Rheumatology International

, Volume 30, Issue 2, pp 147–158

A systematic review of the effects of dynamic exercise in rheumatoid arthritis

Review Article

Abstract

Exercise is commonly used in the management of patients with rheumatoid arthritis (RA); however, there is little consensus in the literature to support its use. This systemic review aimed to determine the effects of dynamic exercise on patients with RA. A systematic search of Medline (1949–2007), Cinahl (1982–2007), Embase (1974–2007) and Cochrane library was performed for randomised-controlled trials using the keywords “rheumatoid arthritis” and “exercise” or “training” or “sport”. The methodological quality of studies was assessed using a ten-point scale. Eighteen papers relating to 12 different studies met inclusion criteria. The mean methodological quality score was 6.9/10. Studies using aerobic training, strength training and combinations of both were included. Patients with early, stable, and active RA were studied. A number of studies reported improvement in muscle strength, physical function and aerobic capacity with dynamic exercise. Some studies also reported improvements in disease activity measures, and small improvements in hip bone mineral density. One study reported significantly less progression of small joint radiographic damage of the feet in the dynamic exercise group. However, one study also reported worse large joint radiographic damage in patients using dynamic exercise who had pre-existing large joint damage, though this was a retrospective analysis. No studies reported worse outcomes for function, disease activity or aerobic capacity with dynamic exercise. Cardiovascular outcomes were not reported in any study, and no data were presented to assess the effect of exercise on patients with significant underlying cardiovascular disease. This systematic review suggests that the majority of patients with RA should be encouraged to undertake aerobic and/or strength training exercise. Exercise programmes should be carefully tailored to the individual, particularly for patients with underlying large joint damage or pre-existing cardiovascular disease.

Keywords

Rheumatoid arthritis Exercise Rehabilitation Systematic review 

References

  1. 1.
    Naz SM, Symmons DP (2007) Mortality in established rheumatoid arthritis. Best Pract Res Clin Rheumatol 21(5):871–883. doi:10.1016/j.berh.2007.05.003 CrossRefPubMedGoogle Scholar
  2. 2.
    Szekanecz Z, Kerekes G, Der H, Sandor Z, Szabo Z, Vegvari A, Simkovics E, Soos L, Szentpetery A, Besenyei T, Szucs G, Szanto S, Tamasi L, Szegedi G, Shoenfeld Y, Soltesz P (2007) Accelerated atherosclerosis in rheumatoid arthritis. Ann N Y Acad Sci 1108:349–358. doi:10.1196/annals.1422.036 CrossRefPubMedGoogle Scholar
  3. 3.
    Gerli R, Sherer Y, Bocci EB, Vaudo G, Moscatelli S, Shoenfeld Y (2007) Precocious atherosclerosis in rheumatoid arthritis: role of traditional and disease-related cardiovascular risk factors. Ann N Y Acad Sci 1108:372–381. doi:10.1196/annals.1422.038 CrossRefPubMedGoogle Scholar
  4. 4.
    Snow MH, Mikuls TR (2005) Rheumatoid arthritis and cardiovascular disease: the role of systemic inflammation and evolving strategies of prevention. Curr Opin Rheumatol 17(3):234–241PubMedGoogle Scholar
  5. 5.
    Iversen MD, Fossel AH, Daltroy LH (1999) Rheumatologist-patient communication about exercise and physical therapy in the management of rheumatoid arthritis. Arthritis Care Res 12(3):180–192CrossRefPubMedGoogle Scholar
  6. 6.
    Van Den Ende CH, Vliet Vlieland TP, Munneke M, Hazes JM (2000) Dynamic exercise therapy for rheumatoid arthritis. Cochrane Database Syst Rev 2(2):CD000322Google Scholar
  7. 7.
    Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, Knipschild PG (1998) The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 51(12):1235–1241. doi:10.1016/S0895-4356(98)00131-0 CrossRefPubMedGoogle Scholar
  8. 8.
    van Tulder M, Furlan A, Bombardier C, Bouter L, Editorial Board of the Cochrane Collaboration Back Review Group (2003) Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine 28(12):1290–1299CrossRefPubMedGoogle Scholar
  9. 9.
    Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83(8):713–721PubMedGoogle Scholar
  10. 10.
    Munneke M, de Jong Z, Zwinderman AH, Ronday HK, van Schaardenburg D, Dijkmans BA, Kroon HM, Vliet Vlieland TP, Hazes JM (2005) Effect of a high-intensity weight-bearing exercise program on radiologic damage progression of the large joints in subgroups of patients with rheumatoid arthritis. Arthritis Rheum 53(3):410–417. doi:10.1002/art.21165 CrossRefPubMedGoogle Scholar
  11. 11.
    Bilberg A, Ahlmen M, Mannerkorpi K (2005) Moderately intensive exercise in a temperate pool for patients with rheumatoid arthritis: a randomized controlled study. Rheumatology (Oxford) 44(4):502–508. doi:10.1093/rheumatology/keh528 CrossRefGoogle Scholar
  12. 12.
    de Jong Z, Munneke M, Zwinderman AH, Kroon HM, Jansen A, Ronday KH, van Schaardenburg D, Dijkmans BA, Van den Ende CH, Breedveld FC, Vliet Vlieland TP, Hazes JM (2003) Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial. Arthritis Rheum 48(9):2415–2424. doi:10.1002/art.11216 CrossRefPubMedGoogle Scholar
  13. 13.
    de Jong Z, Munneke M, Lems WF, Zwinderman AH, Kroon HM, Pauwels EK, Jansen A, Ronday KH, Dijkmans BA, Breedveld FC, Vliet Vlieland TP, Hazes JM (2004) Slowing of bone loss in patients with rheumatoid arthritis by long-term high-intensity exercise: results of a randomized, controlled trial. Arthritis Rheum 50(4):1066–1076. doi:10.1002/art.20117 CrossRefPubMedGoogle Scholar
  14. 14.
    de Jong Z, Munneke M, Zwinderman AH, Kroon HM, Ronday KH, Lems WF, Dijkmans BA, Breedveld FC, Vliet Vlieland TP, Hazes JM, Huizinga TW (2004) Long term high intensity exercise and damage of small joints in rheumatoid arthritis. Ann Rheum Dis 63(11):1399–1405. doi:10.1136/ard.2003.015826 CrossRefPubMedGoogle Scholar
  15. 15.
    Hakkinen A, Sokka T, Kotaniemi A, Kautiainen H, Jappinen I, Laitinen L, Hannonen P (1999) Dynamic strength training in patients with early rheumatoid arthritis increases muscle strength but not bone mineral density. J Rheumatol 26(6):1257–1263PubMedGoogle Scholar
  16. 16.
    Hakkinen A, Sokka T, Kotaniemi A, Hannonen P (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 Rheum 44(3):515–522. doi:10.1002/1529-0131(200103)44:3<515::AID-ANR98>3.0.CO;2-5 CrossRefPubMedGoogle Scholar
  17. 17.
    Hakkinen A, Sokka T, Lietsalmi AM, Kautiainen H, Hannonen P (2003) Effects of dynamic strength training on physical function, Valpar 9 work sample test, and working capacity in patients with recent-onset rheumatoid arthritis. Arthritis Rheum 49(1):71–77. doi:10.1002/art.10902 CrossRefPubMedGoogle Scholar
  18. 18.
    Hakkinen A, Sokka T, Hannonen P (2004) A home-based two-year strength training period in early rheumatoid arthritis led to good long-term compliance: a five-year followup. Arthritis Rheum 51(1):56–62. doi:10.1002/art.20088 CrossRefPubMedGoogle Scholar
  19. 19.
    Hakkinen A, Sokka T, Kautiainen H, Kotaniemi A, Hannonen P (2004) Sustained maintenance of exercise induced muscle strength gains and normal bone mineral density in patients with early rheumatoid arthritis: a 5 year follow up. Ann Rheum Dis 63(8):910–916. doi:10.1136/ard.2003.013003 CrossRefPubMedGoogle Scholar
  20. 20.
    Harkcom TM, Lampman RM, Banwell BF, Castor CW (1985) Therapeutic value of graded aerobic exercise training in rheumatoid arthritis. Arthritis Rheum 28(1):32–39. doi:10.1002/art.1780280106 CrossRefPubMedGoogle Scholar
  21. 21.
    Komatireddy GR, Leitch RW, Cella K, Browning G, Minor M (1997) Efficacy of low load resistive muscle training in patients with rheumatoid arthritis functional class II and III. J Rheumatol 24(8):1531–1539PubMedGoogle Scholar
  22. 22.
    Lyngberg KK, Harreby M, Bentzen H, Frost B, Danneskiold-Samsoe B (1994) Elderly rheumatoid arthritis patients on steroid treatment tolerate physical training without an increase in disease activity. Arch Phys Med Rehabil 75(11):1189–1195. doi:10.1016/0003-9993(94)90003-5 CrossRefPubMedGoogle Scholar
  23. 23.
    McMeekin J, Stillman B, Story I, Kent P (1999) The effects of knee extensor and flexor muscle training on the timed-up-and-go test in individuals with rheumatoid arthritis. Physiother Res Int 4(1):55–67Google Scholar
  24. 24.
    Melikoglu MA, Karatay S, Senel K, Akcay F (2006) Association between dynamic exercise therapy and IGF-1 and IGFBP-3 concentrations in the patients with rheumatoid arthritis. Rheumatol Int 26(4):309–313. doi:10.1007/s00296-005-0605-y CrossRefPubMedGoogle Scholar
  25. 25.
    van den Ende CH, Breedveld FC, le Cessie S, Dijkmans BA, de Mug AW, Hazes JM (2000) Effect of intensive exercise on patients with active rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis 59(8):615–621. doi:10.1136/ard.59.8.615 CrossRefPubMedGoogle Scholar
  26. 26.
    van den Ende CH, Hazes JM, le Cessie S, Mulder WJ, Belfor DG, Breedveld FC, Dijkmans BA (1996) Comparison of high and low intensity training in well controlled rheumatoid arthritis. Results of a randomised clinical trial. Ann Rheum Dis 55(11):798–805CrossRefPubMedGoogle Scholar
  27. 27.
    Westby MD, Wade JP, Rangno KK, Berkowitz J (2000) A randomized controlled trial to evaluate the effectiveness of an exercise program in women with rheumatoid arthritis taking low dose prednisone. J Rheumatol 27(7):1674–1680PubMedGoogle Scholar
  28. 28.
    Baslund B, Lyngberg K, Andersen V, Halkjaer Kristensen J, Hansen M, Klokker M, Pedersen BK (1993) Effect of 8 wk of bicycle training on the immune system of patients with rheumatoid arthritis. J Appl Physiol 75(4):1691–1695PubMedGoogle Scholar
  29. 29.
    Bearne LM, Scott DL, Hurley MV (2002) Exercise can reverse quadriceps sensorimotor dysfunction that is associated with rheumatoid arthritis without exacerbating disease activity. Rheumatology (Oxford) 41(2):157–166CrossRefGoogle Scholar
  30. 30.
    Bell MJ, Lineker SC, Wilkins AL, Goldsmith CH, Badley EM (1998) A randomized controlled trial to evaluate the efficacy of community based physical therapy in the treatment of people with rheumatoid arthritis. J Rheumatol 25(2):231–237PubMedGoogle Scholar
  31. 31.
    Brighton SW, Lubbe JE, van der Merwe CA (1993) The effect of a long-term exercise programme on the rheumatoid hand. Br J Rheumatol 32(5):392–395CrossRefPubMedGoogle Scholar
  32. 32.
    Brus HL, van de Laar MA, Taal E, Rasker JJ, Wiegman O (1998) Effects of patient education on compliance with basic treatment regimens and health in recent onset active rheumatoid arthritis. Ann Rheum Dis 57(3):146–151CrossRefPubMedGoogle Scholar
  33. 33.
    Buljina AI, Taljanovic MS, Avdic DM, Hunter TB (2001) Physical and exercise therapy for treatment of the rheumatoid hand. Arthritis Rheum 45(4):392–397CrossRefPubMedGoogle Scholar
  34. 34.
    Daltroy LH, Robb-Nicholson C, Iversen MD, Wright EA, Liang MH (1995) Effectiveness of minimally supervised home aerobic training in patients with systemic rheumatic disease. Br J Rheumatol 34(11):1064–1069CrossRefPubMedGoogle Scholar
  35. 35.
    Ekdahl C, Andersson SI, Moritz U, Svensson B (1990) Dynamic versus static training in patients with rheumatoid arthritis. Scand J Rheumatol 19(1):17–26CrossRefPubMedGoogle Scholar
  36. 36.
    Eversden L, Maggs F, Nightingale P, Jobanputra P (2007) A pragmatic randomised controlled trial of hydrotherapy and land exercises on overall well being and quality of life in rheumatoid arthritis. BMC Musculoskelet Disord 8:23CrossRefPubMedGoogle Scholar
  37. 37.
    Hakkinen A, Hakkinen K, Hannonen P (1994) Effects of strength training on neuromuscular function and disease activity in patients with recent-onset inflammatory arthritis. Scand J Rheumatol 23(5):237–242CrossRefPubMedGoogle Scholar
  38. 38.
    Hakkinen A, Hannonen P, Nyman K, Lyyski T, Hakkinen K (2003) Effects of concurrent strength and endurance training in women with early or longstanding rheumatoid arthritis: comparison with healthy subjects. Arthritis Rheum 49(6):789–797CrossRefPubMedGoogle Scholar
  39. 39.
    Hakkinen A, Malkia E, Hakkinen K, Jappinen I, Laitinen L, Hannonen P (1997) Effects of detraining subsequent to strength training on neuromuscular function in patients with inflammatory arthritis. Br J Rheumatol 36(10):1075–1081CrossRefPubMedGoogle Scholar
  40. 40.
    Hall J, Skevington SM, Maddison PJ, Chapman K (1996) A randomized and controlled trial of hydrotherapy in rheumatoid arthritis. Arthritis Care Res 9(3):206–215CrossRefPubMedGoogle Scholar
  41. 41.
    Hansen TM, Hansen G, Langgaard AM, Rasmussen JO (1993) Longterm physical training in rheumatoid arthritis. A randomized trial with different training programs and blinded observers. Scand J Rheumatol 22(3):107–112CrossRefPubMedGoogle Scholar
  42. 42.
    Lineker SC, Bell MJ, Wilkins AL, Badley EM (2001) Improvements following short term home based physical therapy are maintained at one year in people with moderate to severe rheumatoid arthritis. J Rheumatol 28(1):165–168PubMedGoogle Scholar
  43. 43.
    Lyngberg K, Danneskiold-Samsoe B, Halskov O (1988) 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. Clin Exp Rheumatol 6(3):253–260PubMedGoogle Scholar
  44. 44.
    Marcora SM, Lemmey AB, Maddison PJ (2005) Can progressive resistance training reverse cachexia in patients with rheumatoid arthritis? Results of a pilot study. J Rheumatol 32(6):1031–1039PubMedGoogle Scholar
  45. 45.
    Minor MA, Hewett JE, Webel RR, Anderson SK, Kay DR (1989) Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum 32(11):1396–1405CrossRefPubMedGoogle Scholar
  46. 46.
    Minor MA, Hewett JE (1995) Physical fitness and work capacity in women with rheumatoid arthritis. Arthritis Care Res 8(3):146–154CrossRefPubMedGoogle Scholar
  47. 47.
    Moffet H, Noreau L, Parent E, Drolet M (2000) Feasibility of an eight-week dance-based exercise program and its effects on locomotor ability of persons with functional class III rheumatoid arthritis. Arthritis Care Res 13(2):100–111CrossRefPubMedGoogle Scholar
  48. 48.
    Nordemar R, Ekblom B, Zachrisson L, Lundqvist K (1981) Physical training in rheumatoid arthritis: a controlled long-term study. I. Scand J Rheumatol 10(1):17–23PubMedGoogle Scholar
  49. 49.
    Nordemar R (1981) Physical training in rheumatoid arthritis: a controlled long-term study. II. Functional capacity and general attitudes. Scand J Rheumatol 10(1):25–30PubMedGoogle Scholar
  50. 50.
    Noreau L, Martineau H, Roy L, Belzile M (1995) Effects of a modified dance-based exercise on cardiorespiratory fitness, psychological state and health status of persons with rheumatoid arthritis. Am J Phys Med Rehabil 74(1):19–27CrossRefPubMedGoogle Scholar
  51. 51.
    Neuberger GB, Press AN, Lindsley HB, Hinton R, Cagle PE, Carlson K, Scott S, Dahl J, Kramer B (1997) Effects of exercise on fatigue, aerobic fitness, and disease activity measures in persons with rheumatoid arthritis. Res Nurs Health 20(3):195–204CrossRefPubMedGoogle Scholar
  52. 52.
    Stenstrom CH (1994) Radiologically observed progression of joint destruction and its relationship with demographic factors, disease severity, and exercise frequency in patients with rheumatoid arthritis. Phys Ther 74(1):32–39PubMedGoogle Scholar
  53. 53.
    Stenstrom CH (1994) Home exercise in rheumatoid arthritis functional class II: goal setting versus pain attention. J Rheumatol 21(4):627–634PubMedGoogle Scholar
  54. 54.
    Stenstrom CH, Arge B, Sundbom A (1997) Home exercise and compliance in inflammatory rheumatic diseases—a prospective clinical trial. J Rheumatol 24(3):470–476PubMedGoogle Scholar
  55. 55.
    van den Berg MH, Ronday HK, Peeters AJ, le Cessie S, van der Giesen FJ, Breedveld FC, Vliet Vlieland TP (2006) Using internet technology to deliver a home-based physical activity intervention for patients with rheumatoid arthritis: a randomized controlled trial. Arthritis Rheum 55(6):935–945CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of RheumatologyMusgrave Park HospitalBelfastNorthern Ireland, UK
  2. 2.Health and Rehabilitation Sciences Research Institute, School of Health SciencesUniversity of UlsterJordanstownNorthern Ireland, UK

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