Arthritis and Exercise
Richard A. Feely, D.O., FAAO, FCA, FAAMA
In the 1980's the idea of including exercise as part of a treatment plan was seen as a radical approach to the management of arthritis.
Marion Minor, PhD, thought otherwise. In 1989 she conducted a study with 120 arthritic patients with osteoarthritis and rheumatoid arthritis. The patients were randomly assigned to aerobic walking, aerobic aquatics, or to a control group of nonaerobic range of motion exercises. The duration of the study was for 12 weeks.
The results showed that the aquatics and walking exercise groups showed significant improvement over the control group in their capacitiy to do aerobics, 50-foot walking time, depression, anxiety, and physical activity after the 12-week program.
“Participants said that they were gaining back control on their lives, and not subject to the whim of the disease,” Minor said. “This provides a good prototype for self-management and problem-solving, the types of things that can further improve the condition of people with arthritis.” (1)
Around the same time in Denmark researchers were also looking into physical training as a way of helping rheumatoid arthritis patients. They looked at a graduated exercises going from 2 times per week of aerobics and strengthening exercises to eventually progressing to strenuous exercises over an 8-week period.
The results were encouraging in this study also. The patients had significantly fewer swollen joints than before. Exercising the muscles of the swollen joints resulted in more than a 35% decrease in the number of swollen joints. (2) The Denmark study showed that improving muscle strength also improved the affected joint. This was further confirmed in other studies.
One particular study looked at the effect of strengthening the knee muscles of patients with arthritis of the knee joint. In this trial 20 volunteers with knee joint arthritis were randomly assigned to a treatment group (10 people) or to a control group (10 people). The treatment group completed six sets of five strong contractions three times per week for a period of 8 weeks.
At the end of the study the treatment group as compared to the control group showed a a significant decrease in pain and stiffness and a significant increase in the ability to move. There was also a significant decline in the Osteoarthritis Screening Index and the Arthritis Impact Measurement Scale. (3)
Other areas of exercise therapy for arthritis have also been investigated. One such area was to determine whether high or low intensity exercises were more effective.
100 patients with moderately severe rheumatoid arthritis were randomly assigned to (a) intensive group exercises that included full weight bearing and also conditioning exercises on a stationary bike; (b) range of motion exercises and isometric exercises group; (c) individual isometric and range of motion; and (d) home instructions for isometric and range of motion exercises. The study ran for 12 weeks.
There was about a 17% increase in aerobic capacity strength and joint mobility in the high intensity exercise as compared to the other exercise groups. When the patients stopped their exercise training whatever gains they had achieved in physical capacity disappeared.(4)
In a study published in the Journal of the American Medical Association researchers looked at whether a structured exercise program would help older people with arthritis of the knee. 439 adults, aged 60 or older, took part in either an aerobic exercise program, a resistance exercise program, and a health education program. 83% of the people completed the 18 month study.
The results showed that the aerobic exercise group had 10% lower scores on the physical disability questionnaire, a 12% lower score on the knee pain questionnaire, improved performance on the 6-minute walk test, and also had improved the time it took to carry 10 pounds as compared to the health education group. The resistance exercise group also showed improvements but not as good as the aerobic exercise group. (5)
Even though exercise is now considered standard treatment for arthritis it is not widely prescribed. In a study involving 110 elderly persons with chronic hip and knee pain, fewer than half had received the medical advice to exercise. Arthritis specialists did much better in prescribing exercise than the primary care physician. Further, those patients who were told to exercise by their physician were making an attempt to do so but only 10% were doing the exercises in a way that would be therapeutic. (6)
(1) Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Minor MA, Hewett JE, Webel RR, Anderson SK, Kay DR. Arthritis Rheum 1989 Nov;32(11):1396-1405
(2) The effect of physical training on patients with rheumatoid arthritis: changes in disease activity, muscle strength and aerobic capacity. A clinically controlled minimized cross-over study. Lyngberg K, Danneskiold-Samsoe B, Halskov O. Clin Exp Rheumatol 1988 Jul;6(3):253-260
(3) Effects of muscle-strength training on the functional status of patients with osteoarthritis of the knee joint. Schilke JM, Johnson GO, Housh TJ, O'Dell JR. Nurs Res 1996 Mar;45(2):68-72
(4) Comparison of high and low intensity training in well controlled rheumatoid arthritis. Results of a randomised clinical trial. van den Ende CH, Hazes JM, le Cessie S, Mulder WJ, Belfor DG, Breedveld FC, Dijkmans BA. Ann Rheum Dis 1996 Nov;55(11):798-805
(5) A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial. Ettinger WH Jr, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, Shumaker S, Berry MJ, O'Toole M, Monu J, Craven T. JAMA 1997 Jan 1;277(1):25-31
(6) Joint exercises in elderly persons with symptomatic osteoarthritis of the hip or knee. Performance patterns, medical support patterns, and the relationship between exercising and medical care. Dexter PA. Arthritis Care Res 1992 Mar;5(1):36-41