Poor performance on tests to quantify physical fitness and functional capacity predicts mortality in normal populations and in various diseases such as cardiac, neoplastic, renal, pulmonary and rheumatic diseases. Self-report of a physically inactive life-style and poor physical function have been shown to be independent predictors of mortality in every population of normal and diseased individuals in which they have been studied (1). On the other hand, regular physical activity is associated with better physical and mental health. The risk of all cause mortality is typically reduced by 30% in those who participate in regular physical activities compared to those who have an inactive life style. In population studies, regular physical activity is associated with prevention of cardiovascular diseases and stroke, diabetes, certain cancers, falls and injuries, and obesity.
Patients with arthritis are known to be at risk for physical inactivity (2). Traditionally, patients with rheumatoid arthritis (RA) were advised to avoid or limit physical exercises with a fear that physical exercises might increase disease activity and harm joints. Physical therapy for RA was directed to relieve pain, and included heat and cold therapy, splints, range of motion exercises, and other conservative regimens. In fact, decades ago many clinical RA patients had severe destructive disease and instructions to participate in rigorous physical activities, and even minimal exercise were regarded as inappropriate.
Over the past decade, the importance of exercise as a component of the management of RA has been recognized with recommendations of regular physical exercises; benefits such as increased muscle force and aerobic capacity, decreased inflammation and pain, improved function, and sense of well-being (3) have been observed in patients with RA. Obviously regular physical exercise could also have beneficial effects concerning cardiovascular morbidity and mortality in patients with rheumatic diseases.
In our clinical practice, all patients with early RA receive care from a multidisciplinary team. Patients are tested for aerobic capacity and muscle strength. A physical therapist and the patient together make a plan for an individual exercise program that takes into account patient’s environment and resources. General recommendations are applied: a minimum of 2.5 hours of aerobic exercises and muscle strength exercises twice weekly.
Sokka T, Hakkinen A. Poor physical fitness and performance as predictors of mortality in normal populations and patients with rheumatic and other diseases. Clin Exp Rheumatol 2008 Sep;26(5 Suppl 5):14-20.
Sokka T, Hakkinen A, Kautiainen H, Maillefert JF, Toloza S, Mork Hansen T, et al. Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Rheum 2008;59(1):42-50.
Häkkinen A, Sokka T, Kotaniemi A, Hannonen P. A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis. Arthritis Rheum 2001;44:515-22.
Disclosure of Interest None Declared
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