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Sustained maintenance of exercise induced muscle strength gains and normal bone mineral density in patients with early rheumatoid arthritis: a 5 year follow up

A Häkkinen¹, T Sokka^2,3, H Kautiainen⁴, A Kotaniemi⁴, P Hannonen²

¹ Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Jyväskylä, Finland
² Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
³ Vanderbilt University Medical Centre, Nashville, USA
⁴ Rheumatism Foundation Hospital, Heinola, Finland

Correspondence to:
Correspondence to:
Dr A Häkkinen
Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, Keskussairaalantie 19, FIN-40620 Jyväskylä, Finland; arja.hakkinen{at}ksshp.fi

Objective: To investigate at 5 years whether an initial 2 year home based strength training period imposes sustained effects on muscle strength, bone mineral density (BMD), structural joint damage, and on disease activity in patients with early rheumatoid arthritis (RA).

Methods: Seventy patients were randomised either to perform home based strength training with loads of 50–70% of repetition maximum (EG) or range of motion exercises (CG). Both groups were encouraged to take part in aerobic activities 2–3 times a week. Maximal muscle strength of different muscle groups was measured by dynamometers, and BMD at the femoral neck and lumbar spine by dual x ray densitometry. Disease activity was assessed by the 28 joint disease activity score, and joint damage by x ray findings.

Results: 62 patients completed 2 years’ training and 59 patients attended check up at 5 years. Mean (SD) maximum muscle strength indices increased from baseline to 2 years—in EG from 212 (78) kg by a mean (95% CI) of 68 (55 to 80) and in CG from 195 (72) kg by 35 (13 to 60) kg—and remained at that level for the next 3 years. Development of BMD in EG tended to be more favourable than that in CG. Muscle strength training was not detrimental to joint structures or disease activity.

Conclusion: The patients’ exercise induced muscle strength gains during a 2 year training period were maintained throughout a subsequent self monitored training period of 3 years. Despite substantial training effects in muscle strength, BMD values remained relatively constant. Radiographic damage remained low even at 5 years.

Abbreviations: BMD, bone mineral density; CG, control group; DAS, disease activity score; DMARDs, disease modifying antirheumatic drugs; EG, experimental group; HAQ, Health Assessment Questionnaire; MTX, methotrexate; RA, rheumatoid arthritis; ROM, range of motion; VAS, visual analogue scale

Keywords: rheumatoid arthritis; muscle strength; bone mineral density; radiological damage; disease activity

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