Exercise Must Not be Ignored in Rheumatoid Arthritis Treatment

Rheumatoid arthritis exercise may be the last thing on your mind when you are already mentally and physically drained by your chronic fatigue, joints aches and swelling; but it may be also just what you need to ease the pain and improve your energy level.

Today, I am going to highlight the importance and multitude of beneficial effects of exercising in patients with RA. RA, as we know, is a systematic, autoimmune disease characterised by decrements to joint health including joint pain and inflammation, fatigue, increased incidence of cardiovascular disease and accelerated loss of muscle mass. These factors all contribute to functional limitation, loss of range of motion, disability and reduced quality of life.

Exercise training for RA sufferers has been reported to be efficacious in reversing the loss of muscle mass and substantially improving function without exacerbating the disease activity and at the same time, likely to reduce the risk of cardiovascular disease. Therefore, it has become crucial that we include a variety of exercise programs as part of our routine care and treatment protocol.

Low physical activity is yet another reversible characteristic of RA. It is understood that RA patients tend to do less exercise than their healthy counterparts. More than 80% of RA patients are physically inactive in some countries around the world. Over time, the physical inactivity of RA sufferers becomes a vicious cycle in terms of health and disease progression and therefore, it is apparent that exercising is essential or encouraged to be incorporated as part of our overall wellness treatment program of RA.

Clinical Research on Importance of Regular Exercise As Therapeutic Approach for RA
A growing body of research is showing that regular exercise has become a necessary component of a treatment protocol for RA:

Forrest G, Rynes RI (1994). Department of Physical Medicine and Rehabilitation, Albany Medical College, NY, USA.
Exercise for Rheumatoid Arthritis.
“The approach to treating rheumatoid arthritis is changing. Greater emphasis on the exercise component of physical therapy can improve patients’ muscle strength, endurance, and emotional well-being, and may even result in decreased joint inflammation.”

Perandini LA et al (2012). Rheumatology Division, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
Exercise as a therapeutic tool to counteract inflammation and clinical symptoms in autoimmune rheumatic diseases.
“Chronic inflammation is a common feature shared by several autoimmune rheumatic diseases, such as rheumatoid arthritis… blocking or reducing inflammation is one of the major treatment strategies in these diseases. In this context, exercise training has emerged as a potential therapeutic tool in counteracting systemic inflammation, thereby leading to better clinical outcomes.”

Baillet A et al (2012). Hôpital Sud, Grenoble Teaching Hospital, Echirolles Cedex, France.
Efficacy of resistance exercises in rheumatoid arthritis: meta-analysis of randomized controlled trials.
“Randomized controlled trials (RCTs) comparing resistance exercise based therapy with interventions without resistance exercise for the treatment of RA patients were included.Resistance exercises significantly improved isokinetic strength, isometric strength, grip strength and … had a positive impact on the 50-foot walking test. Subgroup analysis revealed a trend towards higher efficacy associated with high-intensity programmes. Conclusion: Resistance exercise in RA is safe, and the improvement in most outcomes was statistically significant and possibly clinically relevant for RA disability.”

Benefits of Exercise in RA

Skeletal Muscle Function
Loss of strength, of up to 70%, is a common finding in RA patients in comparison to healthy people. Loss of muscle mass is the main, though not sole, contributor to loss of muscle strength other than decreased physical activity and immunologic factors associated with RA. Lower strength and power then lead on to functional limitation in RA. Thus, early and persistent exercise training is necessary to improve muscle physiological properties that are impaired as a result of disease flare.

Bone Mineral Density
People with RA is at greater risk of lower bone mineral density (BMD), but the disease in itself, ie its systemic inflammation and high-dose oral steroid medication when used as part of RA treatment, often results in radiological changes including bone loss. Hence, physical activity that involves muscles strengthening can assist in mitigating the BMD loss, which is also associated with increases in both muscle strength and aerobic fitness.

Joint Health
The role of exercise in promoting the joint health of a person with RA is of crucial importance. The health of the joint involves a combination of factors:

(1) Tendons are tough bands of fibrous tissues that connect muscle to bone or muscle to muscle. They are made to withstand tension, working in conjunction with the muscle to exert pulling force. Stiffer tendons are said to provide more efficient force production. RA may cause synovial inflammation of tendon sheaths, raising circulating inflammatory cytokines that affect collagen, leading to damage of tendon structure. Tendon stiffness can be increased, however, following strength training and endurance training.

(2) The ligaments are another fibrous and somewhat stretchy tissues that connect one bone to another in the body, forming a joint. They control the joint’s range of motion and stabilize the joint so that the bones move in the correct alignment. Similar to the research surrounding tendons and the effects of exercise, it is known that exercise strengthens ligaments and that even relatively short periods of immobilisation weakens them.

(3) The primary function of cartilage within the synovial joint is to protect the bone from damage by helping to minimize friction between adjacent bones during movement. It is known that the compression and decompression achieved through regular exercising can help prevent cartilage tissue from becoming fragile and dysfunctional.

Concern that Exercise May Damage Joint Structure?
For many years, intensive dynamic and weight-bearing exercises were considered inappropriate for people with RA due to concerns that such activities may cause damage to the structure of the joint.

Despite this long-held beliefs, many studies have concluded that exercises do not cause an increase in the rate of damage to both small and large joints of the body. Some evidences even suggest that the raised intra-articular pressure during dynamic exercise may actually increase synovial blood flow that translates a beneficial effect in joint inflammation. Aside from these, it is noticeable that exercises also follow an improved strength and endurance of muscles alongside tone and elasticity of connective tissues that promotes joint stability and alignment, joint mobility as well as physical function without detrimental effect on disease activity in the RA patients of the clinical studies.

Get Moving Now
While this discovery is important, it’s the very action to get yourself moving that is worth everything. If we think seriously about how we can control the levels of inflammatory compounds in our circulation and how we can regain strength in our joints and muscles, it makes sense to start now than later or never. In that sense, exercises – the activities that cause powerful anti-inflammatory action, is one of the best lifestyle factor that we must mandate in our lives. Be it a simple stretch or brisk walk, yoga training, swimming or trekking, do not miss the chance to use and move the body. As the saying goes, use it or lose it! Learn about the exercises that we can do in the next post – What are Some Joint-Friendly Exercises for Rheumatoid Arthritis? – Stay tuned!

References:
http://www.hindawi.com/journals/jar/2011/681640/