# Exercise as it relates to Disease/Efficacy of Aerobic Exercise in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease, which primarily affects the lining of the joints (synovial membrane). Characterised by erosive synovitis and severe inflammation, RA patients experience severe joint pain, swelling and stiffness, reduced muscle strength and impaired physical function. The progression of RA may lead to rheumatoid cachexia (loss of muscle mass), as well as joint destruction, further restricting the individual’s daily physical activities.

#### Treatment

Based on self reports, approximately 50% of individuals with RA reported using pharmaceutical medication, 38% utilising health supplements, while an estimated 28% used some form of exercise and 13% massage or water therapy to manage pain and ease symptoms. Surgical paths and rehabilitation are also recognised as current treatments for RA.

#### Prevalence

RA is estimated to be present in 0.5–1% of the general population, twice as often in women, and the age at disease onset is predominantly between 45 and 65 years. The often-serious joint disease affects around 400,000 Australians and is the second most common type of arthritis, following osteoarthritis. In Australia in 2006, RA was cited as the primary cause for 169 deaths (123 females and 46 males).

#### Risk Factors

Below is a table of both Modifiable and Non-Modifiable risk factors of RA
| Modifiable Risk Factors | Non-Modifiable Risk Factors |
| Smoking Reproductive hormonal exposures Alcohol consumption Dietary factors Microbial exposures | Genetics Socio-demographics; RA is typically two to three times higher in women than men. The onset of RA, in both women and men, is highest among those in their sixties. |

## Benefits of Aerobic Exercise in RA

Results from randomised controlled trials advised exercise to be fundamentally beneficial. RA patients have been reported to do less exercise than their healthy counterparts, with over 80% of RA patients conveyed as physically inactive in various countries. Due to the awareness of weight bearing movements provoking joint damage by boosting disease activity, aerobic exercise is believed to be highly advantageous.
Benefits of aerobic exercise include:
* Cardiorespiratory fitness: Aerobic capacity is 20 to 30% lower than age-matched healthy controls
* Improvement in body composition: Reduced adiposity and increased hypertrophy
* Joint and musculoskeletal health: Reduced joint tenderness and improved range of movement and flexibility
* Reduce discomfort, radiologic damage and pain
* Improvement in emotional and psychological well being
* Greater overall levels of self-efficacy
These improvements are feasible to achieve without risk of joint damage or disease activity. Additionally, well-established anti-inflammatory and anti-atherogenic effects of exercise consequently reduce the risk of CVD.

## Evidence-based Recommendations for Aerobic Exercise in RA

The most commonly used mode of aerobic exercise training in studies involving RA patients is cycling, followed by aquatic exercise, aerobic dance and walking/jogging.
| Type of Aerobic Exercise | Intensity | Time/Frequency |
| Walking | 60-85% of maximum heart rate | 30-60 min 3 days/week |
| Aquatics (ROM & Isometric exercises) | 70% of maximum heart rate | 25–60 min 3 days/week |
| Cycling | 60–80% of maximum heart rate | 25–40 min 5 days/week |
| Aerobic Dancing | 50–70% of maximum heart rate | 30–60 min 2days/week |
* For maximal benefits to occur, patients should have well-controlled RA before commencing exercise and continue the use of anti-inflammatory medications.

## Considerations

* Aerobic training should be determined by the patient’s current levels of fitness and allowed by their cardiovascular risk stratification.
* Gradual adjustment of intensity and duration of exercise is recommended.
* Exercise should be initially supervised by an experienced exercise professional so that the program can be tailored to individual aspirations and adapted to the disease activity, joint defects, and symptoms of patients.
* Contraindications to exercise as a result of comorbidities need to be monitored by a physician.
* Exercise programs must account for pre-exercise disease status and degree of joint deficits.

## Further reading

* Arthritis Foundation - http://arthritis.org/
* Exercise and Arthritis - https://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Exercise_and_Arthritis/
* A picture of rheumatoid arthritis in Australia; National Centre for Monitoring Arthritis and Musculoskeletal Conditions - http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459857
* Centers for Disease Control and Prevention; Rheumatoid Arthritis - http://www.cdc.gov/arthritis/basics/rheumatoid.htm
--Ellen123 (discuss • contribs) 00:09, 1 October 2014 (UTC)

## References

* 1 2 3 4 . Strasser, B, Leeb, G, Strehblow, C, Schobersberger, W, Haber, P & Cauza, E. (2010). The effects of strength and endurance training in patients with rheumatoid arthritis. Clinical Rheumatology, 30, 623-632.
* 1 2 . A picture of rheumatoid arthritis in Australia. Australian Institute of Health and Welfare, 2009, 9, 8-11
* 1 2 3 4 . Strenstorm, C & Minor, M. (2003). Evidence for the benefit of aerobic and strengthening exercise in rheumatoid arthritis. Arthritis Care and Research, 49(3), 428-434.
* ↑ Rheumatoid Arthritis. Centers for Disease Control and Prevention. 2012 [Online]. Available: http://www.cdc.gov/arthritis/basics/rheumatoid.htm
* 1 2 3 4 5 6 7 . Cooney, J, Law, R, Matschke, V, Lemmey,A, Moore, J, Ahmad, Y, Jones, J, Maddison, P & Thom, J. (2011). Benefits of Exercise in Rheumatoid Arthritis. Journal of Aging [Online]. Available: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042669/
* 1 2 . Bilberd, A, Ahlmen, M & Mannerkorpi, K. (2005). Moderately intensive exercise in a temperate pool for patients with rheumatoid arthritis: a randomized controlled study. Oxford Journals, 44(4), 502-508
* ↑ Cooney, J, Law, R, Matschke, V, Lemmey, A, Moore, J, Ahmad, J, Jones, J, Maddison, P & Thom, J. (2011). Benefits of Exercise in Rheumatoid Arthritis. Journal of Aging Research [Online]. Available: http://www.hindawi.com/journals/jar/2011/681640/
* 1 2 . Metsios, G, Stavropoulos-Kalingolou, A, Veldhuijzen van Zanten, J, Treharne, G, Panoulas, V, Douglas, K, Koutedakis, Y & Kitas, G. (2008). Rheumatoid arthritis, cardiovascular disease and physical exercise: a systematic review. Oxford journals, 47(3), 239-248.
* ↑ Metsios, G, Stavropoulos-Kalingolou, A, Veldhuijzen van Zanten, J, Treharne, G, Panoulas, V, Douglas, K, Koutedakis, Y & Kitas, G. (2008). Interventional training regimens in patients with rheumatoid arthritis—aquatic programmes. Oxford Journals, 47(3), 239-248.
* ↑ Durstine, J, Moore, G, Painter, P & Roberts, S. (2003). ACSM's Exercise Managment for Persons with Chronic Diseases and Disabilities, Human Kinetics, Champaign, Ill, USA, 3rd edition.
* ↑ Metsios, G, Stavropoulos-Kalingolou, A, Veldhuijzen van Zanten, J, Treharne, G, Panoulas, V, Douglas, K, Koutedakis, Y & Kitas, G. (2008). Interventional training regimens in patients with rheumatoid arthritis—dancing programmes. Oxford Journals, 47(3), 239-248.
* ↑ Strasser, B, Leeb, G, Strehblow, C, Schobersberger, W, Haber, P & Cauza, E. (2010). The effects of strength and endurance training in patients with rheumatoid arthritis’. Clin Rheumatol, doi:10.1007/s10067-010-1584-2
* ↑ Walsmith, J & Roubenoff, R.(2002). Cachexia in rheumatoid arthritis. International Journal of Cardiology, 85, 89–99