Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. Effects of a Group-Based Exercise and Educational Program on Physical Performance and Disease Self-Management in Rheumatoid Arthritis: A Randomized Controlled Study Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. Effects of aerobic, resistance and balance training in adults with intellectual disabilities. Slowing of bone loss in patients with rheumatoid arthritis by long-term high-intensity exercise: results of a randomized, controlled trial. Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. A HOME-BASED MULTIDIMENSIONAL EXERCISE PROGRAM REDUCED PHYSICAL IMPAIRMENT AND FEAR OF FALLING Community rehabilitation for older adults with osteoarthritis of the lower limb: a controlled clinical trial Balneotherapy and tap water therapy in the treatment of knee osteoarthritis The usability and preliminary effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis Dynamic Balance Training Improves Physical Function in Individuals With Knee Osteoarthritis: A Pilot Randomized Controlled Trial. The value of a continuous ambulatory activity monitor to quantify the amount and intensity of daily activity in patients with rheumatoid arthritis. Effect of intensive exercise on patients with active rheumatoid arthritis: a randomised clinical trial Effects of detraining subsequent to strength training on neuromuscular function in patients with inflammatory arthritis. Change in knee cartilage volume in individuals completing a therapeutic exercise program for knee osteoarthritis. Pilates for Improvement of Muscle Endurance, Flexibility, Balance, and Posture The effect of physical training on patients with rheumatoid arthritis: changes in disease activity, muscle strength and aerobic capacity. A clinically controlled minimized cross-over study. Comparable effect of partly supervised and self-administered exercise programme in early rheumatoid arthritis--a randomised, controlled trial. Efficacy of low load resistive muscle training in patients with rheumatoid arthritis functional class II and III. The limited value of the Health Assessment Questionnaire as an outcome measure in short term exercise trials. Cardiovascular risk factors, including thrombotic variables, in a population with rheumatoid arthritis. Impact of Weight Loss on Physical Function with Changes in Strength, Muscle Mass, and Muscle Fat Infiltration in Overweight to Moderately Obese Older Adults: A Randomized Clinical Trial
AIM This paper reports a study of the effects of aquatic exercise on physical fitness ( flexibility , strength and aerobic fitness ) , self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee . BACKGROUND Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement . Exercise is important for preventing and /or managing the functional limitations associated with joint disease . Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis ; however , few studies have examined the effects on people with osteoarthritis , and these have yielded inconsistent results . METHODS A two-group r and omized controlled trial with a convenience sample was used . Participants were recruited from community sources and r and omly assigned to a 12-week aquatic programme or a non-exercise control condition . Data for 38 participants were collected at baseline , week 6 , and week 12 during 2003 and 2004 . Instruments were a st and ard plastic goniometer , a h and held dynamometer , the 6-minute walk test , the multidimensional Health Assessment Question naire , and a visual analogue scale for pain . RESULTS Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility , strength and aerobic fitness , but had no effect on self-reported physical functioning and pain . The exercise adherence rate was 81.7 % , and no exercise-related adverse effect was observed or reported . CONCLUSIONS Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee . Although the programme may not offer pain relief or self-reported improvements in physical functioning , results suggest that aquatic exercise does not worsen the joint condition or result in injury . Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients Background Evidence supports the use of educational and physical training programs for people with rheumatoid arthritis ( RA ) . Objective The purpose of this study was to evaluate the effects of a group-based exercise and educational program on the physical performance and disease self-management of people with RA . Design This was a r and omized controlled trial . Setting The study was conducted at a rehabilitation center in the Netherl and s. Participants Thirty-four people diagnosed with RA participated in the study . Participants were r and omly assigned to either an intervention group ( n=19 ) or a waiting list control group ( n=15 ) . Intervention The intervention in this study was an 8-week , multidisciplinary , group therapy program for people with RA , consisting of physical exercise design ed to increase aerobic capacity and muscle strength ( force-generating capacity ) together with an educational program to improve health status and self-efficacy for disease-self-management . Measurements The main outcome measures were maximum oxygen uptake ( V̇o2max ) , muscle strength of the elbow and knee flexors and extensors , health status , and perceived self-efficacy . All data were recorded before intervention in week 1 , after intervention in week 9 , and at follow-up in week 22 . Results The intervention group showed significant improvement ( 12.1 % ) in V̇o2max at week 9 compared with the control group ( −1.7 % ) . Although significant within-group changes were found over time for muscle strength of the upper and lower extremities and health status that favored the intervention group , no between-group changes were found regarding these outcomes . Limitations An important limitation was the small number of participants included in our study , which may have result ed in a lack of power . Conclusions The present group-based exercise and educational program for people with RA had a beneficial effect on aerobic capacity but not on muscle strength , health status , or self-efficacy OBJECTIVE Twelve forms of Sun-style tai chi exercise have been developed specifically to reduce the symptoms and improve the physical functioning of arthritic patients , and this r and omized study examined the changes in symptoms and physical characteristics in older women with osteoarthritis ( OA ) at the completion of a 12-week tai chi exercise program . METHODS Seventy-two patients with OA were r and omly assigned into 2 groups . Due to a 41 % overall dropout rate , 22 experimental subjects and 21 controls completed pre- and post-test measures over a 12 week interval . Outcome variables were physical symptoms and fitness , body mass index , cardiovascular functioning , and perceived difficulties in physical functioning . The independent t test was used to examine group differences . RESULTS The homogeneity test confirmed that there were no significant group differences in demographic data and pretest measures . Mean comparisons of the change scores revealed that the experimental group perceived significantly less pain ( t = -2.19 , p = 0.034 ) and stiffness ( t = -2.13 , p = 0.039 ) in their joints , and reported fewer perceived difficulties in physical functioning ( t = -2.81 , p = 0.008 ) , while the control group showed no change or even deterioration in physical functioning after 12 weeks . In the physical fitness test , there were significant improvements in balance ( t = 3.34 , p = 0.002 ) and abdominal muscle strength ( t = 2.74 , p = 0.009 ) for the tai chi exercise group . No significant group differences were found in flexibility and upper-body or knee muscle strength in the post-test scores . CONCLUSION Older women with OA were able to safely perform the 12 forms of Sun-style tai chi exercise for 12 weeks , and this was effective in improving their arthritic symptoms , balance , and physical functioning . A longitudinal study with a larger sample size is now needed to confirm the potential use of tai chi exercise in arthritis management Adults with intellectual disability ( ID ) have decreased cardiovascular fitness and strength present with lower rates of physical activity ( PA ) , and often have balance and functional impairments . The purpose of this study was to investigate the effect of a combined PA program ( CPAP ) utilizing aerobic , strength and balance training on cardiovascular fitness , strength , balance and functional measures in a controlled clinical trial . Adults with mild to moderate ID were assigned into either the intervention group ( IG ; n=37 ) or the control group ( CG ; n=29 ) . The IG trained 3 day/week , 1 h/day over 14 weeks , while the CG did not participate in any exercise program .  Cardiovascular fitness , strength , balance , flexibility and functional ability were assessed pre-post training . The IG increased cardiovascular fitness ( 26.8 vs. 29.3 ml kg(-1 ) min(-1 ) ) , h and grip strength ( 19.2 vs. 21.9 kg ) , leg strength , and balance following the training period ( p<.05 ) . Body weight ( 70.1 vs. 68.1 kg ) and body mass index ( 27.4 vs. 26.6 kg m(-2 ) ) decreased ( p<.05 ) in the IG group . The CG showed no changes in any parameter . These data suggest a combined aerobic , strength and balance exercise training program is beneficial among individuals with ID OBJECTIVE Patients with rheumatoid arthritis ( RA ) are more at risk for the development of osteoporosis and osteoporotic fractures than are their healthy peers . In this r and omized , controlled , multicenter trial , the effectiveness of a 2-year high-intensity weight-bearing exercise program ( the Rheumatoid-Arthritis- Patients -In-Training [ RAPIT ] program ) on bone mineral density ( BMD ) was compared with usual care physical therapy , and the exercise modalities associated with changes in BMD were determined . METHODS Three hundred nine patients with RA were assigned to an intervention group , either the RAPIT program or usual care physical therapy . The primary end points were BMD of the hip and spine . The exercise modalities examined were aerobic fitness , muscle strength , and , as a surrogate for those effects not directly measured by the RAPIT program , attendance rate . RESULTS The data on the 136  RAPIT participants and 145 usual care participants who completed the study were analyzed . The mean rate of decrease in hip BMD , but not in lumbar spine BMD , was smaller in patients participating in the RAPIT program when compared with that in the usual care group , with a mean decrease of 1.6 % ( 95 % confidence interval [ 95 % CI ] 0.8 - 2.5 ) over the first year and 0.5 % ( 95 % CI 1.1 - 2.0 ) over the second year . The change in hip BMD was significantly and independently associated with changes in both muscle strength ( multivariate odds ratio [ OR ] 1.75 , 95 % CI 1.07 - 2.86 ) and aerobic fitness ( OR 1.79 , 95 % CI 1.10 - 2.90 ) , but not with the attendance rate ( OR 1.00 , 95 % CI 0.99 - 1.00 ) . CONCLUSION A long-term high-intensity weight-bearing exercise program for RA patients is effective in slowing down the loss of BMD at the hip . The exercise modalities associated with this effect are muscle strength and aerobic fitness OBJECTIVE To examine effects of activity strategy training ( AST ) , a structured rehabilitation program taught by occupational therapists and design ed to teach adaptive strategies for symptom control and engagement in physical activity ( PA ) . METHODS A r and omized controlled pilot trial was conducted at 4 sites ( 3 senior housing facilities and 1 senior center ) in southeastern , lower Michigan . Fifty-four older adults with hip or knee osteoarthritis ( mean + /- SD age 75.3+/-7.1 years ) participated . At each site , older adults were r and omly assigned to 1 of 2 programs : exercise plus AST ( Ex + AST ) or exercise plus health education ( Ex + Ed ) . The programs involved 8 sessions over 4 weeks with 2 followup sessions over a 6-month period , and were conducted concurrently within each site . Pain , total PA and PA intensity ( measured objective ly by actigraphy and subjectively by the Community Healthy Activities Model Program for Seniors question naire ) , arthritis self-efficacy , and physical function were assessed at baseline and posttest . RESULTS At posttest , participants who received Ex + AST had significantly higher levels of objective peak PA ( P=0.02 ) compared with participants who received Ex + Ed . Although not statistically significant , participants in Ex + AST tended to have larger pain decreases , increased total objective and subjective PA , and increased physical function . No effects were found for arthritis self-efficacy . CONCLUSION Although participants were involved in identical exercise programs , participants who received AST tended to have larger increases in PA at posttest compared with participants who received health education . Future studies will be needed to examine larger sample s and long-term effects of AST A group of 120 patients with rheumatoid arthritis or osteoarthritis volunteered to be subjects for this study of aerobic versus nonaerobic exercise . Patients were stratified by diagnosis and r and omized into an exercise program of aerobic walking , aerobic aquatics , or nonaerobic range of motion ( controls ) . The retention rate for the 12-week program was 83 % . Exercise tolerance , disease-related measures , and self-reported health status were assessed . The aquatics and walking exercise groups showed significant improvement over the control group in aerobic capacity , 50-foot walking time , depression , anxiety , and physical activity after the 12-week exercise program . There were no significant between-group group differences in the change scores for flexibility , number of clinical ly active joints , duration of morning stiffness , or grip strength . Our findings document the feasibility and efficacy of conditioning exercise for people who have rheumatoid arthritis or osteoarthritis Abstract Objective . To investigate the efficacy of a guided and grade d home-based exercise program for improving a range of physical outcomes in older people . Design . Controlled clinical trial of 16 weeks Setting . Two geographical areas in Gent , Belgium Participants . 66 independent-living older people ( age : 71 - 98 ) with a history of falls and moderate physical impairment Intervention . Twenty-four 30-minute training sessions were given by a trained physiotherapist over a period of 16 weeks in the participant ’s home . Different types of exercises on balance , aerobic performance , flexibility , and muscle strength were provided . Main outcome measures . Muscle strength , static and dynamic balance , aerobic performance , activities in daily living , fear of falling and avoidance of daily activities were assessed at baseline and after 16 weeks intervention . Results : At baseline , there were no significant differences in the measured variables between exercise and control groups . After 16 weeks , the exercise group showed significantly improved ankle muscle strength , balance performance and aerobic capacity , and decreased fear of falling , dependency in daily activities and avoidance of daily activities compared to the control group . The improvements in knee muscle strength , timed chair st and s , and functional reach were not significant . Conclusion : The home-based , individualized exercise program was effective in reducing several physical factors associated with falls in community-dwelling older people with moderate physical impairment . The decrease in fear of falling and other behavioural variables needs to be considered with care and needs further investigation Objective : To examine the effectiveness of a 12-month community-based water exercise programme on measures of self-reported health and physical function in people aged over 60 years old with knee-hip osteoarthritis ( OA ) . Design : A quasi-experimental design consisting of an exercise group and an age-matched control group . Setting : Public community swimming pool in Sheffield , UK . Subjects : One hundred and six community-dwelling sedentary older people , with confirmed knee-hip osteoarthritis , enrolled in an experimental controlled trial for 12 months . Sixty-six subjects in the exercise group were offered a water-exercise programme .  Forty age-matched , nonexercising , ‘ control ’ subjects received monthly education material and quarterly telephone calls . Interventions : Participants in the exercise group were asked to attend two exercise sessions a week of 1 hour duration led by specially trained swimming instructors . Main measures : Primary outcome measure was the disease-specific Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) . Secondary outcomes included a battery of performance-based physical function tests . Results : Adherence to exercise averaged 70 % ( ±14 % ) over the year : 77 % of the exercising subjects and 89 % control subjects completed both pre- and post- outcome measures . After one year , participants in the exercise group experienced a significant improvement in physical function ( 4.0 ± 9.1 versus -0.4 ± 7.3 units ; 95 % confidence interval ( CI ) 0.96–7.96 , p < 0.05 ) and reduction in the perception of pain ( 1.3 ± 3.7 versus 0.2 ± 2.5 units ; 95 % CI -0.19 - 2.52 , p < 0.05 ) compared with the control group , as measured by the WOMAC Osteoarthritis Index . In addition , the exercise group performed significantly better in the ascending and descending stairs tests ( p < 0.05 ) , had significantly greater improvements in knee range of movement ( p < 0.01 ) and hip range of movements ( p < 0.005 ) . There were no significant differences in the two groups for quadriceps muscle strength and psychosocial well-being ( Arthritis Impact Measurement Scales 2 question naire ) . Conclusions : Older people with knee/hip osteoarthritis gained modest improvements in measures of physical function , pain , general mobility and flexibility after participating in 12 months of community-based water exercise To investigate if spa water is superior to tap water ( TW ) in relieving the symptoms of pain , joint motion , life quality in knee osteoarthritis ( KOA ) patients . In this r and omized placebo-controlled trial , 52 patients with KOA were followed in two groups . In group I ( n = 27 ) , patients were treated in the pool full of spa water at 37 ° C for 20 min a day , 5 days a week , for a period of 2 weeks . In group II ( n = 25 ) , the same protocol was used but spa water was replaced by TW heated to 37 ° C . Patients in both groups were given a home-based st and ardized exercise program . Evaluation parameters were pain ( pVAS ) , tenderness score ( TS ) , 50-ft walking duration , quadriceps muscle strength ( QMS ) , active flexion degree ( AFD ) , WOMAC OA index , and Nottingham Health Profile ( NHP ) . The first evaluation was done after the informed consent was obtained . Second and third evaluations were done at the 2nd and 12th week . PVAS , 50-ft walking duration , AFD , TS , WOMAC , and NHP variables improved in group I. Same variables except QMS improved also in group II . Comparison of the groups just after treatment showed that only pVAS ( P = 0.015 ) , NHP pain score ( P = 0.020 ) , and TS ( P = 0.002 ) differed significantly in favor of group I at the 2nd or 12th week . Both of the thermal treatment modalities were found to be effective in the management of the clinical symptoms and quality of life in KOA patients . However , pain and tenderness improved statistically better with balneotherapy . There were no significant differences between the groups for the other variables Background A large proportion of patients with knee and /or hip osteoarthritis ( OA ) do not meet the recommended levels of physical activity ( PA ) . Therefore , we developed a web-based intervention that provides a tailored PA program for patients with knee and /or hip OA , entitled Join2move . The intervention incorporates core principles of the behaviour grade d activity theory ( BGA ) . The aim of this study was to investigate the preliminary effectiveness , feasibility and acceptability of Join2move in patients with knee and /or hip OA . Methods A non-r and omized pilot study was performed among patients with knee and /or hip OA . Primary outcomes were PA ( SQUASH Question naire ) , physical function ( HOOS and KOOS question naires ) and self-perceived effect ( 7-point Likert scale ) . Baseline , 6 and 12 week follow-up data were collected via online question naires . To assess feasibility and acceptability , program usage ( modules completed ) and user satisfaction ( SUS question naire ) were measured as secondary outcomes . Participants from the pilot study were invited to be interviewed . The interviews focused on users ’ experiences with Join2move . Besides the pilot study we performed two usability tests to determine the feasibility and acceptability of Join2move . In the first usability test , software experts evaluated the website from a list of usability concepts . In the second test , users were asked to verbalize thoughts during the execution of multiple tasks . Results Twenty OA patients with knee and /or hip OA between 50 and 80 years of age participated in the pilot study . After six weeks , pain scores increased from 5.3 to 6.6 ( p=0.04 ) . After 12 weeks this difference disappeared ( p=0.5 ) . Overall , users were enthusiastic about Join2move . In particular , performing exercise at one 's own pace without time or travel restrictions was cited as convenient . However , some minor flaws were observed . Users perceived some difficulties in completing the entire introduction module and rated the inability to edit and undo actions as annoying . Conclusions This paper outlines the preliminary effectiveness , feasibility and acceptability of a web-based PA intervention . Preliminary results from the pilot study revealed that PA scores increased , although differences were not statistically significant . Interviews and usability tests suggest that the intervention is feasible and acceptable in promoting PA in patients with knee and /or hip OA . The intervention was easy to use and the satisfaction with the program was high . Trial registration The Netherl and s National Trial Register . Trial number : OBJECTIVE To examine the effect of a targeted balance training program on dynamic balance and self-reported physical function in people with medial tibiofemoral osteoarthritis ( OA ) . DESIGN Single-blind r and omized controlled trial . SETTING Exercise gymnasium and community dwellings . PARTICIPANTS Individuals with medial compartment knee OA ( N=40 ) . INTERVENTIONS Ten weeks of partially supervised exercises targeting dynamic balance and strength performed 4 times per week or no intervention ( nonintervention group ) . MAIN OUTCOME MEASURES Dynamic balance was measured using the Community Balance and Mobility Scale ( CB&M ) , and self-reported physical function was measured using the Western Ontario and McMaster Universities Arthritis Index physical function subscale . Secondary outcomes included knee pain , fear of movement , knee joint proprioception , and muscle strength . RESULTS Forty individuals underwent baseline testing , with 36 participants completing follow-up testing .  Adherence to exercise in the training group was high , with 82.2 % of all home-based exercise sessions completed . No significant changes were observed in any outcome in the nonintervention group at follow-up . Significant improvements in self-reported pain , physical function , and fear of movement were observed in the training group when compared with the nonintervention group . No other within- or between-group differences were observed . CONCLUSIONS A 10-week dynamic balance training program for people with knee OA significantly improved self-reported knee pain , physical function , and fear of movement ; however , there was no change in dynamic balance as quantified by the CB&M. Further research is needed to investigate how exercise may result in improvement on objective measures of dynamic balance OBJECTIVE To examine the reliability , validity , and responsiveness of a continuous ambulatory activity monitor in patients with rheumatoid arthritis ( RA ) . METHODS Forty-one patients with RA , participating in a r and omized controlled trial examining the effect of an intensive exercise program  , were assessed by means of the  Dynaport ADL ( activities of daily living ) monitor ( AM ) .  The time spent on activities ( locomotion , st and ing , and active sitting ) during 24 hours and the intensity of trunk movement during these activities were recorded . To determine test-retest reliability 20 patients were reassessed with the AM one week after the first assessment . Construct validity of the AM was determined by comparing the AM results with physical fitness measures ( muscle strength , endurance , joint mobility ) , disease activity , and functional status . As well , 37 patients were assessed 18 months after the first assessment to determine responsiveness . RESULTS All AM measurements showed satisfactory test-retest reliability ( ICC 0.63 - 0.76 ) . AM measures were significantly associated with physical fitness , functional status , and disease activity , indicating construct validity of the AM . The AM could discriminate between patients with improvement and deterioration in physical fitness , indicating sufficient responsiveness of AM variables . CONCLUSION This study shows the value of an ambulatory activity monitor to quantify both the amount and intensity of physical activity of patients with RA during a day in their own environment . The ambulatory activity monitor seems to be a promising instrument for research into rehabilitation of patients with RA OBJECTIVE To investigate the effects of a dynamic , intensive exercise regimen on pain , disease activity , and physical functioning in active rheumatoid arthritis ( RA ) . METHODS 64 patients with RA with a mean age of 60 ( 13 ) years and mean disease duration of 8 ( 8) years , admitted to hospital because of active disease , were r and omly assigned to an  intensive exercise programme or to a  conservative exercise programme during their period in hospital with a mean length of 30 ( 14 ) days . The intensive exercise programme consisted of knee and shoulder dynamic and isometric muscle strengthening exercises against resistance five times a week and conditioning bicycle training three times a week and was supplemental to the conservative exercise programme of range of motion and isometric exercises . Indices of disease activity , pain , muscle strength , and functional ability were assessed at 0 , 3 , 6 , 12 , and 24 weeks by a blinded observer . RESULTS The medical treatment during the study was the same in both groups . Both groups improved in measures of disease activity , differences between groups were not statistically significant . The mean improvement in disease activity score at 24 weeks in the intensive and conservative exercise group was −1.4 ( 1.5 ) and −0.7 ( 1.4 ) , respectively . Measures of physical functioning improved significantly for patients in the intensive exercise group , and differences between groups were statistically significant for measures of muscle strength . CONCLUSION A short term intensive exercise programme in active RA is more effective in improving muscle strength than a conservative exercise programme and does not have deleterious effects on disease activity The effects of detraining subsequent to strength training on neuromuscular function were examined in 39 recent-onset rheumatoid arthritis ( RA ) patients . Eighteen age- and sex-matched healthy people ( H ) served as controls . Patients were r and omly allocated either to the experimental group ( PE ) , who carried out progressive strength training for 6 months , or to the control group ( PC ) , who maintained only their habitual physical activities . After 6 months , PE returned to their earlier physical activities and strength training was terminated . At baseline , the maximal strength of the trunk extensors ( not significant ) , grip strength and maximal dynamic strength and the shape of the force-time curve of the knee extensors were lower in PE and PC ( P < 0.05 - 0.001 ) than in H. Strength training in PE led to remarkable increases ( P < 0.05 - 0.001 ) in the maximal strength of all muscle groups without changes in the shape of the force-time curve . The increases in muscle strength in PE obtained by strength training were lost to a great degree during the detraining period for the isometric trunk extension ( P < 0.01 ) and flexion ( P < 0.01 ) strength and for the dynamic knee extension strength ( P < 0.05 ) , but not for the grip strength . In PC , trunk extension and flexion strength decreased significantly throughout the study period . At the post-test , all the strength values in both patient groups were much lower than in H. RA is a chronic disease which seems to need continuous physical exercise with sufficient intensity to minimize/prevent the loss of muscle strength and functional capacity STUDY DESIGN Prospect i ve cohort study . OBJECTIVES To characterize knee cartilage change in individuals with knee osteoarthritis ( KOA ) who have completed a therapeutic exercise program .  BACKGROUND While therapeutic exercise is frequently used successfully to improve pain and function in individuals with KOA , no studies have reported the volume of cartilage change or individual factors that may impact volume of cartilage change in those completing an exercise program  for KOA . METHODS Thirteen individuals with KOA underwent  magnetic resonance imaging to quantify cartilage volume change in the weight-bearing regions of the medial and lateral femoral condyles and the entire surface of the tibial plateaus from baseline to 1-year follow-up . Body structure and function measures were taken for body mass index , knee axis alignment , knee motion , and knee strength . Activity limitations and activity levels were also measured prior to the therapeutic exercise program , using the Western Ontario and McMaster Universities Osteoarthritis Index and the Physical Activity Scale for the Elderly . At 6 months from baseline , follow-up clinical measurements of knee strength and motion were performed . At 1 year from baseline , imaging of the knee cartilage and knee alignment were performed , and participants completed the Western Ontario and McMaster Universities Osteoarthritis Index and Physical Activity Scale for the Elderly . RESULTS The central region of the medial femoral condyle ( cMF ) had a median volume of cartilage loss of 3.8 % . The other 3 knee tibiofemoral articular surfaces had minimal median cartilage volume change . Individuals were dichotomized into progressors ( n = 6 ) and nonprogressors ( n = 7 ) , based on the st and ard error of measurement of cartilage volume change for the cMF . Progressors were younger , had a larger body mass index , had a higher Kellgren-Lawrence grade in the medial compartment of the knee , and had a greater increase in knee varus alignment from baseline to 1-year follow-up . The progressors also had frontal plane hip and knee kinetics during baseline gait analysis that potentially increased medial knee joint loading . CONCLUSION The loss of cMF cartilage volume was highly variable and the median loss of cartilage was within the range previously reported . Seven of the 13 individuals did not have cMF cartilage volume loss greater than the st and ard error of measurement . Change in cartilage volume of the cMF may be influenced to a greater extent by personal factors than by completion of a therapeutic exercise program . Additional research is needed to decipher the interactions among therapeutic exercise and personal characteristics that impact knee cartilage loss Kloubec , JA . Pilates for improvement of muscle endurance , flexibility , balance , and posture . J Strength Cond Res 24(3 ) : 661 - 667 , 2010-Many cl aims have been made about the effectiveness of Pilates exercise on the basic parameters of fitness . The purpose of this study was to determine the effects of Pilates exercise on abdominal endurance , hamstring flexibility , upper-body muscular endurance , posture , and balance .  Fifty subjects were recruited to participate in a 12-week Pilates class , which met for 1 hour 2 times per week . Subjects were r and omly assigned to either the experimental ( n = 25 ) or control group ( n = 25 ) . Subjects performed the essential ( basic ) mat routine consisting of ∼25 separate exercises focusing on muscular endurance and flexibility of the abdomen , low back , and hips each class session . At the end of the 12-week period , a 1-way analysis of covariance showed a significant level of improvement ( p ≤ 0.05 ) in all variables except posture and balance . This study demonstrated that in active middle-aged men and women , exposure to Pilates exercise for 12 weeks , for two 60-minute sessions per week , was enough to promote statistically significant increases in abdominal endurance , hamstring flexibility , and upper-body muscular endurance . Participants did not demonstrate improvements in either posture or balance when compared with the control group . Exercise-training programs that address physical inactivity concerns and that are accessible and enjoyable to the general public are a desirable commodity for exercise and fitness trainers . This study suggests that individuals can improve their muscular endurance and flexibility  using relatively low-intensity Pilates exercises that do not require equipment or a high degree of skill and are easy to master and use within a personal fitness routine For decades , physical training of rheumatoid arthritis (RA)- patients has been controversial , especially for patients with active disease . The aim of this study was to investigate whether RA- patients could receive graduated training without increasing the activity of the disease . In a controlled cross-over study the effect of graduated progressive training has been evaluated in 18 RA- patients with moderately active disease . The training was performed twice weekly with aerobic conditioning and strength exercises progressing to strenuous exercises over an 8-week period . The design was a crossover project with two groups obtained by minimisation . After training the patients had significantly fewer swollen joints than before . Training of the muscles acting over the swollen joints result ed in more than a 35 % decrease in the number of swollen joints . The hemoglobin level increased significantly after the training period . The erythrocyte sedimentation rate , the complement factor C3d , and the number of sore joints remained unchanged . A decrease in the need for medicine was non-significant . From this study it appears that RA- patients with some activity are trainable without aggravating the disease , even in the chronically swollen joints . The rheumatoid arthritis activity decreased with fewer swollen joints and higher hemoglobin level after training INTRODUCTION There is a need to establish a framework and exercise level for patients with early rheumatoid arthritis ( RA ) . The aim of this study was to compare the effect of a partly supervised and a self-administered exercise programme for patients with early RA . METHODS A total of 51 patients with early ( ≤ 5 years ) RA were r and omised to either a six-week supervised , progressive , high-intensity exercise programme followed by a six-week self-administered exercise programme or a 12-week self-administered exercise programme . RESULTS A total of 36 patients completed the study . Following the 12 weeks of exercises , patients in the two groups had improved both their muscle strength and their physical fitness . There was a significant difference in Disease Activity Score in 28 joints calculated with C-reactive protein between the two exercise groups , but no significant differences in physical fitness , pain perception , Health Assessment Question naire , Short Form 36 health survey question naire , Fear-Avoidance Beliefs Question naire , or in muscle strength , except from a significant difference in trunk extensors . The dropout was 40 % in the supervised group versus 20 % in the self-administered group . CONCLUSION A progressive , high-intensity exercise programme is feasible for patients with early RA , although we observed an elevated number of dropouts for reasons not related to the intervention . The partly supervised exercise programme with follow-up after 12 weeks does not seem to be more effective than the self-administered exercise programme . FUNDING none . TRIAL REGISTRATION The trial was registered with www . clinical trials.gov ( NCT01553305 ) OBJECTIVE To determine the effect of a low load resistance exercise training program on muscle strength , functional outcome , and cardiovascular endurance . METHODS Forty-nine patients , 37 women and 12 men between the ages of 35 - 76 yrs ( mean 60.5 yrs ) , with definite rheumatoid arthritis ( RA ) functional class II and III ( mean disease duration of 10.5 yrs ) were r and omly assigned to exercise and control groups for a 12 wk resistive muscle training program . A circuit weight bearing form of training was incorporated using light loads with high repetitions . A video tape demonstrating the exercises was given to all exercising participants to enable them to continue the program at home at least 3 times per wk with a biweekly self-report evaluation . Baseline and post-intervention evaluations included joint activity , muscle strength , endurance , functional outcome , and self-report . Cardiovascular fitness measured by treadmill time , anaerobic threshold and peak oxygen consumption ( VO2 ) in this group were assessed at baseline and 12 wks . RESULTS A significant improvement at 12 wks was noted in the exercise group for self-reported joint count ( p = 0.02 ) , number of painful joints ( p = 0.004 ) , HAQ ( p = 0.012 ) , sit-to-st and time ( p = 0.02 ) , grip strength ( p = 0.05 ) knee extension 60 degrees ( p = 0.03 ) , Arthritis Impact Measurement Scales dexterity ( p = 0.02 ) , and time to anaerobic threshold ( p = 0.03 ) . Significant improvement in the exercise group compared to the control group was noted for self-reported joint count ( p = 0.02 ) , night time pain ( p = 0.05 ) , and sit-to-st and time ( p = 0.02 ) . Increase in treadmill time was not statistically significant nor was a change in peak oxygen consumption ( VO2 ) noted . Abnormalities on initial treadmill screening were detected in 2 of 49 asymptomatic patients . They were excluded from the study and subsequent workup revealed significant coronary artery disease . CONCLUSION Low load resistive muscle training increased functional capacity as reported by patients and is a clinical ly safe form of exercise in functional class II and III RA . Screening this population for dormant coronary artery disease is recommended OBJECTIVE To examine the value of the  Health Assessment Question naire ( HAQ ) as an outcome measure in short term exercise trials . We studied the association of the objectives of exercise , namely joint mobility , muscle strength , and physical condition , with the HAQ . METHODS Data for 100 patients with rheumatoid arthritis ( RA ) included in a study to examine the effect of exercise therapy were used for secondary analysis . Disease activity was determined by the disease activity score ( DAS3 ) , pain was scored on a visual analog scale ( VAS ) , and depression was measured by the Dutch Arthritis Impact Measurement Scale . Aerobic capacity ( VO2max ) estimated from a submaximal ergometer test , grip strength ( kPa ) ,  isokinetic muscle strength of the knee  ( Nm/kg ) , and the  Escola Paulista de Medicina range of motion ( EPM-ROM ) score , a measure of general flexibility , were used as indicators for physical impairments . All variables were entered in a forward multiple regression analysis with the HAQ as dependent variable . RESULTS The HAQ was significantly correlated with the DAS3 score ( r = 0.53 ) , pain ( r = 0.51 ) , depression ( r = 0.40 ) , joint mobility ( r = 0.27 ) , quadriceps strength ( r = -0.35 ) , and grip strength ( r = -0.50 ) , but not with physical condition . The DAS3 score was first entered in the multiple regression analysis model , followed by pain , quadriceps strength , and grip strength ( R2 = 0.45 ) . After 12 weeks of exercise therapy changes in the HAQ were significantly correlated with changes in pain ( r = 0.41 ) , in depression ( r = 0.33 ) , and in quadriceps strength ( r = -0.25 ) , but not with changes in joint mobility or physical condition . CONCLUSION Physical impairments are weakly associated with the HAQ .  The HAQ is not an appropriate instrument to detect changes in physical impairments due to short term exercise therapy OBJECTIVE To compare prevalent cardiovascular disease , conventional cardiovascular risk factors and thrombotic variables in a cohort with well-controlled rheumatoid arthritis ( RA ) and in population controls . METHODS Seventy-six RA patients and 641 controls , r and omly sample d from the local population in the North Glasgow MONICA study . Conventional cardiovascular risk factors ( blood pressure , smoking , cholesterol ) and thrombotic variables [ fibrinogen , von Willebr and factor ( vWF ) , tissue plasminogen activator antigen ( t-PA ) , fibrin D-dimer , plasminogen activator inhibitor ( PAI-1 ) , plasma viscosity ] were measured by st and ard procedures . RESULTS RA patients had a significantly higher prevalence of angina pectoris ( P=0.03 ) . Stroke also tended to be more common in the RA group , but the difference did not reach statistical significance ( P=0.08 ) . Diastolic blood pressure was significantly higher and serum cholesterol significantly lower in the RA group than in controls . Current smoking habits and exercise history were similar in the two groups , although RA patients were more likely to have previously smoked . Significant elevations in several thrombotic predictors of cardiovascular disease ( fibrinogen , vWF , t-PA antigen and fibrin D-dimer ) were found in the RA group . CONCLUSIONS In this RA patient population , diastolic blood pressure was higher than in controls and thrombotic variables were elevated compared with controls . These features are identified as potential additional cardiovascular risk factors in the RA patients studied . Prospect i ve studies of risk modification may permit the identification of factors which could lead to a reduction in the known increased cardiovascular risk in RA Purpose . Evaluate the effects of weight loss on muscle mass and area , muscle fat infiltration , strength , and their association with physical function . Methods . Thirty-six overweight to moderately obese , sedentary older adults were r and omized into either a physical activity plus weight loss ( PA+WL ) or physical activity plus successful aging health education ( PA+SA ) program . Measurements included body composition by dual-energy X-ray absorptiometry , computerized tomography , knee extensor strength , and short physical performance battery ( SPPB ) . Results . At 6 months , PA+WL lost greater thigh fat and muscle area compared to PA+SA . PA+WL lost 12.4 % strength ; PA+SA lost 1.0 % . Muscle fat infiltration decreased significantly in PA+WL and PA+SA . Thigh fat area decreased 6-fold in comparison to lean area in PA+WL . Change in total SPPB score was strongly inversely correlated with change in fat but not with change in lean or strength . Conclusion . Weight loss result ed in additional improvements in function over exercise alone , primarily due to loss of body fat
Conclusion Exercises and PA promotion according to public health recommendations  for PA improved cardiovascular fitness , muscle strength and PA behaviour , with moderate effect sizes in people with SpA , RA and HOA/KOA .
Objective To evaluate the effectiveness of exercise and physical activity ( PA ) promotion on cardiovascular fitness , muscle strength , flexibility , neuromotor performance ( eg , balance ) and daily PA in people with rheumatoid arthritis ( RA ) , spondyloarthritis ( SpA ) and hip/knee osteoarthritis ( HOA/KOA ) .