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Evidence summaries

Dynamic Exercise Therapy for Rheumatoid Arthritis

Dynamic exercise programs (aerobic capacity and muscle strength training) appear to be effective and safe at increasing aerobic capacity and muscle strength in patients with rheumatoid arthritis. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 8 studies with a total of 575 subjects. In all trials participants with low to medium disease activity were included and patients with serious co-morbidities were excluded. Exercise programmes had to fulfil the following criteria: frequency at least twice weekly for > 20 minutes; duration> 6 weeks; aerobic exercise intensity > 55% of the maximum heart rate and/or muscle strengthening exercises starting at 30% to 50% of one repetition maximum; and performed under supervision. Short-term, land-based aerobic capacity training showed a positive effect on aerobic capacity (SMD 0.99, 95% CI 0.29 to 1.68; 3 studies, n=82) immediately after the intervention. Short-term, land-based aerobic capacity and muscle strength training showed a positive effect on aerobic capacity and muscle strength (SMD 0.47, 95% CI 0.01 to 0.93; 2 studies, n=74) immediately after the intervention. Short-term, water-based aerobic capacity training: one of the two included trials reported statistically significant positive effects of the intervention on functional ability (P < 0.05) and aerobic capacity (P < 0.05) immediately after the intervention. Data could only be pooled for aerobic capacity resulting in a non-significant trend toward a positive effect (SMD 0.47, 95% CI -0.04 to 0.98; 2 studies, n=88). Long-term, land-based aerobic capacity and muscle strength training (2 years) showed a positive effect on aerobic capacity (SMD 0.46, 95% CI 0.22 to 0.70; 1 study, n=281) and a non-significant trend toward a positive effect on muscle strength (SMD 0.49, 95% CI -0.06 to 1.04; 2 studies, n=305). In the one study including a 18-month follow-up, the improvement of muscle strength was maintained in those participants from the intervention group who continued exercising at similar intensity levels as in the original intervention (although on average at a lower frequency) but not in those who did not remain physically active. With respect to safety, no deleterious effects were found in any of the included studies.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and inadequate intention-to-treat adherence).

    References

    • Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, Van den Ende EC. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev 2009;(4):CD006853. [PubMed]

Primary/Secondary Keywords