Background Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects small and large joints symmetrically, leads to cartilage destruction and synovitis and in some cases pannus may occur. Aggressive and untreated cases can lead to deformity and disability1. Previously it was believed that the exercises were beneficial to the range of motion and muscle strength (MS), however it could cause damages2. Currently, several studies show that the exercises are safe and beneficial for aerobic conditioning in RA3, but with respect to disease activity, functional ability, pain and quality of life (QL) studies are still inconclusive. Studies on the effectiveness of the global progressive resistance training in RA are scarce.
Objectives To evaluate the effectiveness of the global progressive resistance training in improving functional capacity (FC), QL and pain in patients with RA.
Methods 60 patients with RA by ACR criteria, aged 18-65 years, stable medication, that were not doing physical activity, had no other musculoskeletal disease or contraindications for physical activity were included. Patients were randomized into two groups: intervention group (IG) who carried out the global progressive resistance training for 12 weeks, 2 times a week associated to a drug treatment established by a rheumatologist and control group (CG) who did not perform the exercises but received a drug treatment established by a rheumatologist. Progressive resistance strength training program consisted of exercises for some muscle groups, all performed with 50% and 70% of 1 repetition maximum in machines for each muscle group and dumbbells. The load was re-evaluated after 6 weeks of initial assessment. Disease activity was assessed by a rheumatologist and FC, QL, MS, amount of drug consumed and pain by a blinded evaluator at the beginning of the study, in the 6th and 12th week.
Results 33 were randomized to the CG and 27 to the IG. Groups were similar at baseline. In the analysis between groups were found better results for the IG in HAQ (p=0.001), in some domains of the SF-36 (FC: p<0.001; pain: p=0.002 and social aspects: p=0.049), pain (p=0.035) and the MS of some muscle groups (p<0.05). There was no significant difference in the consumption of medication between the groups (p>0.05).
Conclusions Global progressive resistance strength training program was effective for improving the FC of patients with RA assessed by HAQ. In addition the training improved pain, certain domains of QL and MS without worsening the disease.
C. Kisner, Colby LA. Therapeutic exercises: fundamentals and techniques. 4.ed. Barueri, SP: Manole, 2005. 841p.
The Baillet, Zeboulon N, Gossec L, et al. Efficacy of Cardiorespiratory Aerobic Exercise in Rheumatoid Arthritis: Meta-analysis of Randomized Controlled Trials. Arthritis Care & Research. 62 (7): 984-992, 2010.
Hurkmans Emalie, van der Giesen Florus J, Vliet Vlieland Thea PM, Schoones Jan Van den Ende Els CHM. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in Patients with rheumatoid arthritis. Cochrane database of Systematic Reviews. In: The Cochrane Library, Issue 9, 2014
Acknowledgements To FAPESP and CAPES for all the support.
Disclosure of Interest None declared