Background International recommendations and results of randomized controlled trials consider physical exercises, aiming to improve range of motion, aerobic capacity and muscle strength, as an important part of treating rheumatoid arthritis (RA) [1–3].
Objectives To compare the efficacy of two 12-month exercise programs in patients with early RA.
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. All patients received methotrexate or leflunomide. At hospital stage 15 patients underwent 10 high-intensity dynamic exercises using gym apparatus Enraf-Nonius with biofeedback 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 12 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 12 months.
Results After 12 months in the both exercise groups there were statistically significant differences from the control group in most parameters (p<0,05), excluding ESR and DAS28 (p>0,05). Efficacy of the gym exercises was higher than the therapeutic exercises by tender joint count, pain on VAS, RAPID3 and extension power of a weaker knee joint (p<0,05).
Adherence to the regular therapeutic exercises for 12 months was better (72,2%) then to the gym exercises (53,3%). Predictors of the regular gym exercises were the young age (under 40 years) and the very early stage of RA at the onset of the study. Patients of the both exercise groups, who regularly did exercises during 12 months, had DAS28 low disease activity or remission.
Conclusions The both long-term exercise programs reduce pain, increase functional status, quality of life and power of motion in early RA patients without negative effect on disease activity.
Hurkmans E. et al. Cochrane Database Syst Rev 2009;4:CD006853.
De Jong Z. et al. Clin Rheumatol 2009;28(6):663–71.
Baillet A. et al. Arthritis Care Res 2010;62:984–92.
Disclosure of Interest None declared