# Exercise as it relates to Disease/The effect of exercise on rheumatoid arthritis

Rheumatoid Arthritis (RA) is one of the most common autoimmune diseases in the world. It is a chronic inflammatory disease associated with erosive synovitis, which if left untreated will lead to joint destruction$^$. This leads to disability and an increased risk of premature mortality$^{[1]}$. The onset of RA is generally between 30 to 50 years of age and commonly affects more woman than men. The cause of RA is unknown, however it is believed that 50% of the risk of developing RA is due to genetic factors. Environmental risk factors such as smoking are also believed to be linked$^$. Symptoms can include; sudden onset of joint pain, swelling in multiple joints, morning stiffness, inability to perform daily activities and disturbed sleep due to pain$^{[1]}$.

## Complications of Rheumatoid Arthritis

The chronic inflammation involved in RA may lead to a number of systemic complications including:
* Rheumatoid nodules
* Vasculitis
* Vasculitis- associated neuropathy
* Interstitial lung disease
* Felty's syndrome
Patients with an autoimmune disorder such as RA, have an increased risk of developing non-hodgkins lymphoma and sjorgren's syndrome due to chronic lymphocyte stimulation$^{[5]}$. Cardiovascular disease (CVD) is also associated with RA as a result of physical inactivity$^{[5]}$.

## Exercise Recommendations

RA patients are usually started on a range of pharmaceuticals to reduce disease activity$^{[1]}$. Some patients are unresponsive to these therapies$^{[1]}$. The anti-inflammatory effects of exercise may help to reduce the risk of developing complications, other autoimmune diseases and increase cardiovascular health. Further, exercise promotes overall health and helps to reduce joint pain$^{[7]}$. Exercise that positively affects RA includes;
| Form of Exercise | Benefit | Per Week |
| Aerobic | Improves cardiovascular and respiratory fitness. Reduces joint pain and improves functional ability of the joint$^$ | Three times a week for 30 to 45 minutes |
| Strength Training | Promote muscles to absorb shock which helps to protect the joint and alleviate pain$^{[7]}$. Also increases range of movement$^{[8]}$. | Twice a week, with moderate loads (50–70% of the repetition maximum), 2 sets per exercise, and 8–12 repetitions per set$^{[8]}$ |
| Stretching | Enhances joint flexibility and range of movement | Daily$^{[9]}$ |
| Tai Chi | Improves muscle function in the lower limbs and also improves the mental capacity to tolerate pain | 60 minutes twice a week$^{[10]}$ |
If the patient has any co-morbidities such as hypertension, obesity or diabetes, then a doctors approval must be secured before exercise programs can begin. If the patient is under time constraints, aerobic exercise should be recommended over other forms of exercise. This is because aerobic exercise promotes overall health, reduces risk of co-morbidities and has the greatest therapeutic effect to reduce joint pain$^{[7]}$. Also, exercise such as jogging and heavy weight lifting should be avoided as they promote joint damage$^{[9]}$.

### Other Recommendations

A change in diet may also reduce RA symptoms. Diets found to suppress the inflammatory response and reduce RA symptoms include;
* Vegetarian
* Vegan
* Elimination (eliminating foods from the diet that promote inflammation)

## Further reading

http://www.rheumatology.org/practice/clinical/guidelines/Singh%20et%20al-ACR%20RA%20GL-May%202012%20AC&R.PDF
http://www.glucosamine-arthritis.org/arthritis/arthritis-exercises.html#7

## References

* ↑ Fleischmann, R., 2012, ‘New Approaches in the Treatment of Rheumatoid Arthritis: Treating to Target’, Medscape Education: Orthopaedics. Available from: http://www.medscape.org/viewarticle/756397
* ↑ Gettings, L. (2010) 'Psychological Well-Being in Rheumatoid Arthritis: A Review of the Literature'. Musculoskeletal Care, vol. 8, pp. 99- 106
* ↑ Ronningen, A., Kjeken, I. 2008, 'Effect of intensive hande exercise program in patients with rheumatoid arthritis', Scandinavian Journal of Occupational Therapy, vol. 15, pp. 173-183
* ↑ Scott, D., Wolfe, F., Huizinga, T., 2010 'Rheumatoid Arthritis', The Lancet, vol. 376, no. 9746, pp 1094–1108
* ↑ Turesson, C. 2007, 'Systemic Effects of Rheumatoid Arthritis', US Musculoskeletal Review, vol. 1, pp. 64-66
* ↑ Lundberg, I and Nader, G. 2008, 'Molecular effects of exercise in patients with inflammatory rheumatic disease', Nature Reviews Rheumatology, vol. 4, pp. 597-604
* ↑ Rahnama, N and Mazloum, V. 2012, 'Effects of strengthening and aerobic exercise on pain severity and function in patients with knee rheumatoid arthritis', International Journal of Preventative Medicine, vol. 3, no. 7, pp. 493-499
* ↑ Häkkinen, A et al. 2001, 'A randomized two year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis' Arthritis and Rheumatism, vol. 44, no. 3, pp.515-522
* ↑ Arthritis Foundation, 2012, 'Rheumatoid Arthritis- What can you do about it?' Acessed from: http://www.arthritis.org/what-can-you-do-about-it.php
* ↑ Uhlig, T et al. 2010, 'Exploring tai chi in rheumatoid arthritis: a quantitative and qualitative study', BMC Musculoskeletal Disorders, vol. 11, no. 43, pp.1-7
* ↑ Stamp, L., James, M & Cleland, L., 2005, ‘Diet and Rheumatoid Arthritis: A Review of the Literature’, Seminars in Arthritis and Rheumatism, vol. 35, no. 2, pp. 77-94