Efficacy of an exercise programme on the functional capacity and disease activity in females with rheumatoid arthritis

Abstract

BACKGROUND: Rheumatoid arthritis (RA) is a chronic, immune-inflammatory disease of unknown aetiology affecting the synovial membrane of joints and surrounding tissues. Typically RA affects both large and small joints in a bilateral, symmetrical, poly-articular fashion. Degradation of bone, cartilage and muscle eventually lead to a reduction in physical function. The purpose of this study was to determine the efficacy of an endurance exercise programme on the fitness parameters (flexibility, strength and aerobic measurements), quality of life (visual analogue scale and health assessment questionnaire) and disease activity (DAS28[4] version with CRP) of female RA patients. METHODS: Female RA patients were randomly allocated to the experimental group (EG) (n=19) and the control group (CG) (n=8). All participants went through a battery of tests before the intervention, and again after completion of the study. The 12 week training programme consisted of three 45-minute training sessions per week and included walking or aquatics, as well as stretches and isotonic strengthening exercises. The Mann-Whitney U test was used to compare measurements between groups. The Wilcoxon signed-rank test was used to compare baseline and post-intervention measurements within each group. RESULTS: At the initiation of the study the CG and the EG were comparable for fitness, quality of life and disease activity. On completion of the training programme, statistically significant improvements at the 5% level of significance were seen between the EG and CG, in favour of the EG, for left lateral flexion (p=O.O15) and the 1 mile walk test (p=O.O11). Within the EG there were improvement of knee flexion left (p=O.026), knee extension (right p=O.O11; left p=O.009), scratch test (right p=O.007; left p=O.O1), chair sit and reach (right p=O.Ol1; left p<O.OOl), strength parameters (p<O.05), 1 mile walk test (p<O.OO1), V02 max (p=O.O1) and DAS scores (p<O.OO1). Within the CG, improvements were shown for knee extension(right p=O.05; left p=O.013). Although their strength parameters improved significantly it was not in the same order as for the EG. The CG had a decline in their aerobic measurements but their HAQ score improved (p=O.03). CONCLUSION: An endurance exercise programme, combined with isotonic strengthening exercise and stretching, improves the functional capacity, quality of life and disease activity of female patients with RA. Attention received during the study may have led to some placebo-induced improvements in control subjects, but not to the same extent as those involved in exercise programmes.