Background The patients with rheumatoid arthritis (RA) are less physically active than the general population [1]. Physical exercises improve muscle strength, range of movements, aerobic capacity and bone density in patients with RA [2–4]. However, some physicians fear to recommend the intensive exercises.

Objectives To compare the efficacy of two exercise programs in patients with early RA during 6 months.

Methods 51 patients with early RA (92,2% females, age of 18 to 53 years, disease duration of 2 to 17 months) were randomized into 3 groups. At hospital stage 15 patients underwent 10 high-intensity dynamic exercises using gym apparatus Enraf-Nonius for 45–60 min, including aerobic part (En-Cardio) and 18–20 muscle-strengthening exercises (En-Dynamic Track), 18 patients – 10 therapeutic exercises for joints for 45 min under the supervision of a trainer. At outpatient stage the exercises lasted for 6 months 3 times a week. 18 patients received only drug therapy (control). Tender and swollen joint count, pain on 100-mm VAS, erythrocyte sedimentation rate (ESR), DAS28, HAQ, RAPID3, the average powers of knee extension and ankle flexion by EN-TreeM movement analysis were evaluated at baseline and at 6 months.

Results After 6 months in the both exercise groups there were statistically significant differences from the control group in most parameters (p<0,05). Efficacy of the intensive gym exercises was higher than the therapeutic exercises by tender joint count, HAQ, RAPID3 (p<0,05).

Adherence to the regular therapeutic exercises for 6 months was better (77,8%) then to the gym exercises (60,0%). Predictors of the regular high-intensity gym exercises were the young age (under 40 years) and the very early stage of RA. Most patients, who regularly did exercises, had DAS28 low disease activity (66,7% in the gym group and 57,1% in the therapeutic exercises group vs 36,7% in the control group, p<0,05).

Conclusions The both 6-month exercise programs reduce pain, increase functional status, quality of life and power of motion without detrimental effect on disease activity.

References

1. van den Berg M.H. et al. J Clin Rheumatol 2007;13(4):181–6.

2. Hurkmans E. et al. Cochrane Database Syst Rev 2009;4:CD006853.

3. De Jong Z. et al. Clin Rheumatol 2009;28(6):663–71.

4. Baillet A. et al. Arthritis Care Res 2010;62:984–92.

Disclosure of Interest None declared