Effects of dynamic strength training on physical function,Valpar 9 work sample test,and working capacity in patients with recent‐onset rheumatoid arthritis

Objective

To study the impact of 24 months of strength training on the physical function of patients with early rheumatoid arthritis (RA).

Methods

Seventy patients were assigned to either the strength training (experimental) group (n = 35) or the control group (n = 35). Patients in the experimental group performed strength training for 24 months, and control patients were instructed to perform range of motion exercises. Maximal strength of the knee extensors, trunk flexors, and extensors, as well as grip strength were recorded with dynamometers. Disease activity was assessed by the erythrocyte sedimentation rate and Ritchie's articular index, joint damage was determined by the Larsen x‐ray index, and functional capacity was assessed using the Valpar 9 test and the Stanford Health Assessment Questionnaire (HAQ). The employment status of each patient was recorded.

Results

In the experimental group, strength training led to significant increases (19–59%) in maximal strength of the trained muscles. Such increases in the control group varied from 1% to 31%. There was a clear training effect on muscular strength in favor of the experimental group, but significant improvements in the HAQ indices as well as in the Valpar 9 test were seen also in control patients. Results of the Valpar 9 and the HAQ were statistically significantly better in patients who remained gainfully employed compared with patients who retired preterm during followup. However, compared with patients who remained in the work force, patients who retired were older, and their work was physically more demanding.

Conclusion

As expected, strength training led to increased muscle strength, but this increase did not correlate with improved physical function as assessed by the Valpar 9 work sample test. The increased muscle performance did not prevent a substantial proportion of patients from retiring preterm. The 2 items from the Valpar 9 test that were applied were not sensitive enough to differentiate the patients according to their working status.

     

The effects of strength and endurance training in patients with rheumatoid arthritis

Patients with rheumatoid arthritis (RA) suffer from muscle loss, causing reduced muscle strength and endurance. The current study aimed to: (1) evaluate the effects of combined strength and endurance training (CT) on disease activity and functional ability in patients with RA and (2) investigate the benefits of a 6-month supervised CT program on muscle strength, cardio-respiratory fitness, and body composition of RA patients. Forty patients with RA, aged 41–73 years, were recruited for the current study. Twenty of these patients (19 females, one male) were randomly assigned to a 6-month supervised CT program; 20 patients (17 females, three males) served as controls. Within the CT program, strength training consisted of sets of weight bearing exercises for all major muscle groups. In addition to strength training, systematic endurance training was performed on a cycle ergometer two times per week. For RA patients involved in CT, disease activity (p = 0.06) and pain (p = 0.05) were reduced after the 6-month training period while general health (p = 0.04) and functional ability (p = 0.06) improved. Cardio-respiratory endurance was found to have improved significantly (by 10%) after 6 months of CT (p < 0.001). The overall strength of patients undertaking CT increased by an average of 14%. Lean body mass increased, and the percentage of body fat was found to decrease significantly (p < 0.05). A combination of strength and endurance training resulted in considerable improvements in RA patients’ muscle strength and cardio-respiratory endurance, accompanied by positive changes in body composition and functional ability. Long-term training appears to be effective in reducing disease activity and associated pain and was found to have no deleterious effects.     

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

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 resulted 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.     

The clinical and health status of patients with recent-onset rheumatoid arthritis

This study was designed to document the clinical and health status of patients with recent-onset rheumatoid arthritis (RA). Three groups were studied: 108 patients who had had RA for greater than 1 year (established RA group), 313 patients who had had RA for less than or equal to 1 year (recent-onset RA group), and 188 healthy friend of the patients with recent-onset RA (no RA group). Clinical status was measured using tender joint count, erythrocyte sedimentation rate, and overall physician assessment. Health status was measured using the physical, psychological, pain, and arthritis impact scores of the Arthritis Impact Measurement Scales. Scores on all clinical and health status measures indicated substantial disease effects in the group with recent-onset RA. For most of these measures, effect size analysis indicated that clinical and health status impacts in the recent-onset RA group were similar in magnitude to those found in the groups with more established disease, with scores in both groups being substantially different from those found in the no RA group. These results document the magnitude of the clinical and health status impacts in recent-onset RA. They lend support to recent arguments advocating aggressive therapy earlier in the course of this frequently disabling disease.     

Prognosis of functional capacity and work capacity in rheumatoid arthritis

Summary In the study functional capacity and work capacity were investigated in a series of 405 hospital patients suffering from rheumatoid arthritis. One-third of the patients had had the disease for 5 years, one-third for 10 years and one-third for 15 years. The functional capacity index presented by Lee et al. (1973) was used. Half of the patients in the 5 and 10-year groups and one-third of those in the 15-year group had good functional capacity. One-fourth in the 5 and 10-year groups and one-third of those in the 15-year group had poor functional capacity. Sixty per cent of the 5-year group, 50 per cent of the 10-year group and 33 per cent of the 15-year group were able to work. The prognosis of functional capacity and work capacity was better for young persons than for older ones. No differences were found between the prognoses for men and women. High ESR, a positive blood rheumatoid factor and joint erosion seemed to be linked with an unfavourable prognosis of functional capacity. Light work was favoured for the prognosis of functional capacity and work capacity and extensive general education and vocational training for work capacity. The results indicate that starting vocational rehabilitation at an early stage of the disease could improve the prognosis of functional capacity and work capacity.     

Physical fitness and work capacity in women with rheumatoid arthritis

Objective. To investigate physical fitness and work capacity in women with rheumatoid arthritis (RA). Methods. The 42 subjects were a subset of a prospective trial of conditioning exercise in rheumatic disease. Assignment to an exercise or nonexercise group was determined by proximity to the intervention, a 3-month supervised group exercise program. Physical fitness and work capacity were assessed at baseline, 3 months, and 12 months. Results. At baseline, subjects were deconditioned and limited in hand function, lifting ability, and lower extremity mobility. Only the exercise group improved their aerobic capacity and exercise tolerance. There were no significant changes in measured work capacity in either group. Moderate to strong correlations were found between aerobic capacity. mobility, hand function, and work capacity. Grip strength was a strong and consistent correlate of work capacity. Conclusion. Our findings suggest that physical capacity, particularly hand function, may be important in the complex phenomenon of work disability in RA.     

The relationship between the leg muscle strength and physical capacity in patients with rheumatoid arthritis, with reference to the influence of corticosteroids

It has been shown that patients with rheumatoid arthritis have weak muscles, especially when they are treated with corticosteroids. Forty-six female patients suffering from rheumatoid arthritis were evaluated with regard to the physical capacity in the lower legs by measuring the walking speed and the climbing performance as correlated to the isokinetic muscle strength of the knee extensors and the plantar flexors. Twenty-six of the patients (average age 60 years, range 34-76) had been treated with corticosteroids. Twenty patients (average age 58 years, range 31-72) had never received corticosteroids. The mean maximal isokinetic muscle strength of the knee extensors in corticosteroid treated patients was 62 +/- 28 Nm (SD) at the angular velocity 30 degrees/s, and the mean maximal isokinetic muscle strength of the plantar flexors in the same group of patients was 33 +/- 21 Nm (SD) at the same angular velocity. Compared to patients with rheumatoid arthritis who had never been treated with corticosteroids the reduction in muscle strength was 37% and 28%, respectively (p less than 0.001 and p less than 0.01). The mean walking speed in patients with corticosteroid treatment was 0.9 m/s, which was a 36% reduction as compared with that found in patients who had not received corticosteroids (p less than 0.01). Half of the patients who had not received corticosteroids were able to climb a 50 cm step, while this was possible in only 16% of the group of corticosteroid-treated patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

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

OBJECTIVE: To evaluate the impact of a 2-year program of strength training on muscle strength, bone mineral density (BMD), physical function, joint damage, and disease activity in patients with recent-onset (<2 years) rheumatoid arthritis (RA). METHODS: In this prospective trial, 70 RA patients were randomly assigned to perform either strength training (all major muscle groups of the lower and upper extremities and trunk, with loads of 50-70% of repetition maximum) or range of motion exercises (without resistance) twice a week; all were encouraged to engage in recreational activities 2-3 times a week. All patients completed training diaries (evaluated bi-monthly) and were examined at 6-month intervals. All were treated with medications to achieve disease remission. Maximum strength of the knee extensors, trunk flexors and extensors, and grip strength was measured with dynamometers. BMD was measured at the femoral neck and lumbar spine by dual x-ray densitometry. Disease activity was determined by the Disease Activity Score, the extent of joint damage by the Larsen score, and functional capacity by the Health Assessment Questionnaire (HAQ); walking speed was also measured. RESULTS: Sixty-two patients (31 per group) completed the study. Strength training compliance averaged 1.4-1.5 times/week. The maximum strength of all muscle groups examined increased significantly (19-59%) in the strength-training group, with statistically significant improvements in clinical disease activity parameters, HAQ scores, and walking speed. While muscle strength, disease activity parameters, and physical function also improved significantly in the control group, the changes were not as great as those in the strength-training group. BMD in the femoral neck and spine increased by a mean +/- SD of 0.51 +/- 1.64% and by 1.17 +/- 5.34%, respectively, in the strength-training group, but decreased by 0.70 +/- 2.25% and 0.91 +/- 4.07% in the controls. Femoral neck BMD in the 17 patients with high initial disease activity (and subsequent use of oral glucocorticoids) remained constantly at a statistically significantly lower level than that in the other 45 patients. CONCLUSION: Regular dynamic strength training combined with endurance-type physical activities improves muscle strength and physical function, but not BMD, in patients with early RA, without detrimental effects on disease activity.     

Quality of life and work in patients with rheumatoid arthritis and ankylosing spondylitis of working age

OBJECTIVE: To investigate the relationship between work and quality of life (QOL) in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) aged 16-59. METHODS: 1056 patients with RA and 658 with AS were included in the study. Data were obtained by postal questionnaire, which included several generic and disease related QOL instruments. Separate dimensions and physical and mental summary scores from the SF-36 were compared. Stepwise multiple regression was performed to study the relationship between work and physical and mental health related QOL, including disease related factors, coping, and fatigue. RESULTS: Physical health related QOL was reported to be worse, and mental health related QOL better, in RA than in AS in people of working age. No differences between RA and AS were found in somatic pain, physical role functioning, social functioning, emotional role functioning, vitality, or general health perception; nor were there any significant differences in fatigue and behavioural coping styles. Work was positively associated with physical health related QOL in both groups and, after disease characteristics, was the most important determinant. No association was found with mental health related QOL. CONCLUSIONS: Although physical health related QOL was worse in patients with RA, the impact on several dimensions of health related QOL in patients with RA and AS of working age under rheumatological care was comparable. Patients with RA and AS experienced similar limitations in physical role functioning, including work. Work is an important independent external determinant of physical health related QOL, but not of mental health related QOL.     

Effects of physical training on central haemodynamics and working capacity in myocardial infarction.

Changes in central haemodynamics and physical working capacity were followed in 23 patients with myocardial infarction: in 12 of them, after six-month intense physical training, and in 11, after an equal control period without training. The haemodynamic indicators revealed after rehabilitation a significant decrease in the exercise heart rate in comparison with the unchanged value in the controls. The changes in the other haemodynamic values were not significant. The pulmonary arterial end-diastolic pressure, regarded as an indicator of the left ventricular filling pressure, sustained no significant change by the training. Some additional changes, such as decreases in the arterial and venous oxygen pressure both at rest and during exercise, were found in both groups of patients. The physical working capacity increased significantly after rehabilitation in comparison to the control group. It is emphasized that no adverse influence upon the central haemodynamics was revealed in patients with myocardial infarction after intense training according to WHO criteria.     

Working status among Dutch patients with rheumatoid arthritis: work disability and working conditions

OBJECTIVES: To assess work disability and variables associated with work disability among Dutch patients with rheumatoid arthritis (RA). METHODS: A questionnaire on working status was filled out by 296 patients of working age. Employment and work disability rates adjusted for age and sex from the Dutch population were determined using indirect standardization. Cox proportional hazard analysis was used to assess baseline predictors of work disability in a subgroup of patients (n = 195). RESULTS: After a mean disease duration of 4.3 yr, patients had a 0.78 (95% CI 0.67-0.88) chance of being employed and a 2.14 (95% CI 1.75-2.54) risk of being work disabled when compared with the Dutch population. Functional disability and job type at the start of the disease were predictors of future work disability. In total, 48 (37%) currently employed patients had changed their working conditions, of which reduced working hours (46%), reduced pacing of work (42%) and help from colleagues (49%) were the most important alterations. Of the 60 work disabled patients without a paid job, only 11 patients (18%) would be willing to work again. CONCLUSION: This study shows that the adjusted employment rates were lower and that work disability rates were higher in patients with RA when compared with the general Dutch population. In addition, a substantial number of employed patients had to change their working conditions due to RA. Only a minority of work disabled RA patients was willing to return to the paid labour force.     

Functional capacity in rheumatoid arthritis patients: comparison between Spanish and Brazilian sample

The main objective of this study is to compare Spanish and Brazilian self-reported health-related functional capacity in patients with rheumatoid arthritis (RA). 197 patients diagnosed with RA were studied in Spain (n = 127) and Brazil (n = 70). Pain (Visual analog scale) and functional capacity (Health Assessment Questionnaire/HAQ) were assessed. Patients were questioned about regular exercise practice. Comparisons between groups were performed with Chi-square tests and Student t test. Pearson’s correlation coefficient and linear regression models were used to analyze the associations. Brazilian patients were younger (p = 0.013), had worse levels of pain (p = 0.001) and a trend to experience worse functional capacity (p = 0.057) than Spanish ones. Spanish RA patients had higher body mass index (BMI) (p = 0.019) and longer disease duration (p = 0.001). Also, a higher percentage of subjects with RA from the Spanish cohort had been elected to take early retirement when compared with Brazilian patients (p = 0.010). Spanish RA patients had received more drugs than Brazilians (oral corticosteroids p = 0.010, Leflunomide p = 0.023, Methotrexate p = 0.072, non-steroidal anti-inflammatory drugs p = 0.064, biologic therapies p = 0.001). The functional capacity (HAQ) was correlated with age (p = 0.001), disease duration (p = 0.001), age at diagnosis (p = 0.001), pain (p = 0.001) and BMI (p = 0.001) in Spanish patients. In Brazilian, these correlations were only found with disease duration (p = 0.004) and pain (p = 0.001). In conclusion, our data suggest a better management of RA in Spanish when compared with Brazilians. Even with less pain and functional capacity, they receive more drug treatment and a higher percentage of them are retired early.     

Effectiveness and safety of strength training in rheumatoid arthritis

PURPOSE OF REVIEW: As muscle weakness is common in patients with rheumatoid arthritis (RA), strength training is considered to be an important cornerstone of the nonpharmacological treatment. The training methods have varied widely between the studies. Thus, the purpose of this review is to discuss effectiveness and safety but also basic principles and specificity of strength training. RECENT FINDINGS: Moderate or high-intensity strength training has been effective and well-tolerated method to increase or maintain muscle strength in patients with rheumatoid arthritis. No deleterious effects on disease activity and pain were observed. More information is needed regarding long-term effects of strength training on functional capacity, bone mineral density, and radiologic progression. SUMMARY: Moderate or high-intensity strength training programs have better training effects on muscle strength in RA than low-intensity programs. The type of exercises, intensity, and frequency of training are key factors in the effectiveness of training. It is, however, essential to maintain the training routine to obtain long-term benefits from it.     

Early suppression of disease activity is essential for maintenance of work capacity in patients with recent-onset rheumatoid arthritis: five-year experience from the FIN-RACo trial

OBJECTIVE: To explore the impact of an early treatment response on maintenance of work capacity in patients with early, active rheumatoid arthritis (RA). METHODS: In the Finnish Rheumatoid Arthritis Combination Therapy trial, 195 patients with recent-onset RA were randomized to receive either a combination of disease-modifying antirheumatic drugs (DMARDs) with prednisolone or a single DMARD with or without prednisolone for 2 years. Treatment responses were evaluated according to the American College of Rheumatology (ACR) criteria. After a 5-year followup, the cumulative number of days of sick leave and RA-related permanent work disability was calculated for each of the 162 patients who were available for the active work force at baseline. RESULTS: Of the 159 patients assessed at 6 months, 29 were in clinical remission, 66 achieved an ACR50 response but not remission, 29 achieved an ACR20 response but not an ACR50 response, and 35 failed to achieve an ACR20 response. In these 4 groups, the median numbers of work disability days per patient-year from 6 months through 60 months of followup were 0 (interquartile range [IQR] 0-3), 4 (IQR 0-131), 16 (IQR 0-170), and 352 (16-365), respectively (P < 0.001). Pairwise multiple comparisons showed a statistically significant difference between all groups except the ACR50 and ACR20 groups. At 12 months, 30 patients were in remission. None of the 44 patients in remission at 6 or 12 months became permanently work disabled over the 5-year followup, as compared with 15 patients in the ACR50 group (23%), 6 in the ACR20 group (21%), and 19 without an ACR20 response at 6 months (56%). CONCLUSION: Prompt induction of remission translates into maintenance of work capacity. At 6 months, an ACR50 response is no better than an ACR20 response with regard to future productivity, while failure to achieve an ACR20 response carries a high risk for work disability.     

Association of physical function and physical activity in women with rheumatoid arthritis

Objective

To explore the associations between measures of physical activity (PA) and measures of physical function (PF) in women with rheumatoid arthritis (RA). We hypothesized that the strength of the associations between PA and PF would be moderate, and that after controlling for social and biomedical characteristics, the associations would decrease.

Methods

Women with RA (n = 47, mean ± SD age 56.5 ± 7.0 years) participated in the cross‐sectional analysis of this study. Social and biomedical characteristics explored included age, ethnicity, disease duration, marital and educational status, height, weight, comorbidity, and disease activity. PF was measured by the self‐reported Health Assessment Questionnaire (HAQ) and by a battery of performance‐based measures that included self‐selected gait speed, the 5 chair rise test, and the single leg stance test. PA was measured by a portable activity monitor worn for 10 days, and was characterized in 2 ways: daily average number of steps and daily energy expenditure during moderate levels of PA.

Results

Correlations between measures of PA and PF were small to moderate (zero‐order correlations = 0.189–0.479). After controlling for social and biomedical characteristics, the correlations became smaller (semi‐partial correlations = 0.095–0.277) and only HAQ score remained significantly associated with PA.

Conclusion

Associations between measures of PA and measures of PF were explained, in part, by social and biomedical characteristics in women with RA. The results indicate that measures of PF and PA may represent different constructs and support the need to measure PA in rehabilitation research in RA.     

Longitudinal study on the locomotor function test in patients with rheumatoid arthritis]

With the help of a four-year observation of the course of rheumatoed arthritis in 100 patients the evidence of the locomotor functional test after Keitel is examined for the longitudinal research. The locomotor functional test proved depending on the actual activity and in a high percentage of patients showed considerable variations from year to year which were not parallel to the clinical and radiological progression.It is not sufficiently evident as the only criterion for the establishment of the progression of the disease. The locomotor functional test is well suited for the judgement of the success of therapy in short periods and the objectivation of the actual restriction of the function especially for questionings of experts. It is proposed to include the locomotor functional test into the criteria for the establishment of the degree of function.