Exercise In Rheumatoid Arthritis Research Articles

Prescribing hand strengthening exercise for patients with rheumatoid arthritis; clinical cues influencing occupational therapists' and physiotherapists' judgements.

To explore the clinical judgements of therapists in prescribing the intensity of hand strengthening exercise in rheumatoid arthritis (RA). Phase I: Eleven therapists knowledgeable in treating patients with RA subjectively identified seven clinical cues. These were incorporated into 54 hypothetical patient case scenarios. Therapists with ≥2years post-registration experience and current or recent experience in treating patients with RA were asked to assess 69 case scenarios in total (54+15 repeats) and judge what intensity of hand strengthening exercise they would prescribe using the OMNI-Resistance Exercise Scale of perceived exertion. Using responses to the repeated cases, the Cochran-Weiss-Shanteau index of expertise was used to identify therapists who prescribed more consistently. Multiple regression was used to determine which clinical cues were most strongly associated with the intensity of exercise prescribed. A sub-group analysis explored differences between consistent and inconsistent prescribers. Fifty-three therapists took part. Thirty completed all 69 case scenarios. Across all therapists, the three most important clinical cues associated with lower intensity of exercise prescribed were (1) Patient's reported pain intensity whilst practising the exercise (β=-1.150, p<0.001), (2) Disease activity (β=-0.425, p<0.001) and (3) average hand pain over the last week (β=-0.353 p<0.001). Twelve therapists were categorised as consistent prescribers. This group relied on fewer clinical cues (three vs. seven) when judging what intensity of exercise to prescribe. This study provides insights into how therapists prescribe hand exercises. Intensity of hand strengthening exercise was influenced by three key clinical cues, including pain intensity and disease activity.

Effect of resistance exercise on serum leptin levels in a prospective longitudinal study of women patients with rheumatoid arthritis

BackgroundExercise has an anti-inflammatory effect and reduces fat mass. Leptin has been known to be proinflammatory adipokines mainly produced by adipocytes. However, few studies have investigated the association between exercise and changes in serum leptin levels of patients with RA. This study evaluated the effect of an individualized resistance exercise on inflammatory markers including leptin as well as muscle strength and exercise capacity in patients with rheumatoid arthritis (RA).MethodsA total of 42 age- and sex-matched participants were assigned to a resistance exercise program (60 min, once a week for 12 weeks, and self-exercise twice a week) or to a control group. Muscle strength, exercise capacities, and inflammatory markers such as cytokines and adipokines were assessed at baseline and at 12 weeks follow-up. Longitudinal changes in muscle strength, exercise capacity, cytokines, and adipokines between groups were tested with repeated measures analysis of variance or using the generalized estimating equation, with adjustment for baseline disease activity score 28-C response protein as a covariate.ResultsA total of 37 of 42 female patients with RA completed this prospective intervention study. Grip strength improved significantly in the exercise group (P < 0.05), while no between-group changes were found. Quadriceps contraction power (P for group-time interaction = 0.035 for the right side and P for group-time interaction = 0.012 for the left side) and 6-minute walking distance (P for group-time interaction = 0.021) were all improved significantly in the exercise group compared with the control group. In addition, serum leptin levels were significantly decreased in the exercise group compared with the control group (P for group-time interaction = 5.22 × 10−5), but not the other cytokines or adipokines. The change in serum leptin levels correlated with the changes in fat mass (Rho = 0.491, P= 0.015) and visceral fat area (Rho = 0.501, P= 0.013).ConclusionIn addition to muscle strength and exercise capacity, the 12 weeks of individualized resistance exercise reduced serum leptin levels in keeping with body fat mass or visceral fat area, suggesting that serum leptin levels might be a surrogate marker of exercise in RA.

Where's the evidence? A systematic review exploring the evidence underpinning exercise dose in clinical trials of rheumatoid arthritis

Purpose: Selecting what dose to prescribe is an essential step in the development of clinical trials evaluating exercise-based interventions. Therefore, we aimed to evaluate the evidence reported to underpin exercise dose in randomised controlled trials (RCTs) using strengthening exercise in rheumatoid arthritis.

Effectiveness of resistance exercises in the treatment of rheumatoid arthritis: A meta-analysis.

Background:We aimed to assess the efficacy of resistance exercise in rheumatoid arthritis (RA) in randomized controlled trials (RCTs).Method:PubMed, the Cochrane Library, and Embase were searched according to the index words to identify eligible RCTs, and relevant literature sources were also searched. The latest search was done in August 2019. Odds ratios (OR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze the main outcomes.Result:Seventeen RCTs were included in the meta-analysis with 512 patients in the resistance exercise group and 498 patients in the control group. The results showed that compared with the control group, resistance exercise significantly decreased disease activity score in 28 joints (DAS-28) scores (standard mean difference [SMD]: –0.69, 95% CI: –1.26 to –0.11), reduced erythrocyte sedimentation rate (ESR) (SMD: –0.86, 95% CI: –1.65 to –0.07), and shortened the time of 50 ft. walking (SMD: –0.64, 95% CI: –0.99 to –0.28). No significant difference was observed in visual analog scale (VAS) scores (SMD: –0.61, 95% CI: –1.49–0.27) and health assessment questionnaire (HAQ) scores (weighted mean difference: –0.10, 95% CI: –0.26–0.06).Conclusion:Resistance exercise showed reducing DAS-28 score, ESR score, and the time of 50 ft. walking in RA patients compared with the control group. However, high quality multicenter RCTs with larger sample sizes to confirm the conclusion.

Autonomous motivation, cardiorespiratory fitness, and exercise in rheumatoid arthritis: Randomised controlled trial

ObjectiveRheumatoid arthritis (RA) is an autoimmune disease, characterised by high-grade systemic inflammation, pain, and swollen joints. RA patients have an increased risk for cardiovascular disease (CVD). This study examined if a 3-month individualised RA-tailored exercise programme with one-on-one Self-Determination Theory (SDT)-based support for physical activity (PA) facilitated autonomous motivation, increased PA behaviour, and induced greater improvements in cardiovascular and RA-related disease characteristics, and wellbeing in RA, compared to a standard provision tailored exercise programme. Methods115 RA patients were randomised into either the SDT-based psychological intervention + exercise programme (experimental group) or an exercise programme only (control group). Cardiorespiratory fitness (primary outcome), self-reported PA, disease characteristics, CVD risk, wellbeing, and SDT constructs were assessed at baseline (pre-intervention), 3 months (post-intervention), 6 months, and 12 months follow-up. Mixed linear modeling was used to examine within- and between participant changes in these outcome measures. ResultsIn 88 patients with complete baseline data, cardiorespiratory fitness did not change from baseline to 3-, 6- or 12 months in either group. CVD risk, disease characteristics, wellbeing, and need satisfaction did not change, with the exception of diastolic blood pressure. Significant group by time interaction effects were found for functional ability (6- & 12-months), CVD risk (6-months) and PA (3-months). Autonomous motivation increased and controlled motivation decreased more in the experimental group compared to the control group at 3 months. ConclusionsDespite improving quality of motivation for exercise, no changes in cardiorespiratory fitness or other psychological and physiological health outcomes were found. This suggests more intensive support is needed when initiating an exercise programme to achieve health benefits in RA.

Increased sympathetic and haemodynamic responses to exercise and muscle metaboreflex activation in post-menopausal women with rheumatoid arthritis.

Rheumatoid arthritis (RA) patients present exacerbated blood pressure responses to exercise, but little is known regarding the underlying mechanisms involved. This study assessed autonomic and haemodynamic responses to exercise and to the isolated activation of muscle metaboreflex in post-menopausal women with RA. Participants with RA showed augmented pressor and sympathetic responses to exercise and to the activation of muscle metaboreflex. These responses were associated with multiple pro- and anti-inflammatory cytokines and with pain. The results of the present study support the suggestion that an abnormal reflex control of circulation is an important mechanism underlying the exacerbated cardiovascular response to exercise and increased cardiovascular risk in RA. Studies have reported abnormal cardiovascular responses to exercise in rheumatoid arthritis (RA) patients, but little is known regarding the underlying mechanisms involved. This study assessed haemodynamic and sympathetic responses to exercise and to the isolated activation of muscle metaboreflex in women diagnosed with RA. Thirty-three post-menopausal women diagnosed with RA and 10 matched controls (CON) participated in this study. Mean arterial pressure (MAP), heart rate (HR) and muscle sympathetic nerve activity (MSNA frequency and incidence) were measured during a protocol of isometric knee extension exercise (3min, 30% of maximal voluntary contraction), followed by post-exercise ischaemia (PEI). Participants with RA showed greater increases in MAP and MSNA during exercise and PEI than CON (ΔMAPexercise =16±11 vs. 9±6mmHg, P=0.03; ΔMAPPEI =15±10 vs. 5±5mmHg, P=0.001; ΔMSNAexercise =17±14 vs. 7±9burstsmin-1 , P=0.04; ΔMSNAPEI =14±10 vs. 6±4burstsmin-1 , P=0.04). Autonomic responses to exercise showed significant (P<0.05) association with pro- (i.e. IFN-γ, IL-8, MCP-1 and TNFα) and anti-inflammatory (i.e. IL-1ra and IL-10) cytokines and with pain. In conclusion, post-menopausal women with RA showed augmented pressor and sympathetic responses to exercise and to the activation of muscle metaboreflex. These findings provide mechanistic insights that may explain the abnormal cardiovascular responses to exercise in RA.

Physical activity, exercise and rheumatoid arthritis: Effectiveness, mechanisms and implementation.

Rheumatoid arthritis (RA) is characterised by functional disability, pain, fatigue and body composition alterations that can further impact on the physical dysfunction seen in RA. RA is also associated with systemic manifestations, most notably an increased risk for cardiovascular disease. There is strong evidence to suggest that increasing physical activity and/or exercise can simultaneously improve symptoms and reduce the impact of systemic manifestations in RA. However, implementation of interventions to facilitate increased physical activity and/or exercise within routine clinical practice is slow because of not only patient-specific and healthcare professional-related barriers but also lack of relevant infrastructure and provision. We review the evidence supporting the physiological adaptations and beneficial effects occurring as a result of increased physical activity and/or exercise in RA and propose an implementation model for facilitating the long-term engagement of patients with RA. We propose that implementation should be led, in a pragmatic manner, by rheumatology healthcare practitioners and supported by social innovation.

Commentary: Rheumatoid Cachexia Revisited: A Metabolic Co-morbidity in Rheumatoid Arthritis.

The “mini review” by Masuko (1) contains a quite extensive summary of “rheumatoid cachexia” (2) [i.e., loss of muscle mass in rheumatoid arthritis (RA)], an often overlooked and misdiagnosed co-morbidity. Masuko looks at the definition of “rheumatoid cachexia,” as well as the pathogenesis of the condition referring to the key role of pro-inflammatory cytokines. Interestingly, various strategic therapy options designed to attenuate rheumatoid cachexia by disease-modifying anti-rheumatic drugs (DMARDS), anti-cytokine therapies, and exercise training (i.e., resistance and endurance) are covered. However, what the review fails to mention or expand upon, is the relative ineffectiveness of exercise on “rheumatoid cachexia” once supervision is withdraw. The review also neglects to discuss (despite referencing a relevant trial) another potential key tool in the armory against “rheumatoid cachexia”: nutritional supplementation. This commentary will confine itself to briefly recounting some of these. As Masuko states that resistance training is the most beneficial means to increase both lean mass and physical function in RA. Both Marcora et al. (3) and Lemmey et al. (4) showed that progressive resistance training (PRT) for a period of 12 and 24 weeks (exercising two and three times per week, respectively) was able to attenuate the effects of rheumatoid cachexia, specifically increasing lean mass, strength, and physical function in patients with RA. However, a follow-up study for 3 years later by Lemmey et al. (5) found that once supervision was withdrawn, no subjects from the original study (4) were performing relevant PRT or any other form of regular high intense exercise and, as a result, lean mass had regressed to baseline levels, as had much of the trunk fat mass and body fat percentage. Lack of adherence to high-intense exercise in RA has been demonstrated by others (6). Unfortunately, it seems habitually performed, high-intensity exercise (i.e., PRT) is unlikely to be widely adopted as a general treatment strategy for reversing “rheumatoid cachexia” and restoring function, then the challenge to develop a treatment option that is easily administered, inexpensive, and makes limited demands of the patient remains. Anabolic nutritional supplementation offers a potential treatment option that is easily administered, inexpensive, and makes limited demands of the patient. Scientific evidence continues to suggest that nutrition should be part of routine care in those with muscle wasting disorders [for review, see Stamp et al. (7)]. Specifically, up to 75% of RA patients believe that food and nutrition play an important role in their symptom severity, with 50% of RA patients reportedly trying some form of dietary manipulation in an attempt to attenuate symptomology (7). Marcora et al. (8) previously investigated the effects of daily 12 weeks of a mixture of β-hydroxy-β-methylbutyrate, glutamine, and arginine (HMB/GLN/ARG) protein supplementation in 40 RA patients. The results showed that both HMB/GLN/ARG and a control mixture of other non-essential amino acids (alanine, glutamic acid, glycine, and serine) were both equally effective in increasing lean mass (~0.4 kg) and improving some measures of physical function and strength. Creatine monohydrate, a combination of essential amino acids, has generally been shown to be more effective in increasing lean mass and physical performance than other protein-based supplements, including HMB/GLN/ARG [for review, see Nissen (9)]. In the only study investigating the use of creatine in RA, Willer et al. (10) found that creatine supplementation increased muscle strength in 8 out of the 12 patients by an average of 14% as determined by the muscle strength index, although this increase in strength was not actually associated with changes of creatine (or phosphocreatine) levels in the muscle. Nonetheless, creatine has been shown to be effective, without additional exercise training, in range of clinical populations, including muscular dystrophy patients and the elderly who, like RA patients, present with reduced muscle mass and impaired physical function [for review, see Wilkinson et al. (11)]. Evidently, more research is needed, and as such we have just completed a randomized control trial investigating the effects of creatine in RA patients (manuscript in preparation). To summarize, although PRT exercise is arguably the most effective way to attenuate the effects of rheumatoid cachexia, due to its high-intense nature, it is unlikely to be widely adopted as a general treatment strategy. Nutritional supplementation, specifically those that focus on muscle anabolism may be a viable option. Alongside, HMB/GLN/ARG protein supplementation, creatine monohydrate may be a potential therapeutic option in RA, as it has been effective in range of clinical and elderly populations.

Perceived Barriers, Facilitators and Benefits for Regular Physical Activity and Exercise in Patients with Rheumatoid Arthritis: A Review of the Literature.

Rheumatoid arthritis (RA) is an autoimmune disease, which not only affects the joints but can also impact on general well-being and risk for cardiovascular disease. Regular physical activity and exercise in patients with RA have numerous health benefits. Nevertheless, the majority of patients with RA are physically inactive. This indicates that people with RA might experience additional or more severe barriers to physical activity or exercise than the general population. This narrative review provides an overview of perceived barriers, benefits and facilitators of physical activity and exercise in RA. Databases were searched for articles published until September 2014 using the terms ‘rheumatoid arthritis’, ‘physical activity’, ‘exercise’, ‘barriers’, ‘facilitators’, ‘benefits’, ‘motivation’, ‘motivators’ and ‘enablers’. Similarities were found between disease-specific barriers and benefits of physical activity and exercise, e.g. pain and fatigue are frequently mentioned as barriers, but reductions in pain and fatigue are perceived benefits of physical activity and exercise. Even though exercise does not influence the existence of barriers, physically active patients appear to be more capable of overcoming them. Therefore, exercise programmes should enhance self-efficacy for exercise in order to achieve long-term physical activity and exercise behaviour. Encouragement from health professionals and friends/family are facilitators for physical activity and exercise. There is a need for interventions that support RA patients in overcoming barriers to physical activity and exercise and help sustain this important health behaviour.

THU0466-HPR Maintenance of physical activity in patients with rheumatoid arthritis: A qualitative interview study

BackgroundSeveral exercise trials indicate that physical activity (PA) may improve physical function and quality of life, and reduce pain in patients with rheumatoid arthritis (RA).1,2 Few of these studies have...

AB0212 A study to determine the relationship between fatigue, physical activity and sitting time in patients with inflammatory arthritis.

BackgroundFatigue is a common and debilitating symptom in inflammatory arthritis. Higher levels of physical activity are associated with better general health status and with better outcomes in inflammatory arthritis [1].ObjectivesOur...

OP0197 Many patients with rheumatoid arthritis remain physically inactive

BackgroundPhysical inactivity is a major recognized public health challenge. Rheumatoid arthritis (RA) limits physical function, and physical inactivity may contribute to the increased risk of cardiovascular disease in patients with...

Benefits of Exercise in Rheumatoid Arthritis

This paper aims to highlight the importance of exercise in patients with rheumatoid arthritis (RA) and to demonstrate the multitude of beneficial effects that properly designed exercise training has in this population. RA is a chronic, systemic, autoimmune disease characterised by decrements to joint health including joint pain and inflammation, fatigue, increased incidence and progression of cardiovascular disease, and accelerated loss of muscle mass, that is, “rheumatoid cachexia”. These factors contribute to functional limitation, disability, comorbidities, and reduced quality of life. Exercise training for RA patients has been shown to be efficacious in reversing cachexia and substantially improving function without exacerbating disease activity and is likely to reduce cardiovascular risk. Thus, all RA patients should be encouraged to include aerobic and resistance exercise training as part of routine care. Understanding the perceptions of RA patients and health professionals to exercise is key to patients initiating and adhering to effective exercise training.

Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: Meta‐analysis of randomized controlled trials

Several lines of evidence have emphasized an improvement in aerobic capacity and muscle strength after physical exercise programs in rheumatoid arthritis (RA) patients. Our objective was to evaluate the efficacy of aerobic exercises in RA on quality of life, function, and clinical and radiologic outcomes by a systematic literature review and a meta-analysis. A systematic literature search was performed in the Medline, EMBase, and Cochrane databases up to July 2009 and in the abstracts presented at rheumatology scientific meetings during the last 5 years. Randomized controlled trials (RCTs) comparing aerobic exercises with non-aerobic interventions in RA patients were included. Outcomes studied were postintervention quality of life, function assessed by the Health Assessment Questionnaire (HAQ), a pain visual analog scale (VAS), joint count, the Disease Activity Score in 28 joints (DAS28), and radiologic damage. Efficacy was assessed by standardized mean differences (SMDs; difference between groups of mean outcome variation from baseline/SD at baseline) of aerobic exercises versus non-aerobic rehabilitation. Heterogeneity was tested. SMDs were pooled by a meta-analysis using the inverse of variance model. Fourteen RCTs, including 1,040 patients, met the inclusion criteria. Exercise improved the postintervention quality of life (SMD 0.39, P < 0.0001), HAQ score (SMD 0.24, P = 0.0009), and pain VAS (SMD 0.31, P = 0.02). Exercise in this RA population appeared safe, since global compliance, DAS28, and joint count were similar in both groups. Cardiorespiratory aerobic conditioning in stable RA appears to be safe and improves some of the most important outcome measures. However, the degree of the effect of aerobic exercise on the abovementioned parameters is small.

A systematic review of the effects of dynamic exercise in rheumatoid arthritis

Exercise is commonly used in the management of patients with rheumatoid arthritis (RA); however, there is little consensus in the literature to support its use. This systemic review aimed to determine the effects of dynamic exercise on patients with RA. A systematic search of Medline (1949–2007), Cinahl (1982–2007), Embase (1974–2007) and Cochrane library was performed for randomised-controlled trials using the keywords “rheumatoid arthritis” and “exercise” or “training” or “sport”. The methodological quality of studies was assessed using a ten-point scale. Eighteen papers relating to 12 different studies met inclusion criteria. The mean methodological quality score was 6.9/10. Studies using aerobic training, strength training and combinations of both were included. Patients with early, stable, and active RA were studied. A number of studies reported improvement in muscle strength, physical function and aerobic capacity with dynamic exercise. Some studies also reported improvements in disease activity measures, and small improvements in hip bone mineral density. One study reported significantly less progression of small joint radiographic damage of the feet in the dynamic exercise group. However, one study also reported worse large joint radiographic damage in patients using dynamic exercise who had pre-existing large joint damage, though this was a retrospective analysis. No studies reported worse outcomes for function, disease activity or aerobic capacity with dynamic exercise. Cardiovascular outcomes were not reported in any study, and no data were presented to assess the effect of exercise on patients with significant underlying cardiovascular disease. This systematic review suggests that the majority of patients with RA should be encouraged to undertake aerobic and/or strength training exercise. Exercise programmes should be carefully tailored to the individual, particularly for patients with underlying large joint damage or pre-existing cardiovascular disease.

Barriers to Exercise in Rheumatoid Arthritis – a Focus Group Study

Barriers to Exercise in Rheumatoid Arthritis – a Focus Group Study

Safety of exercise in patients with rheumatoid arthritis

Patients with rheumatoid arthritis benefit from long-term moderate or high-intensity exercises. Moderate or high-intensity exercises were found to improve aerobic capacity, muscle strength, functional ability, and psychological well-being, and slow the age-related and sex-related decrease in bone mineral density of the hip. Despite these positive findings, there is also concern about its risks. Studies on the effects of exercise on disease activity and joint damage are reviewed. Studies on the effects of moderate or high-intensity exercise in rheumatoid arthritis demonstrate either decreased or stable disease activity. From the few available studies that address exercise and radiologic progression of the small joints, results indicate that exercises are safe for the joints of hands and feet. However, a recent study suggests caution in prescribing long-term high-intensity weight-bearing exercises to patients who have significant radiologic damage of large joints, as some patients might develop additional damage. Moderate or high-intensity weight-bearing exercises are safe with respect to disease activity and radiologic damage of the hands and feet. In the absence of sufficient data on exercise and radiologic progression of the large joints, patients with significant radiologic damage of the large joints should not be encouraged to participate in moderate to high-intensity weight-bearing exercise unless individualized to protect affected joints. A broader dissemination of the effectiveness and safety of moderate and high-intensity exercise for patients with rheumatoid arthritis is needed among rheumatologists, physical therapists, and patients.

Evidence for the benefit of aerobic and strengthening exercise in rheumatoid arthritis.

Introduction Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown etiology. It usually presents as symmetric polyarthritis, but also confers general inflammatory symptoms. RA is present in 0.5–1% of the general population, twice as often in women, and the age at disease onset is mainly between 45 and 65 years. The American College of Rheumatology (formerly American Rheumatism Association [ARA]) has suggested diagnostic criteria (1) for RA. The disease course varies and prediction of the prognosis is difficult in any particular case. In the long run, a reduced function, difficulties in activities of daily living (ADL), and a negative psychosocial impact are often seen. RA also is connected with increased risk for osteoporosis (2), cardiovascular disease, and premature death (3). Criteria for the classification of functional loss have been suggested (4). Functional class (FC) I includes individuals without difficulties in daily life, FC II includes those with symptoms but minor limitations only, FC III includes those who are partly dependent, and FC IV includes those who are totally dependent on other persons in daily life. The vast majority of individuals with RA belong to FC II. Pain, stiffness, and fatigue generally occur early in the course of RA. Reduction of body function, such as range of motion (ROM), muscle strength, and aerobic capacity, may follow. As previously summarized by van den Ende et al (5), 50% of patients with RA displayed decreased hand ROM at their first rheumatology visit. Two years later, reduced ROM was found in large joints; the decreased ROM varied between 25% and 35% in different joints (6). Patients with RA and some functional loss (ARA FC II) have been found to have a 25–50% reduction in muscular strength compared with age-matched healthy controls (7– 10), and 55% deficit in muscular endurance (9). In patients with more serious RA, reductions of muscular strength up to 70% have been reported (11). Patients taking long-term oral steroids have a more pronounced loss of muscle strength (12,13). Reduced muscle function in patients with RA may also present itself as loss of functional balance and coordination (14). Among patients with RA who were able to perform bicycle ergometer tests, the aerobic capacity was reduced by 20–30% (7,9,15,16). The aerobic capacity is probably even lower among those who are not able to perform such tests. A portion of the reduced physical capacities found among individuals with RA may be attributed to inadequate levels of physical activity. The treatment of RA focuses on decreasing inflammatory activity and symptoms, limiting joint destruction and disability, and improving health related quality of life. It includes a rich variety of medication, surgery, and rehabilitation. Despite earlier fear of aggravation of symptoms, increased disease activity, and joint destruction, there is now scientific support that various forms of exercise are both safe and beneficial (17). Exercise has become an important part of rehabilitation during the last decades. A number of studies of various quality have been carried out to investigate the effects of aerobic and strengthening exercise in RA, but no recent reviews have been published. The aim of the present study was to investigate the evidence for the benefit of aerobic and strengthening exercise in RA.

EFFICACY OF EXERCISE FOR ARTHRITIS AND WASTING SYNDROMES, INCLUDING HIV

Many wasting and cachectic conditions cause muscle wasting that can be reversed with exercise. Over the past 2 decades much progress has been made in demonstrating the feasibility and utility of exercise in rheumatoid arthritis, HIV infection, and other chronic inflammatory conditions. More recent data suggest that the immune system is intimately involved in the regulation of muscle response to both catabolic and anabolic stimuli. I will review the current evidence for these concepts in this talk.

RECREATIONAL EXERCISE IN ARTHRITIS

For the person with arthritis, the consequences of prolonged inactivity add measurably, and unnecessarily, to disease-related impairments, functional limitation, and disability. Inadequate levels of regular physical activity also increase the risk of cardiovascular disease, hypertension, diabetes, and obesity. This article reviews the benefits of regular physical activity for general health as well as the literature on conditioning exercise in rheumatoid arthritis and osteoarthritis. Recommendations and guidelines are given for including conditioning exercise in comprehensive management.