Supervised, Intense Exercise Improves Physical Fitness in Older Adults With RA

Moderate- to high-intensity aerobic and resistance exercise improved physical fitness in older adults with rheumatoid arthritis (RA), according to a multicenter, randomized controlled study published in Arthritis Care & Research.¹

Decline in physical function and ability to perform desired activities is a concern for patients with RA.² Although studies have shown improvements in aerobic capacity, muscle strength, and disability after an intervention involving aerobic and resistance training, data on the benefits of exercise in older adults (>65 years) with RA are lacking.^3,4 Reduced physical activity in patients with RA is partly because of concern that exercise could damage the joints.^5,6 Therefore, a person-centered approach that focuses on the context, history, and resources of the individual has been suggested for managing long-term diseases.⁷

Researchers randomly assigned 74 older adults (age, 65-75 years) to either a 20-week person-centered exercise at a gym (n=36) or to a home-based exercise of light intensity (n=38).¹ They found no significant differences between the groups for the primary outcome, the Health Assessment Questionnaire-Disability Index (HAQ-DI).

However, within the intervention group, there was a significant improvement of HAQ-DI when compared with baseline (P =.022). When compared with the control group, aerobic capacity (P <.001) and 3 of the 4 additional performance-based tests of endurance and strength significantly improved (P <.05) in the intervention group.

Seventy-one percent of patients in the intervention group rated their health as much or very much improved compared with 24% of the control group (P <.001). At 12-month follow-up, a significant between-group difference was demonstrated in an endurance test (P =.022).

The authors concluded, “Person-centered, intense exercise was found to effectively improve physical fitness in terms of aerobic capacity, endurance, strength and dynamic balance in older adults with RA.”¹

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References

1. Lange E, Kucharski D, Svedlund S, et al. Effects of aerobic and resistance exercise in older adults with rheumatoid arthritis: A randomized controlled trial [published online on April 26, 2018]. Arthritis Care Res. doi: 10.1002/acr.23589
2. Buitinga L, Braakman-Jansen LM, Taal E, van de Laar MA. Future expectations and worst-case future scenarios of patients with rheumatoid arthritis: a focus group study. Musculoskeletal Care. 2012;10(4):240-247.
3. Stavropoulos-Kalinoglou A, Metsios GS, Veldhuijzen van Zanten JJ, Nightingale P, Kitas GD, Koutedakis Y. Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis. Ann Rheum Dis. 2013;72(11):1819-1825.
4. Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, Van den Ende EC. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev. 2009(4):CD006853.
5. Law RJ, Breslin A, Oliver EJ, et al. Perceptions of the effects of exercise on joint health in rheumatoid arthritis patients. Rheumatology (Oxford). 2010;49(12):2444-2451.
6. Wang M, Donovan-Hall M, Hayward H, Adams J. People’s perceptions and beliefs about their ability to exercise with rheumatoid arthritis: a qualitative study. Musculoskeletal Care. 2015;13(2):112-115.
7. Ekman I, Swedberg K, Taft C, et al. Person-centered care–ready for prime time. Eur J Cardiovasc Nurs. 2011;10(4):248-251.