# Exercise as it relates to Disease/The effects of resistance training on rheumatoid athritis
## Background

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterised by joint swelling, joint tenderness and destruction of synovial joints, leading to severe disability. In Australia the estimated prevalance of RA is 0.6% of total population with approximately three quarters of the patients being female and a significantly higher rate of RA in patients aged 65–74 years (0.8 per 100 encounters). Although rheumatoid arthritis is not intrinsically fatal, life expectancy is reduced by an average of 3 to 18 years, and 80% of patients with rheumatoid arthritis are disabled after 20 years with the disease. Deaths from infection occur twenty times more frequently in patients with rheumatoid arthritis The most frequent causes of death in patients suffering rheumatoid arthritis is cardiovascular disease and cancer.

## Benefits of resistance exercise

Physical exercise is the most important and clinically relevant countermeasure against rheumatoid arthritis, but must be prescribed with the patient’s disease status, overall health, and safety in mind. Skeletal muscle strength training with weights has been shown to be particularly effective for countering the loss of muscle strength and concomitant functional losses caused by rheumatoid arthritis.
* Improved muscle strength and tone to protect your joints from injury. It also helps you maintain flexibility and balance and helps you remain independent as you age.
* Weight management and increased muscle-to-fat ratios as you gain muscle, your body burns more kilojoules when at rest.
* Greater stamina as you grow stronger, you won’t get tired as easily.
* Prevention or control of chronic conditions such as diabetes, heart disease, arthritis, back pain, depression and obesity.
* Pain management.
* Improved mobility and balance.
* Improved posture.
* Decreased risk of injury.
* Increased bone density and strength.
* Improved sense of wellbeing resistance training may boost your self-confidence, increased self-esteem and improve your body image and your mood.
* Improved sleep and avoidance of insomnia.
* Enhance performance of everyday tasks.

#### Pre exercise considerations

Resistance training should only be prescribed to patients with a well controlled case of rheumatoid athritits to avoid further joint swelling/damage and pain. All patients should complete a pre-exercise screening under the guidance of a clinical physician. Exercise intensity and weight progression should be in constant consultation with the patients current disease status and their level of pain, stop resistance training immediately if flaring or excessive swelling occurs.

#### Types of resistance training

* Body weight exercises- E.g. Push ups, Sit ups, Lunges, Body weight squats.
* Free weights- E.g. Bench press, Dumbell shoulder press, Deadlifts.
* Weight machines- E.g. Seated row, Lat pull down, Leg extensions.
* Resistance bands- E.g. Theraband shoulder rotations, VMO single leg squats.
* Isometric exercises- E.g. Plank bridge, Isometric bicep curl, Isometric shoulder raise.

#### General exercise considerations

* Skeletal muscle strength training goal for people suffering RA is 80% of maximum amount of weight that can be lifted with each muscle group in one-repetition.
* Patients should be shown correct technique to avoid further damage or injury's.
* All resistance training should be undertaken with the guidance of a qualified physician or personal trainer.
To continue the improvement and benefits from resistance training the following principles must be applied;
* Increase the number of repetitions.
* Increase your workout by 10 or 15 minutes.
* Increase the frequency of workouts, keeping in mind that each muscle needs at least 48 hours of recovery time.
* Switch to different exercises – for example, focus on exercises that use multiple muscle groups and that are functional or specific in nature, meaning that they relate to activities of daily living.
* Increase the weight by about five to 10 per cent.
* Change your workout about every four to eight weeks to keep your muscles guessing.

## Recommendations

Every person with RA should have a regular exercise program specifically tailored to their abilities and needs. The goal of regular exercise is to achieve and maintain optimal health and physical functioning. Regular exercise, including exercises for strengthening muscles, stretching (range of motion), building endurance, and improving coordination and balance, can be useful in managing many of the symptoms that commonly affect people with RA, including fatigue, stiffness, pain, and weakness. Regular exercise is an important key for maintaining joint and bone health. Resistance training should be used in conjuction with aerobic exercise and flexibility or range of movement training but to achieve maximum benefits from strength training the patient needs to be completing a strength based session two to three times a week. The primary goal of resistance training in patients suffering from RA is to improve their life quality and daily functioning therefore all resistance exercise should show a direct relation to an everyday function E.g. single leg squats to improve the ability to get on and off the couch.

## Further reading / Information resources

Arthritis organisation Australia: http://www.arthritis.org.au/
My Joint pain: https://www.myjointpain.org.au/
Rheumatoid arthritis: http://rheumatoidarthritis.net/exercise/
Arthritis foundation: http://www.arthritistoday.org

## References

* 1 2 Charles, J., Britt, H. & Pan, Y. 2013, "Rheumatoid arthritis", Australian Family Physician, vol. 42, no. 11, pp. 765.
* ↑ Harrison C, Britt H, Miller G, Henderson J. Prevalence of chronic conditions in Australia. PLoS ONE 2013;8:e67494
* ↑ T. Pincus, L.F. Callahan. Taking mortality in rheumatoid arthritis seriously—predictive markers, socioeconomic status and comorbidity. Rheumatol, 13 (1986), pp. 841–845
* ↑ D.L. Scott, D.P. Symmons, B.L. Coulton, A.J. Popert. Long-term outcome of treating rheumatoid arthritis: results after 20 years. Lancet, 1 (1987), pp. 1108–1111
* ↑ D.P.M. Symmons. Mortality in rheumatoid arthritis. Br J Rheumatol, 27 (1988), pp. 44–54
* ↑ Walsmith, J. & Roubenoff, R. 2002, "Cachexia in rheumatoid arthritis", International journal of cardiology, vol. 85, no. 1, pp. 89-99.
* 1 2 Better health channel. 2014. Resistance training health benefits . [ONLINE] Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Resistance_training_the_health_benefits. [Accessed 01 October 14].
* ↑ L.C. Rall, R. Roubenoff. Benefits of exercise for patients with rheumatoid arthritis. Nutr Clin Care, 3 (2000), pp. 209–215
* ↑ .Rheumatoid arthritis.net. 2013. Exercises for Rheumatoid arthritis . [ONLINE] Available at: http://rheumatoidarthritis.net/exercise/. [Accessed 01 October 14].