Exercise as it relates to Disease/Efficacy of Aerobic Exercise in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease, which primarily affects the lining of the joints (synovial membrane).. Strasser, B, Leeb, G, Strehblow, C, Schobersberger, W, Haber, P & Cauza, E. (2010). The effects of strength and endurance training in patients with rheumatoid arthritis. Clinical Rheumatology, 30, 623-632. Characterised by erosive synovitis and severe inflammation, RA patients experience severe joint pain, swelling and stiffness, reduced muscle strength and impaired physical function. The progression of RA may lead to rheumatoid cachexia (loss of muscle mass), as well as joint destruction, further restricting the individual’s daily physical activities. Treatment Based on self reports, approximately 50% of individuals with RA reported using pharmaceutical medication, 38% utilising health supplements, while an estimated 28% used some form of exercise and 13% massage or water therapy to manage pain and ease symptoms.. A picture of rheumatoid arthritis in Australia. Australian Institute of Health and Welfare, 2009, 9, 8-11 Surgical paths and rehabilitation are also recognised as current treatments for RA.. Strenstorm, C & Minor, M. (2003). Evidence for the benefit of aerobic and strengthening exercise in rheumatoid arthritis. Arthritis Care and Research, 49(3), 428-434. Prevalence RA is estimated to be present in 0.5–1% of the general population, twice as often in women, and the age at disease onset is predominantly between 45 and 65 years. The often-serious joint disease affects around 400,000 Australians and is the second most common type of arthritis, following osteoarthritis. In Australia in 2006, RA was cited as the primary cause for 169 deaths (123 females and 46 males). Risk Factors Below is a table of both Modifiable and Non-Modifiable risk factors of RA Rheumatoid Arthritis. Centers for Disease Control and Prevention. 2012 [Online]. Available: http://www.cdc.gov/arthritis/basics/rheumatoid.htm Modifiable Risk Factors Non-Modifiable Risk FactorsSmoking Reproductive hormonal exposures Alcohol consumption Dietary factors Microbial exposures Genetics Socio-demographics; RA is typically two to three times higher in women than men. The onset of RA, in both women and men, is highest among those in their sixties. Benefits of Aerobic Exercise in RA Results from randomised controlled trials advised exercise to be fundamentally beneficial. RA patients have been reported to do less exercise than their healthy counterparts, with over 80% of RA patients conveyed as physically inactive in various countries.. Cooney, J, Law, R, Matschke, V, Lemmey,A, Moore, J, Ahmad, Y, Jones, J, Maddison, P & Thom, J. (2011). Benefits of Exercise in Rheumatoid Arthritis. Journal of Aging [Online]. Available: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042669/ Due to the awareness of weight bearing movements provoking joint damage by boosting disease activity, aerobic exercise is believed to be highly advantageous.. Bilberd, A, Ahlmen, M & Mannerkorpi, K. (2005). Moderately intensive exercise in a temperate pool for patients with rheumatoid arthritis: a randomized controlled study. Oxford Journals, 44(4), 502-508 Benefits of aerobic exercise include: Cardiorespiratory fitness: Aerobic capacity is 20 to 30% lower than age-matched healthy controls Cooney, J, Law, R, Matschke, V, Lemmey, A, Moore, J, Ahmad, J, Jones, J, Maddison, P & Thom, J. (2011). Benefits of Exercise in Rheumatoid Arthritis. Journal of Aging Research [Online]. Available: http://www.hindawi.com/journals/jar/2011/681640/ Improvement in body composition: Reduced adiposity and increased hypertrophy Joint and musculoskeletal health: Reduced joint tenderness and improved range of movement and flexibility Reduce discomfort, radiologic damage and pain Improvement in emotional and psychological well being Greater overall levels of self-efficacy These improvements are feasible to achieve without risk of joint damage or disease activity. Additionally, well-established anti-inflammatory and anti-atherogenic effects of exercise consequently reduce the risk of CVD. Evidence-based Recommendations for Aerobic Exercise in RA The most commonly used mode of aerobic exercise training in studies involving RA patients is cycling, followed by aquatic exercise, aerobic dance and walking/jogging.. Metsios, G, Stavropoulos-Kalingolou, A, Veldhuijzen van Zanten, J, Treharne, G, Panoulas, V, Douglas, K, Koutedakis, Y & Kitas, G. (2008). Rheumatoid arthritis, cardiovascular disease and physical exercise: a systematic review. Oxford journals, 47(3), 239-248. Type of Aerobic Exercise Intensity Time/Frequency Walking 60-85% of maximum heart rate 30-60 min 3 days/week Aquatics (ROM & Isometric exercises)Metsios, G, Stavropoulos-Kalingolou, A, Veldhuijzen van Zanten, J, Treharne, G, Panoulas, V, Douglas, K, Koutedakis, Y & Kitas, G. (2008). Interventional training regimens in patients with rheumatoid arthritis—aquatic programmes. Oxford Journals, 47(3), 239-248. 70% of maximum heart rate25–60 min 3 days/week CyclingDurstine, J, Moore, G, Painter, P & Roberts, S. (2003). ACSM's Exercise Managment for Persons with Chronic Diseases and Disabilities, Human Kinetics, Champaign, Ill, USA, 3rd edition. 60–80% of maximum heart rate25–40 min 5 days/week Aerobic DancingMetsios, G, Stavropoulos-Kalingolou, A, Veldhuijzen van Zanten, J, Treharne, G, Panoulas, V, Douglas, K, Koutedakis, Y & Kitas, G. (2008). Interventional training regimens in patients with rheumatoid arthritis—dancing programmes. Oxford Journals, 47(3), 239-248. 50–70% of maximum heart rate 30–60 min 2days/week For maximal benefits to occur, patients should have well-controlled RA before commencing exercise and continue the use of anti-inflammatory medications.Strasser, B, Leeb, G, Strehblow, C, Schobersberger, W, Haber, P & Cauza, E. (2010). The effects of strength and endurance training in patients with rheumatoid arthritis’. Clin Rheumatol, doi:10.1007/s10067-010-1584-2 Considerations Aerobic training should be determined by the patient’s current levels of fitness and allowed by their cardiovascular risk stratification. Gradual adjustment of intensity and duration of exercise is recommended. Exercise should be initially supervised by an experienced exercise professional so that the program can be tailored to individual aspirations and adapted to the disease activity, joint defects, and symptoms of patients. Contraindications to exercise as a result of comorbidities need to be monitored by a physician. Exercise programs must account for pre-exercise disease status and degree of joint deficits. Walsmith, J & Roubenoff, R.(2002). Cachexia in rheumatoid arthritis. International Journal of Cardiology, 85, 89–99 Further reading Arthritis Foundation - http://arthritis.org/ Exercise and Arthritis - https://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Exercise_and_Arthritis/ A picture of rheumatoid arthritis in Australia; National Centre for Monitoring Arthritis and Musculoskeletal Conditions - http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459857 Centers for Disease Control and Prevention; Rheumatoid Arthritis - http://www.cdc.gov/arthritis/basics/rheumatoid.htm --Ellen123 (discuss • contribs) 00:09, 1 October 2014 (UTC) References