Undertaking a supervised exercise programme can have beneficial effects on functional status and physical function, reduce the need for daily corticosteroid and anti-inflammatory intake and improve levels of depression and anxiety in people with rheumatoid arthritis (RA), according to a new study presented June 11 at EULAR 2009, the Annual Congress of the European League Against Rheumatism in Copenhagen, Denmark.
A three-month programme, comprising moderate aerobic and strengthening exercises, conducted for 50-60 minutes three times per week, proved not only to be safe and beneficial both physically and in terms of quality of life for patients, but was also associated with a stabilising effect in disease activity measured by DAS28*. During the Portuguese study's three month period, researchers observed the following:
- A 33% improvement in the HAQ (Health Assessment Questionnaire) disability index measurement of physical functioning (assessing ability to undertake everyday activities such as dressing, eating and walking, and whether assistance from another person or disability aids is required) (p < 0.023)
An improvement in physical function, as outlined below:
- 55% improvement in the 'sit and stand' test (p=0.018)
- 10% improvement in the right-hand grip test (p=0.025) and 15% in the left-hand grip test (p=0.035)
- 19% improvement in the walk time test (p=0.063)
- 62% of patients reported a reduced need for daily corticosteroid intake, from a mean dosage of 5.3mg/day of prednisone to 3.1mg/day (p=0.038)
- 32% of patients reported stopping concurrent NSAID (non-steroidal anti-inflammatory drug) treatment altogether following the exercise programme (p=0.083)
- Mean LDL (low-density lipoprotein) cholesterol increased from 90mg/dl to 125mg/dl (p=0.018)
- 40% improvement in the Depression Anxiety Stress Scales (DASS), a self-reported assessment of negative emotional states, with 28% in the depression and 48% in the anxiety component respectively (p=0.078)
Dr Miguel Sousa of Instituto Português de Rheumatology, Lisbon, Portugal, who led the study, said: "When joints are stiff and painful, proactively taking exercise might seem undesirable for people with RA. However, our study has demonstrated that regular and supervised moderate aerobic workouts and strengthening exercises may be extremely beneficial for both a patient's physical and mental health, with a corresponding effect on quality of life. The challenge for physicians is to provide suitable motivation and reassurance to their RA patients in order that they initiate and stick with such a programme."
The observational longitudinal study followed eight physically-inactive patients (7 female; mean age of 59 (46-71) years; mean disease duration of 16 (3-30) years) with relatively stable RA (stable medication taken for at least three months; mean dose of methotrexate 17.5mg/week) for three months.
* DAS28 (Disease Activity Score) is an index used by physicians to measure how active an individual's RA is. It assesses number of tender and swollen joints (out of a total of 28), the erythrocyte sedimentation rate (ESR, a blood marker of inflammation), and the patient's 'global assessment of global health'. A higher score indicates more active disease.
Diseases of the bone and joints such as rheumatoid arthritis and osteoarthritis cause disability in 4-5% of the adult population and are predicted to rise as people live longer.
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