EXTENDED REPORT

Long term high intensity exercise and damage of small joints in rheumatoid arthritis

Z de Jong¹, M Munneke², A H Zwinderman³, H M Kroon⁴, K H Ronday⁵, W F Lems⁶, B A C Dijkmans, F C Breedveld¹, T P M Vliet Vlieland¹, J M W Hazes^1,7, T W J Huizinga^1,6

¹ Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
² Department of Physical and Occupational Therapy, LUMC, Leiden, The Netherlands
³ Department of Medical Statistics, LUMC, Leiden, The Netherlands
⁴ Department of Radiology, LUMC, Leiden, The Netherlands
⁵ Leyenburg Hospital, The Hague, The Netherlands
⁶ Department of Rheumatology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
⁷ Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, The Netherlands

Correspondence to:
Correspondence to:
Mrs Z de Jong
Albinusdreef 2 Leiden, 2300 RC, The Netherlands; z.de_jong{at}lumc.nl

Objective: To investigate the effect of long term high intensity weightbearing exercises on radiological damage of the joints of the hands and feet in patients with rheumatoid arthritis (RA).

Methods: Data of the 281 completers of a 2 year randomised controlled trial comparing the effects of usual care physical therapy (UC) with high intensity weightbearing exercises were analysed for the rate of radiological joint damage (Larsen score) of the hands and feet. Potential determinants of outcome were defined: disease activity, use of drugs, change in physical capacity and in bone mineral density, and attendance rate at exercise sessions.

Results: After 2 years, the 136 participants in high intensity weightbearing exercises developed significantly less radiological damage than the 145 participants in UC. The mean (SD) increase in damage was 3.5 (7.9) in the exercise group and 5.7 (10.2) in the UC group, p = 0.045. Separate analysis of the damage to the hands and feet suggests that this difference in rate of increase of damage is more pronounced in the joints of the feet than in the hands. The rate of damage was independently associated with less disease activity, less frequent use of glucocorticoids, and with an improvement in aerobic fitness.

Conclusion: The progression of radiological joint damage of the hands and feet in patients with RA is not increased by long term high intensity weightbearing exercises. These exercises may have a protective effect on the joints of the feet.

Abbreviations: ACR, American College of Rheumatology; AF, aerobic fitness; AUC, area under the curve; BMD, bone mineral density; DAS4, Disease Activity Score with four variables; DMARD, disease modifying antirheumatic drug; DXA, dual photon x ray absorptiometry; HAQ, Health Assessment Questionnaire; ICC, intraclass correlation coefficient; IQR, interquartile range; MS, muscle strength; RA, rheumatoid arthritis; RAI, Ritchie Articular Index; RAPIT, Rheumatoid Arthritis Patients In Training; SDD, smallest detectable difference; UC, usual care

Keywords: exercise; joint damage; rheumatoid arthritis

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