# Exercise as it relates to Disease/The effects of strength and endurance training in patients with rheumatoid arthritis

This is an analysis of the journal article "The effects of strength and endurance training in patients with rheumatoid arthritis" by Barbara Strasser Et al (2010).

## Background

Rheumatoid Arthritis is one of the most costly chronic inflammatory auto immune diseases in which is characterised by joint swelling, stiffness, and severe pain which results in a severe disability and in some cases deformity of the joint. The inflammation mainly affects synovial membranes of multiple joints which causes severe pain and deformity, generally resulting in a decreased quality of life. Rheumatoid Arthritis has affected more than three million Australians, 50% of the risk for the development of Rheumatoid Arthritis is attributable to genetic factors. The disorder is known to affect mostly women (17.7% women compared with males at 11.8%) and the elderly. Those with Rheumatoid Arthritis suffer from sarcopenia (loss of muscle and reduced muscular strength) resulting in damage to the musculoskeletal system, with increased energy expenditure for the individual. Unfortunately there is no cure for Rheumatoid Arthritis, it can however be managed. It is suggested that a rehabilitative approach may be useful in reversing the loss of muscle and strength, through the use of a training program. Research has looked into the effects of strength and endurance training in patients with Rheumatoid Arthritis

## Where is the research from?

Evidence to support strength and endurance training was published in the study conducted by Strasser, B Et al. The study was published in 2011 in the Journal of the International League of Associations for Rheumatology

## What kind of research was this?

This was a quantitative study using a randomised method to assign patients to groups.

## What did the research involve?

A Random sample of 40 patients with diagnosed Rheumatoid Arthritis between the ages of 41-73 were recruited from the Rheumatology Unit at Wilhelminen Hospital, Vienna. The duration of the symptoms were greater than two years at the beginning of the study.
20 patients (19 females, 1 male) underwent the 6 month training program and 20 patients (17 females and 3 males) served as the control group. Before commencing the study, each patient was clinically examined by a rheumatologist to assess their clinical status (functional ability, cardiorespiratory fitness and maximum muscle strength), anthropometric measurements were also obtained for baseline measures.
Training load was monitored for each individual and adapted to keep within the rep range (maintaining progressive overload). Every 6 weeks the number of sets for each muscle group was increased from 2 through to 4 at the end of the program. All strength training programs were individualised and consisted of exercises in which targeted major muscle groups.
| Week | Program changes |
| Weeks 1-2 | 10 min warm up, low weight with main focus on technique |
| Weeks 3-8 | 10 min warm up, 2 sets of 10-15 reps per exercise (70% 1RM) |
| Weeks 9-15 | 10 min warm up, 3 sets of 10-15 reps per exercise (70% 1RM) |
| Weeks 16- onwards | 10 min warm up, 4 sets of 10-15 reps per exercise (70% 1RM) |
The endurance training was conducted on a cycle ergometer. For weeks 1-4 patients were to complete 2 sessions of ET training a week for 15 minutes each session. From week 5 the time was increased by 5 minutes every 4 weeks. Heart rate was continuously monitored throughout each session. The total time spent training per week during the last 4 weeks was 80 minutes.
The methodology was an effective way of measuring the change in the two groups, as the only difference between them was the structured program. Each group was able to continue normal medications and any other normal daily activities, therefore any differences in the groups would be as a result of the program.

## What were the Basic results

After the 6 month combined strength and endurance training program results:
| Decreases | Increases |
| Pain | General health |
| Body Fat | Maximum Workload |
| Body Mass | Cardiorespiratory health and fitness |
| | Functional Capacity |

## How did the researchers interpret the results?

The research discussed that patients who suffer from Rheumatoid Arthritis start with an unconditioned status, therefore more general adaptations will occur in these individuals as they are initially untrained and progress is influenced by baseline damage.

## What conclusions should be taken away from this research

When it comes to Rheumatoid Arthritis patients, decreased muscle strength is a major important factor and is considered a major impairment among patients with Rheumatoid Arthritis so it seems reasonable to advise both cardio-respiratory fitness as well as muscle strength programs to these patients. Previous research, concludes that exercise is considered significantly beneficial for those with Rheumatoid Arthritis with reported benefits in improved cardiorespiratory health and fitness, increases in muscle mass and strength and improvements in body composition.

## Implications of this research

The implications of this research was there were a limited number of participants involved with a lack of a follow up period.
This research has shown that combined strength and endurance training could be an effective intervention strategy to help manage Rheumatoid Arthritis. Although in order for this to be successful, patients would need to commit to a training regime and any expenses that may come with that (memberships and fees). Patients would also need to work closely with their rheumatologist and qualified health professionals to ensure an individualised program is designed and technique is appropriate for that particular patient

## Further Information

For further information regarding the benefits of exercise for those suffering from Rheumatoid Arthritis; click the links below
Arthritis Australia: http://www.arthritisaustralia.com.au/
Can I exercise if I have Rheumatoid Arthritis: http://www.webmd.com/rheumatoid-arthritis/guide/exercise-and-rheumatoid-arthritis
Best exercises for Rheumatoid Arthritis: http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/articles/best-exercises-for-ra.php

## References

* 1 2 3 4 5 6 Strasser B, Leeb G, Strehblow C, Schobersberger W, Haber P, Cauza E. The effects of strength and endurance training in patients with rheumatoid arthritis. 2010; 30:623–632
* 1 2 Cooney JK, Law RJ, Matschke V, Lemmey AB, Moore JP, Ahmad Y, et al. Benefits of Exercise in Rheumatoid Arthritis. 2011, vol. 2011, pg1-14
* ↑ Australian Bureau of Statistics. Arthritis and Osteoporosis [internet]. [updated 2013 June 7] Available form: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4338.0main+features272011-13
* ↑ Roubenoff R. Exercise and Inflammatory Disease. Arthritis & Rheumatism (Arthritis Care & Research) 2003 April 15; Vol. 49; No. 2; pp 263–266
* ↑ Lemmey AB, Marcora SM, Chester K, Wilson S, Casanova F, Maddison PJ. Effects of high-intensity resistance training in patients with rheumatoid arthritis: A randomized controlled trial. 2009; Vol 61(12)1726-1734
* ↑ De Jong Z, Munneke M, Zwinderman AH, Kroon HM, Jansen A, Ronday KH, et al. Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis?: Results of a randomized controlled trial. Arthritis and Rheumatology. 2003 September 11; Vol 48(9)2415-2424