# Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis

This Wikibooks is a review of the research paper "Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis" by Marian A. Minor, John E. Hewett, Richard R. Webel, Sharon K Anderson, and Donald R. Kay.

## Research background

This research was conducted with the aid of 120 volunteers, all of whom had some form of Rheumatoid arthritis or Osteoarthritis. Participants were randomly sorted into three groups undertaking either aerobic walking, aerobic aquatics, or non-aerobic range of motion(controls). The research was undertaken over a period of twelve weeks.
* Rheumatoid arthritis (RA) is a long-term systemic autoimmune disorderthat primarily affects joints, although it may affect other parts of the body such as the Skin and lungs.
* Osteoarthritis (OA) is a type of joint disease that is a result of the breakdown of joint cartilage and the underlying bone. As with RA, the most common symptoms are joint pain and stiffness and the symptoms may become more severe over time.
The purpose of investigating whether or not exercise can help RA and OA is due those who suffer from these diseases are between middle-aged to elderly, as the disease gets worse the symptoms often cause the those afflicted to withdraw from daily life, often at a detriment to their physical and mental well-being. It was thought that encouraging those who suffer from RA or OA to participate in exercise may help their symptoms, as such the primary purpose of this study was to investigate the effects of a short-term conditioning exercise program (12 weeks), with follow-up evaluations after 3 months and 9 months, for people with RA or OA.

## Research Location and Type of Research

This research was undertaken in the United States of America at the Departments of Medicine and Statistics, University of Missouri, Colombia.
This research was conducted as a clinical trial, the study also used a 2-factor experimental design: exercise group and time for analysis of data.

## What was involved

The study was divided into three groups, each participant was randomly assigned to one of three groups for the duration of the study. The three groups were assigned to be either aerobic walking, aerobic aquatics, or the range of motion (RoM) exercise control group. All groups met three times a week, for one hour, each week for 12 weeks. Four replications of the initial assessment samples were performed to ensure statistically useful data, this also helped to ensure each class contained no more than 12 subjects. All three groups were run by the same three instructors at all locations. Each class consisted of a warm-up period, with general flexibility and isometric strengthening of postural muscles, progressing to an, aerobically active period of 30 minutes of continuous activity followed by 10 minutes of active range of motion and stretching.
To assess the individuals participating, exercise tolerance, flexibility, disease status, health status, daily activity level, self-concept, and current use of medications were assessed at baseline, end of the 12-week exercise program, and at the 3 and 9-month points after the exercise intervention.
* To assess exercise tolerance the Naughton Treadmill Protocol was used.
* to assess flexibility a sit and reach test was used
* The extent and severity of arthritis were assessed using the following measures: standardized joint examination (for pain, tenderness, and swelling of peripheral joints; presence of either pain, tenderness or swelling was designated clinically active) performed by a rheumatologist, grip strength, self-report of pain, and duration of morning stiffness.
* To assess Health status the Arthritis Impacts Measurement Scales (AIMS) was used. AIMS is used extensively with RA and OA patients and has proven to be a reliable and sensitive measure of arthritis-related function.
* Self-concept was tested using the Tennessee Self-concept scales however only the physical self-concept was analysed for the purpose of this study.

## What were the basic results?

Subjects who participated in the aerobic conditioning exercise study showed significant improvement over control subjects who were only in the range of motion exercise. Most subjects, however, reported no change in their medications used to treat the symptoms of arthritis.
| Drug treatment intensity | Aerobic group | Aquatics Group | Control Group |
| No change | 74% | 86% | 79% |
| More intense | 3% | 7% | 14% |
| Less intense | 23% | 7% | 7% |
Both aerobic groups showed improves in physical activity levels from the initial levels, indicating an improvement in confidence to exercise with their symptoms, it also showed improvement in flexibility and grip strength. The pool group also showed a decrease in the duration of morning stiffness in the affected joints. The control group also showed significant improvements in exercise endurance and grip strength, as well as a reduction of the levels of pain, felt in the afflicted joints.
The results of this study have confirmed previous findings that those who suffer from RA and OA can exercise without exacerbation of their signs and symptoms, it appears from the results of this study that walking is a good conditioning exercise, even for people with arthritis in weight-bearing joints. An incidental outcome of this study was that participants from the walking group reported a continuation of exercise after cessation of the study and reported further improvements in their symptoms and further gains in cardiorespiratory fitness.

## Conclusions from the Research

It can be concluded from this study that the ability of those who suffer from RA and OA to exercise for improved fitness and general well-being is no longer in question. With exercise programs developed with the needs of those impacted by arthritis in mind, enjoyable and effective exercise regimes can be developed and offered to them.
The results of the study seem to suggest the practicality of both aquatic and walking exercise programs as appropriate forms of conditioning exercise for the person who has arthritis. The results also suggest that due to the social nature of these activities that participants are more likely to stick to them and continue to exercise outside of a clinical setting.

## Practical advice

It is recommended that before undertaking any exercise programs a doctor is consulted and that the exercise is conducted under supervision. Furthermore, as per the recommendations of the study, the exercise should be low-impact in nature and sustained only for as long as the individual can handle, pushing beyond the limits of someone suffering from arthritis may very well prove to be detrimental, thus defeating the purpose of exercising.

## Further information/resources

Living and dealing with Arthritis Better Health Channel
Symptom Checker and advice on GP's Healthdirect
More information on Osteoarthritis
More information on Rheumatoid Arthritis

## References

* ↑ Minor, M. A., Webel, R. R., Kay, D. R., Hewett, J. E. and Anderson, S. K. (1989), Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis & Rheumatism, 32: 1396–1405. doi:10.1002/anr.1780321108
* ↑ Naughton JP, Haider R: Exercise testing, Exercise Testing and Exercise Training in Coronary Heart Disease.Edited by JP Naughton, HK Hellerstein. New York, Academic Press, 1973
* ↑ Jette M: The standardized test of fitness in occupational health: a pilot project. Can J Public Health 69:431438, I978
* ↑ Kazis LE, Meenan RF, Anderson JJ: Pain in the rheumatic diseases: investigation of a key health status component. Arthritis Rheum 26: 1017-1022, 1983
* ↑ Meenan RF, Gertman PM, Mason JH, Dunaif R: The Arthritis Impact Measurement Scales: further investigations of a health status measure. Arthritis Rheum 25:1048-1053, 1982
* ↑ Pound RE, Hansen JC, Putnam BA: An empirical analysis of the Tennessee Self-Concept Scale. Educ Psychol Meas 37545-551, 1977
* ↑ Haskell WL, Montoye HJ, Orenstein D: Physical activity and exercise to achieve health-related physical fitness components. Public Health Rep 100:202-211, 1985
* ↑ Ekblom B, Lovgren 0, Alderin M, Fridstrom M, Satterstrom G: Physical performance in patients with rheumatoid arthritis. Scand J Rheumatol 3:121-125, 1974