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Intense Physical Exercise Helps Rheumatoid Arthritis Patients

Authors: Hannah Clark

References: Shoulder1

Abstract
Intense physical exercise improves the mental and physical health of rheumatoid arthritis patients better than standard physical therapy, according to a study in the Sept. issue of the journal Arthritis and Rheumatism.

Avoiding intense exercise seems like common sense for some rheumatoid arthritis patients. Conventional wisdom says that rest helps inflamed joints, and many doctors advise against weight-bearing workouts, fearing they will overly stress the joints. The new study, however, shows that two hours a week of moderate to high intensity exercise can be as beneficial for RA patients as it is for everyone else.

The study, conducted by researchers in the Netherlands, involved 300 volunteers who each participated in one of two different treatment programs over a two year period. Half the volunteers did standard physical therapy. The others participated in a program called Rheumatoid Arthritis Patients in Training (RAPIT). RAPIT involved supervised biweekly exercise sessions that included 20 minutes of bicycling, 20 minutes of strength and mobility exercises, 20 minutes of high-impact sports like volleyball or basketball and 15 minutes of warm up and cool down exercises.

The RAPIT participants had greater improvement than the standard care group in:

aerobic fitness and muscle strength

functional ability

optimism and ability to cope. While improvement in fitness and strength plateaued after the first year, functional ability continued to rise. Functional ability was measured with the McMaster Toronto Arthritis Patient Preference Disability Questionnaire, and covered activities like stair climbing as well as complex and repetitive tasks.

Median damage of the joints did not increase in either group. (The median level of damage is the point at which half have more damage and half have less.) However, those who had severe joint damage at the beginning of the study showed a slight increase in damage over the two year period, and this decrease was greater for RAPIT participants.

Dr. Zuzana de Jong, the lead author of the study, concluded that the RAPIT program was best for patients in the early stages of rheumatoid arthritis. "In early RA, functional ability and physical capacity deteriorate quickly, while the large joints are still relatively spared. The cost-benefit ratio is probably most favorable in these patients," Dr. de Jong wrote. "Until more research is done, it seems wise to offer individually designed exercises that spare the damaged joints to RA patients with considerable damage of the large joints who wish to participate in long-term intensive programs."

Of the 300 participants, 79 percent were female and the median age was 54. The patients in the two groups had mostly similar characteristics, but the RAPIT participants had RA for an average of 7.5 years, compared with five years for the standard care group. They were tested for joint damage and functional ability at the beginning of the program at six month intervals. All but 14 of the RAPIT participants attended the exercise sessions faithfully for the duration of the study.

Rheumatoid arthritis, also known as inflammatory arthritis, is a chronic condition that attacks the joints, their surrounding tissues and organs within the body. It causes the same pain and swelling as osteoarthritis, but with a different mechanism. While the cause is unknown, researchers believe that RA is triggered by an autoimmune reaction, where certain cells within the body are attacked by the immune system because they are mistakenly believed to be foreign.

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