The following article was written by one of my staff, Davin May-Holmes. I hope you find it beneficial.
A meta-analysis review study was published, that marks a recent but important step in creating effective and safe exercise programming for those suffering from rheumatoid arthritis and looking to promote optimal physical health outcomes in every way possible.
Here, the researchers look at several studies and draw conclusions from the various findings on exercise programs for those with rheumatoid arthritis. It indicates that more research needs to be done to find specific exercise protocols that are the most effective for treatment of rheumatoid arthritis, but finds that overall both cardiovascular endurance training (sometimes called ET) and progressive resistance training (PRT) both bring positive effects to those afflicted with the condition. Despite those excellent and optimistic findings, we must consider the full story. You might ask, “but would my loved ones be comfortable with the thought of any intense exercise regime?”. That is a valid question, and the psychological well being of a patient is mentioned in the study as well. Let us take a moment to look at the way the four patient specific areas of this condition can perhaps get better, worsen, or maybe be unaffected by exercise altogether.
A Brief Background on Rheumatoid Arthritis
So first off, what do we know about Rheumatoid Arthritis, and why should we suspect that exercise may help? Rheumatoid arthritis is a chronic condition that causes massive amounts of inflammation throughout the body. The joints of the body suffer the worst, everything from fingers and knuckles, to elbows, knees, and hips. Patients also experience lean body mass reductions (mainly from muscle loss) and are overall said to have lower physical function, in terms of carrying out their daily tasks or normal routine.
According to the same study, there is also greatly increased risk of Cardiovascular disease (CVD). When compared to the general population, people with rheumatoid arthritis were found to be 50% more likely to suffer from cardiovascular disease, in a large meta-analysis that compared well over one-hundred thousand patients to the general population.
Rheumatoid arthritis also affects 1 in 100 adults in Canada, and as many as 1.3 million adults living in the United States, so it is by no means a rare condition. These factors tell us that a variety of health outcomes can be and are often worsted by untreated or even well-managed RA, and so if exercise can play a role in combating some or all of these health risks, then it represents a massive step in the treatment of this condition.
Area to improve #1 – Cardiovascular Disease
A variety of training styles can be used to improve cardio related health for RA. Running, cycling, walking, water aerobics have all been proven to bring benefits. Regular brisk walking for example, even in short bouts (< 30 mins) have been shown to increase cardiovascular fitness and reduce cardiovascular disease risk. Walking is an inexpensive and safe way for someone to train, especially if their disabilities are significantly advanced.
Cycling has also been shown to improve markers of cardio fitness and lower body muscle strength by 17% in both cases, after a 12-week program following the ACSM (American College of Sports Medicine) guidelines for Rheumatoid arthritis. Positive changes in depression, anxiety, and levels of fatigue have also been found in studies that used cardiovascular training from dancing. Pretty cool stuff! Healthy changes and you can get your groove on, that is a good deal I would say.
Area to improve #2 – Muscular Health & Bone Mass Density
Loss of strength, up to 70% is a common finding in those afflicted with RA compared to healthy adults of similar age. We also know that RA causes muscle loss to be increased due to regulation of hormones being altered, leading to higher amounts of proteins that causes muscle wasting. When it comes to using exercise in fighting this muscle and strength loss, a list of highly positive effects was found.
In a 24 week-long program here were the changes:
· Increases in strength ranging 19-59% (Example, if you can curl a 20 lbs. dumbbell for ten reps total at once, but later can lift a 30 lbs. dumbbell for the same reps, that is a 50% increase!)
· Reduced morning sensations of stiffness
· Reduced overall pain, and inflammation in affected joints
These are some massive improvements in RA patients that honestly come as a surprise to most trainers (unless those trainers have worked with people who’ve had rheumatoid arthritis in the past… then they know what to expect). It’s also important to point out that muscular gains can still be seen several years later if sufficient intensity is used, and a progressive overload is pursued (as in, try hard exercises, in a gradual and safe manner, that stimulates your body to adapt – as Igor writes about in his article, The Most Important Factor in an Exercise Program is the progression model).
Loss of bone mineral density and prevention: The study refers to previous works where a group of patients performed ongoing high intensity (%60-80 of 1 Rep Maximum) where an increase in bone mass occurred in the hips. They do point out that not many long-term studies have been conducted on this area and more work is needed, however loading of bone structures with external resistance is likely still essential in combating bone loss.
Area #3 – Joint Health (Ligaments, Cartilage, Tendons)
What exactly is a joint? It is a point where two bones meet and facilitate movement or multiple movements depending on what type of joint it is. We hear a lot about joint pain, somebody you know may have torn a ligament, suffered cartilage loss, or maybe you have even had a sprained ankle or two yourself. But what structures are affected for rheumatoid arthritis patients and how can exercise help? First, here is some context to what joint structures are:
Cartilage – Is a rubbery padding that coats the surface of bones where they meet with each other. These protect our bones from impacts and friction, think of this like sole of your shoes between your feet and the pavement you jog on.
Tendons – These are dense fibres that connect muscles to bones, think of them like an anchoring structure that hold you together and allow you to move. We want them to maintain a level of stiffness yet be elastic as well for proper function.
Ligaments – The ligament is tough but flexible, and kind of like the support beams of your home allowing it to stay upright, these connect bone to bone and hold our skeleton together as we move.
Biggest Joint Improvements from Exercise: It was not conclusively found whether exercise had major changes in any of these structures for those with RA, but it is known that inactivity worsens the state of cartilage and ligament health, leading to the position that exercise is key for maintaining both structures.
Tendons especially were shown to have little effects on them from exercise, but the study makes note that there is potential benefit still, as maintaining and increasing tendon stiffness is observed in non-RA elderly participants in other research studies. The biggest improvement we see is a decrease in pain, and increase in range of motion from regular exercise, with emphasis that both strength and endurance exercise promote optimal joint function and have the effect of preventing deterioration if nothing else. In short, for the joints of our body, exercise is safe and is recommended!
Area #4 – Overall Physical Function
One of the most annoying symptoms that people with rheumatoid arthritis report dealing with is their overall level of fatigue from performing physical tasks, or just experienced throughout a day, even when it is a relatively inactive one. This, combined with the disabilities, joint pain, and body stiffness, leads to limitations in function. Carrying your groceries to climbing stairs, playing with your kids or grandkids, and so on. Even with disease modifying drugs, all these limitations are present.
Exercise, however, was shown to improve not only some but in many cases all these factors, and the researchers note that psychological markers were improved too (healthier and happier? Huh, not bad at all).
The only cases where little improvements were observed following exercise programs, was in patients’ subjective assessments of their disabilities for those individuals with already minor symptoms, and who had a low level of disability compared to more advanced rheumatoid arthritis cases. Why is that important?
Because it tells us that even if someone you know has significantly advanced disabilities and pain from rheumatoid arthritis, they in fact are likely to have bigger results and gains in combating their symptoms, and especially with how they perceive their disease themselves, depending on the individual, of course.
Summarizing the Findings on Exercise for Rheumatoid Arthritis
To quote the researchers as they compare the effects of high intensity resistance exercise in Rheumatoid arthritic patients to middle aged or older participants in previous exercise studies, they find the following, “These findings are important to health professionals and those involved in prescribing exercise for people with RA as rheumatoid muscle should respond to exercise training in a similar way to that of muscle in healthy individuals.”
Essentially, the best data that has been gathered to date regarding RA and the efficacy of exercise tells us that not only is it safe for individuals to progressively work through intense exercise, but that their body will respond in a very similar way to others and in fact be able to make muscular gains, suggesting that intensity is key for this route of treatment to be most effective.
When it comes to cardiovascular health, we know that people with rheumatoid arthritis tend to be generally more sedentary than adults without rheumatoid arthritis of the same age. This is often mainly due to the pain and disability associated with the illness and thus leading to worse cardiovascular health for those with rheumatoid arthritis. Cardio brings noticeable changes, can be done regularly in small bouts, for safe, and practical health improvements for those affected. This is key in promoting longevity in people with rheumatoid arthritis!
Inactivity is said to be strongly avoided! It leads to faster joint deterioration, muscle wasting and poor cardio health.
And finally, what the researchers of this study found is best emphasized in their conclusion, “The importance for the inclusion of exercise training in the treatment of RA is now clear and proven.” They do, however, point out that more research is to generally be done for specific protocols to be made on this subject, but we know enough at this point to say that exercise is not only safe, but key in promoting optimal outcomes for our loved ones who suffer from rheumatoid arthritis.
