exercise and physical fitness within the context of rheumatic disease processes and outcomes.Early reports that persons with arthritis were less fit than their nonaffected peers (3) have been followed by prospective trials demonstrating that persons with both systemic inflammatory disease and OA could participate in aerobic, conditioning exercise programs at levels of intensity sufficient to produce improvements in function, cardiovascular health, and fitness without aggravation of disease signs and symptoms (4,5 physical condition because of the disease itself; that the presence of rheumatic disease precluded meaningful exercise stress testing; that persons with arthritis could not safely participate in exercise vigorous enough to produce a training effect, and that weightbearing exercise was not appropriate for persons with lower extremity joint involvement.As a result of research reported over the past 20 years, we now know that persons with various forms of arthritis can: 1) undergo meaningful diagnostic and prescriptive exercise stress testing; 2) participate in regular conditioning exercise programs of moderate intensity, using exercise modes such as walking, aquatic exercise, stationary bicycle, low-impact aerobic dance, and resistance training; and 3) achieve clinically meaningful improvements in cardiovascular health and fitness, muscle strength and endurance, flexibility, function, and psychosocial status without injury or aggravation of disease.In addition to the general health and function benefits, cumulative experience with various modes of exercise in patients with various diagnoses is beginning to indicate that there may be differential effects of exercise. For persons with RA, range of motion exercise performed in the evening (6) and thrice-weekly aquatic aerobic routine both produced significant reductions in morning stiffness.…”

“…Early reports that persons with arthritis were less fit than their nonaffected peers (3) have been followed by prospective trials demonstrating that persons with both systemic inflammatory disease and OA could participate in aerobic, conditioning exercise programs at levels of intensity sufficient to produce improvements in function, cardiovascular health, and fitness without aggravation of disease signs and symptoms (4,5 physical condition because of the disease itself; that the presence of rheumatic disease precluded meaningful exercise stress testing; that persons with arthritis could not safely participate in exercise vigorous enough to produce a training effect, and that weightbearing exercise was not appropriate for persons with lower extremity joint involvement.…”

“…Early reports that persons with arthritis were less fit than their nonaffected peers (3) have been followed by prospective trials demonstrating that persons with both systemic inflammatory disease and OA could participate in aerobic, conditioning exercise programs at levels of intensity sufficient to produce improvements in function, cardiovascular health, and fitness without aggravation of disease signs and symptoms (4,5). These studies have been important for a number of reasons.…”