A comparison between the effects of land and water based exercises in patients with rheumatoid arthritis

Abstract

Rheumatoid Arthritis (RA) is the most common type of chronic inflammatory arthritis (Thompson, 1998). When appropriately prescribed, therapeutic exercise is useful in the care of patients with RA (Semble et aI., 1990). A pre-test - post-test randomized groups design was adopted for the study to compare the effects of a land- and water-based exercise programme in RA patients. A total of ten subjects, diagnosed with RA functional class I or II according to Steinbrocker, were assigned to either a group performing water-based exercises (W, n=4), a group performing land-based exercises (L, n=4), or a control group, who were requested to continue with their present sedentary lifestyle (C, n=2). For inclusion in the study, subjects were required to be on stable medication. Categories of dependent variables measured, were disease activity, haematology, functional and psychological status as well as physical status. There was a reduction in total swollen and tender joint counts in both experimental groups, but not the control group. The reduction was greater in group W than group L. Total tender joint count (DC) decreased by 53% (p<0.1O) and the total swollen joint count (SJC) decreased by 31% (p>0.05) in group W. In group L, the total TIC decreased by 4,7% (p>0.05) and the total SIC decreased by 8,5% (p>0.05). The haematological values remained globally unchanged in all three groups concerning the hemolglobin (Hb) values. There were changes in the erythrocyte sedimentation rate (ESR) in the groups, however changes were not significant (p>0.05). The ESR decreased by 29% in group Wand by 33% in group C. There was a slight increase in group L's ESR (11,9%) but values remained within the normal range. There was an improvement in the patients self-assessed disability and psychological status in the experimental groups while there was a deterioration in the control group's. Health Assessment Questionnaire (HAQ) scores improved by 15% in group W (p>0.05), 18% in group L (p>0.05) and deteriorated by 13% in group C (p>0.05). There was no change in the total Profile of Mood States (POMS) score of the control group, however, significant (p<0.05) improvements were observed in the experimental groups. There was a 163% improvement in group L's and a 990/0 improvement in group W's affective states. As far as physical condition is concerned, in genera~ there was an improvement in group Wand group L's physical condition, while there was no improvements noted in group C. Group W showed the following changes in physical condition: Body mass decreased by 9,2% (p>0.05). Mean blood pressure values remained unchanged. 50-ft walk time improved by 18% (p<0.05). Right and left grip strength increased by 18% and 35% respectively, (p<0.05). Absolute VO2max increased by 28% and relative VO2max increased by 30% (p<0.05). Right knee flexor strength increased by 43% (p<0.05) and left knee flexor strength by 24% (p>0.05). Increases in right and left knee extensor strength were 32% (p>0.05) and 34% (p>0.05) respectively. Improvement in joint mobility was also noted. There was a significant (p<0.05) improvement in both right and left wrist extension range of motion(ROM). Right wrist extension ROM improved by 49% and left wrist extension ROM improved by 31%. Improvements were also noted in wrist flexion ROM however changes were not significant (p>0.05). There was an 12% and 19% increase in right and left wrist flexion ROM respectively. In addition, there was a 12% (p<0.05) increase in right knee flexion ROM and a 14% increase in left knee flexion ROM (p<0.05). Mean body mass and blood pressure remained unchanged. 50-ft walk test time improved by 15% (p<0.05). Right and left grip strength increased by 4,8% and 16.1% respectively (p>0.05). Relative VO2max increased by 16.6% and absolute VO2max by 31% (p<0.05). Right knee flexor strength increased by 22.1% and left knee flexor strength by 23.8% (p>O.05). Increase in right and left knee extensor strength was 9% and 2,4% respectively (p>O.05). Right wrist extension ROM increased by 20.7% and left wrist extension ROM increased by 15,7% (p>0.05). There was a significant (p<0.05) increase in left wrist flexion (7,6%), but right wrist flexion ROM decreased by 2.6% (p>0.05). Improvements in right and left knee flexion ROM were also significant (p<0.05), 9,2% and 7,4%, respectively. Group C showed the following changes in physical condition: Mean body mass increased by 2% (p>O.05), while blood pressure and 50-ft walk time remained globally unchanged. Left grip strength decreased by 16% (p>O.05) and right grip strength remained the same. Although not significant (p>O.05), there was a 11% decrease in relative VO2max and a 6,7% decrease in absolute VO2max. Muscle strength also showed deterioration in group C. Right and left knee flexor strength decreased by 1,8% and 12%, respectively (p>0.05). Left knee extensor strength remained unchanged while right knee extensor strength decreased by 9,7% (p>0.05). Right wrist extension ROM decreased by 4.7% and left wrist extension ROM increased by 6.7%, although the increase was not significant (p>O.05). While right wrist flexion ROM decreased by 1,3% and left wrist flexion ROM decreased by 21% (p>0.05). There were no significant (p>O.05) changes in group C's right and left knee flexion ROM. Right knee flexion ROM decreased by 1,2% and left knee flexion ROM increased by 1,2%. Based on the above results of the study, both exercise interventions are beneficial in the treatment of RA. Appropriate land-based exercises do not appear to enhance disease activity, however, the water-based exercise programme was superior in controlling the disease activity. Further research is required, using larger samples and evaluating the long-term effects of various exercise interventions.