title: Effect of 8 wk of bicycle training on the immune system of patients with rheumatoid arthritis. A randomized controlled trial to evaluate the efficacy of community based physical therapy in the treatment of people with rheumatoid arthritis. Cost-utility and cost-effectiveness analyses of a long-term, high-intensity exercise program compared with conventional physical therapy in patients with rheumatoid arthritis. Long-term follow-up of a high-intensity exercise program in patients with rheumatoid arthritis Moderately intensive exercise in a temperate pool for patients with rheumatoid arthritis: a randomized controlled study. Effects of detraining subsequent to strength training on neuromuscular function in patients with inflammatory arthritis. A randomized controlled trial to evaluate the effectiveness of an exercise program in women with rheumatoid arthritis taking low dose prednisone. Long term high intensity exercise and damage of small joints in rheumatoid arthritis. Effects of concurrent strength and endurance training in women with early or longstanding rheumatoid arthritis: comparison with healthy subjects. Exercise can reverse quadriceps sensorimotor dysfunction that is associated with rheumatoid arthritis without exacerbating disease activity. Physical fitness and work capacity in women with rheumatoid arthritis. Validity of the MACTAR questionnaire as a functional index in a rheumatoid arthritis clinical trial. The McMaster Toronto Arthritis. Sustained maintenance of exercise induced muscle strength gains and normal bone mineral density in patients with early rheumatoid arthritis: a 5 year follow up. Longterm physical training in rheumatoid arthritis. A randomized trial with different training programs and blinded observers. Conservative hand therapy treatments in rheumatoid arthritis--a randomized controlled trial. A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis. In- and out-patient rehabilitation in rheumatoid arthritis. A controlled, open, longitudinal, cost-effectiveness study. Dynamic training versus relaxation training as home exercise for patients with inflammatory rheumatic diseases. A randomized controlled study. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Effects of strength training on neuromuscular function and disease activity in patients with recent-onset inflammatory arthritis. Effectiveness of minimally supervised home aerobic training in patients with systemic rheumatic disease. A randomized and controlled trial of hydrotherapy in rheumatoid arthritis. Effects of exercise on fatigue, aerobic fitness, and disease activity measures in persons with rheumatoid arthritis. Dynamic strength training in patients with early rheumatoid arthritis increases muscle strength but not bone mineral density. [No difference in effectiveness measured between treatment in a thermal bath and in an exercise bath in patients with rheumatoid arthritis]. Efficacy of low load resistive muscle training in patients with rheumatoid arthritis functional class II and III. Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis. Effects of static and dynamic shoulder rotator exercises in women with rheumatoid arthritis: a randomised comparison of impairment, disability, handicap, and health. Comparison of high and low intensity training in well controlled rheumatoid arthritis. Results of a randomised clinical trial. Dynamic training and circulating neuropeptides in patients with rheumatoid arthritis: a comparative study with healthy subjects. Slowing of bone loss in patients with rheumatoid arthritis by long-term high-intensity exercise: results of a randomized, controlled trial. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Can progressive resistance training reverse cachexia in patients with rheumatoid arthritis? Results of a pilot study. A home-based two-year strength training period in early rheumatoid arthritis led to good long-term compliance: a five-year followup. Physical training in rheumatoid arthritis: a controlled long-term study. I. The effects of knee extensor and flexor muscle training on the timed-up-and-go test in individuals with rheumatoid arthritis. 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. Physical and exercise therapy for treatment of the rheumatoid hand. Physiotherapy in subtropic climate improves functional capacity and health‐related quality of life in Swedish patients with rheumatoid arthritis and spondylarthropathies still after 6 months Effect of intensive exercise on patients with active rheumatoid arthritis: a randomised clinical trial Dynamic versus static training in patients with rheumatoid arthritis. Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial. Effect of a high-intensity weight-bearing exercise program on radiologic damage progression of the large joints in subgroups of patients with rheumatoid arthritis. EFFECTS OF A MODIFIED DANCE-BASED EXERCISE ON CARDIORESPIRATORY FITNESS, PSYCHOLOGICAL STATE AND HEALTH STATUS OF PERSONS WITH RHEUMATOID ARTHRITIS Elderly rheumatoid arthritis patients on steroid treatment tolerate physical training without an increase in disease activity.
abstract: The effect of 8 wk of progressive bicycle training on the immune system was evaluated in a controlled study on 18 patients with rheumatoid arthritis and moderate disease activity .  Maximal O2 uptake increased significantly , whereas heart rate at stage 2 and rate of perceived exertion decreased significantly , in the training group compared with the controls . Resting levels of a number of immune parameters were measured before and after 4 and 8 wk of training . Training did not induce changes in blood mononuclear cell sub population s , proliferative response , or natural killer cell activity . Furthermore the plasma concentrations of interleukin-1 alpha , interleukin-1 beta , and interleukin-6 did not change in response to training . It is concluded that 8 wk of bicycle training does not influence the immune system of patients with rheumatoid arthritis OBJECTIVE To evaluate the short term efficacy of a community based physical therapy ( PT ) program for people with rheumatoid arthritis ( RA ) through a single blind r and omized controlled trial . METHODS Adults with active RA were referred by their physician for community based PT . Participants were r and omized to either an  immediate intervention group [ experimental group ( EG ) ] or a wait list control group  ( CG ) . The intervention was a st and ardized program of education and exercise consisting of at least 4 visits or 3 h of PT over 6 weeks . Baseline , 6 , and 12 week assessment s were by a blinded independent assessor . The primary outcome instrument was the Stanford Arthritis Self-Efficacy Scale ( SES ) and secondary outcome measures included the ACREU Rheumatoid Arthritis Knowledge Question naire ( KQ ) and visual analog scale for pain ( VAS ) . Duration of morning stiffness , grip strength , and tender joint count were also collected at each assessment . Outcome analysis was conducted using analysis of variance . RESULTS Of 150 eligible and r and omized participants , 127 completed the study according to protocol . Baseline analysis showed no differences between the EG and CG for demographics , disease status , or other characteristics . At the 6 week assessment , primary outcome analysis for those who completed the protocol identified a mean change ( improvement ) of 13.5 % in the EG and 5.8 % in the CG , representing a 7.7 % difference in change scores between the 2 groups [ F(1,121 ) = 6.03 ; p = 0.015 ] . A statistically significant difference in change scores was also identified for the KQ [ F(1,120 ) = 6.67 ; p = 0.011 ] , but not for the VAS . Disease status measures did not change , except for duration of morning stiffness , which improved by 68.8 min in the EG and 8.3 min in the CG ( F(1,121 ) = 4.50 ; p = 0.036 ] . CONCLUSION Four hours of a community based PT intervention delivered over 6 weeks significantly improved self-efficacy , disease management knowledge and morning stiffness in people with RA OBJECTIVE To estimate the cost utility and cost effectiveness of long-term , high-intensity exercise classes compared with usual care in rheumatoid arthritis ( RA ) patients . METHODS RA patients ( n = 300 ) were r and omly assigned to either exercise classes or UC ; followup lasted for 2 years . Outcome measures were quality -adjusted life years ( QALYs ) according to the EuroQol ( EQ-5D ) , Short Form 6D ( SF-6D ) , and a transformed visual analog scale ( VAS ) rating personal health ; functional ability according to the Health Assessment Question naire ( HAQ ) and McMaster Toronto Arthritis Patient Preference Interview ( MACTAR ) ; and societal costs . RESULTS QALYs in both r and omization groups were similar according to the EQ-5D and SF-6D , but were in favor of usual care according to the VAS ( annual difference 0.037 QALY ; 95 % confidence interval [ 95 % CI ] 0.002 , 0.069 ) . Functional ability was similar according to the HAQ , but in favor of the exercise classes according to the MACTAR ( annual difference 2.9 QALY ; 95 % CI 0.9 , 4.9 ) . Annual medical costs of the exercise program were estimated at 780 per participating patient ( 1 approximately $ 1.05 ) . The increase per patient in total medical costs of physical therapy was estimated at 430 ( 95 % CI 318 , 577 ) , and the increase in total societal costs at 602 ( 95 % CI -490 , 1,664 ) . For societal willingness-to-pay equal to 50,000 per QALY , usual care had better cost utility than exercise classes , and significantly so according to the VAS . CONCLUSION From a societal perspective and without taking possible preventive health effects into account , long-term , high-intensity exercise classes provide insufficient improvement in the valuation of health to justify the additional costs The aims of this study were to describe rheumatoid arthritis patients ’ compliance with continued exercise after participation in a 2-year supervised high-intensity exercise program  and to investigate if the initially achieved effectiveness and safety were sustained . Data were gathered by follow-up of the participants who completed the 2-year high-intensity intervention in a r and omized controlled trial ( Rheumatoid Arthritis Patient In Training study ) . Eighteen months thereafter , measurements of compliance , aerobic capacity , muscle strength , functional ability , disease activity , and radiological damage of the large joints were performed . Seventy-one patients were available for follow-up at 18 months , of whom 60 ( 84 % ) were still exercising ( exercise group : EG ) , with average similar intensity but at a lower frequency as the initial intervention . Eleven patients ( 16 % ) reported low intensity or no exercises ( no-exercise group : no-EG ) . Patients in the EG had better aerobic fitness and functional ability , lower disease activity , and higher attendance rate after the initial 2-year intervention . At follow-up , both groups showed a deterioration of aerobic fitness and only patients in the EG were able to behold their muscle strength gains . Functional ability , gained during the previous participation in high-intensity exercises , remained stable in both groups . Importantly , no detrimental effects on disease activity or radiological damage of the large joints were found in either group . In conclusion , the majority of the patients who participated in the 24-month high-intensity exercise program continued exercising in the ensuing 18 months . In contrast to those who did not continue exercising , they were able to preserve their gains in muscle strength without increased disease activity or progression of radiological damage OBJECTIVES The aim of this study was to evaluate the effects of moderately intensive pool exercise therapy on patients with rheumatoid arthritis ( RA ) . METHODS Forty-six patients with chronic RA were r and omly assigned to a treatment group and a control group . The treatment group ( n = 20 ) exercised in a temperate pool twice a week for 12 weeks . The control group ( n = 23 ) continued with their previous activities .  Aerobic capacity , measured by means of a submaximum bicycle test , and the physical component of the SF-36 were chosen as the primary outcome measures . Two tests of muscle endurance were chosen as the secondary outcome measure . Additional functional tests and instruments were included . RESULTS No significant differences between the groups were found for the primary outcome measures . Significant improvements in the following aspects of muscular function ( P < 0.05 ) were found in the treatment group when their performance was compared with that of the control group : isometric shoulder endurance , grip force , dynamic endurance of lower extremities ( chair test ) and muscle function of lower extremities . Significant improvements were also found for vitality ( SF-36 ) compared with the control group . The improvements in the training group were maintained for 3 months . CONCLUSIONS Pool exercise therapy of moderate intensity significantly improved muscle endurance in the upper and lower extremities in patients with RA , while no impact on aerobic capacity was found . However , the study population was small and there is a need for further studies with larger population The effects of detraining subsequent to strength training on neuromuscular function were examined in 39 recent-onset rheumatoid arthritis ( RA ) patients . Eighteen age- and sex-matched healthy people ( H ) served as controls . Patients were r and omly allocated either to the experimental group ( PE ) , who carried out progressive strength training for 6 months , or to the control group ( PC ) , who maintained only their habitual physical activities . After 6 months , PE returned to their earlier physical activities and strength training was terminated . At baseline , the maximal strength of the trunk extensors ( not significant ) , grip strength and maximal dynamic strength and the shape of the force-time curve of the knee extensors were lower in PE and PC ( P < 0.05 - 0.001 ) than in H. Strength training in PE led to remarkable increases ( P < 0.05 - 0.001 ) in the maximal strength of all muscle groups without changes in the shape of the force-time curve . The increases in muscle strength in PE obtained by strength training were lost to a great degree during the detraining period for the isometric trunk extension ( P < 0.01 ) and flexion ( P < 0.01 ) strength and for the dynamic knee extension strength ( P < 0.05 ) , but not for the grip strength . In PC , trunk extension and flexion strength decreased significantly throughout the study period . At the post-test , all the strength values in both patient groups were much lower than in H. RA is a chronic disease which seems to need continuous physical exercise with sufficient intensity to minimize/prevent the loss of muscle strength and functional capacity OBJECTIVE To evaluate the effects of a 12 month , weight bearing , aerobic exercise program on disease activity , physical function , and bone mineral density ( BMD ) in women with rheumatoid arthritis ( RA ) taking low dose prednisone .  METHODS A group of women with RA ( n = 23 ) not receiving steroid therapy and in American College of Rheumatology functional class I or II was compared to 30 steroid treated patients with similar demographics . The latter group was r and omized to usual care ( n = 16 ) or an aerobic , weight bearing exercise program ( n = 14 ) 3 times a week for 12 months . All subjects were recruited from an outpatient rheumatology clinic or physical therapy department and met the study inclusion criteria . Outcome measures included disease activity ( erythrocyte sedimentation rate , active joint count ) , physical function ( Health Assessment Question naire disability index , activity level ) and BMD of the spine and femoral neck ( by dual energy projection radiology ) . RESULTS Subjects in the exercise group had a small but nonsignificant decrease in disease activity and statistically significant improvements in function ( p = 0.05 ) and activity levels ( p = 0.05 ) . BMD remained unchanged in the exercise group , decreased significantly ( p = 0.004 ) in the nonsteroid comparison group ( hip ) , and changed nonsignificantly in the control group . However , between-group changes in spinal BMD of the steroid treated groups was not significant ( p = 0.09 ) . CONCLUSION Women with RA taking low dose steroid therapy  can safely participate in a dynamic , weight bearing exercise program with positive effects on their physical function , activity and fitness levels , and BMD with no exacerbation of disease activity OBJECTIVE To investigate the effect of long term high intensity weightbearing exercises on radiological damage of the joints of the h and s and feet in patients with rheumatoid arthritis ( RA ) . METHODS Data of the 281 completers of a 2 year r and omised controlled trial comparing the effects of usual care physical therapy ( UC ) with high intensity weightbearing exercises  were analysed for the rate of radiological joint damage ( Larsen score ) of the h and s and feet . Potential determinants of outcome were defined : disease activity , use of drugs , change in physical capacity and in bone mineral density , and attendance rate at exercise sessions . RESULTS After 2 years , the 136 participants in high intensity weightbearing exercises  developed significantly less radiological damage than the 145 participants in UC . The mean ( SD ) increase in damage was 3.5 ( 7.9 ) in the exercise group and 5.7 ( 10.2 ) in the UC group , p = 0.045 . Separate analysis of the damage to the h and s and feet suggests that this difference in rate of increase of damage is more pronounced in the joints of the feet than in the h and s. The rate of damage was independently associated with less disease activity , less frequent use of glucocorticoids , and with an improvement in aerobic fitness . CONCLUSION The progression of radiological joint damage of the h and s and feet in patients with RA is not increased by long term high intensity weightbearing exercises . These exercises may have a protective effect on the joints of the feet OBJECTIVE To investigate the effects of a 21-week concurrent strength and endurance training protocol on physical fitness profile in women with early or longst and ing rheumatoid arthritis ( RA ) compared with healthy subjects . METHODS Twenty-three female patients with RA volunteered for the study . Twelve had early RA and eleven had longst and ing RA . Twelve healthy women served as controls . Maximal strength of different muscle groups was measured by  dynamometers  , walking speed with light cells  , and  vertical squat jump  on the force platform to mirror explosive force . Maximal oxygen uptake was measured by gas analyzer . Six training sessions ( 3 strength training and 3 endurance training ) were carried out in a 2-week period for 21 weeks . RESULTS The training led to large gains in maximal strength both in women with RA and in healthy women ( P < 0.043 - 0.001 ) . The strength gains were accompanied by increases in walking speed ( P < 0.034 - 0.001 ) and vertical squat jump ( P < 0.034 - 0.001 ) . Significant improvements also occurred in maximal aerobic capacity in all groups ( P < 0.023 - 0.014 ) . CONCLUSIONS Both early and longst and ing RA patients with stable disease can safely improve all characteristics of their physical fitness profile using a progressive concurrent strength and endurance training protocol OBJECTIVES To compare quadriceps sensorimotor function , lower limb functional performance and disability in patients with rheumatoid arthritis ( RA ) and healthy subjects , and to investigate the efficacy and safety of a brief rehabilitation regime . METHODS Quadriceps strength , voluntary activation , proprioceptive acuity and the aggregate time [ aggregate functional performance time ( AFPT ) ] taken to perform four common activities [ aggregate functional performance time ( AFPT ) ] were compared between 103 RA patients who had lower limb involvement and 25 healthy subjects . In addition , disability ( Health Assessment Question naire ) , clinical disease activity and the plasma concentration of proinflammatory cytokines were measured in the RA patients . In a follow-on r and omized controlled trial of rehabilitation , these variables were used as baseline data for 93 of the RA patients , who were r and omized to a rehabilitation or a control group . Changes in the variables were analysed within and between groups . RESULTS Compared with healthy subjects , RA patients had weaker quadriceps [ mean difference 157 N ; 95 % confidence interval ( CI ) 125 - 189 ] , poorer activation ( 8 % , 95 % CI 4.5 - 15 ) and proprioceptive acuity ( 0.8 degrees , 95 % CI 0.4 - 1.3 ) and took longer to perform the AFPT ( 34 s , CI 23.5 - 44.8 ) . Rehabilitation increased quadriceps strength ( mean increase 61 N , 95 % CI 28 - 95 ) and voluntary activation ( 8 % , 95 % CI 3 - 12.4 ) and decreased the AFPT ( 12.3 s , 95 % CI -2 to 27.7 ) and subjective disability ( 0.21 HAQ points , 95 % CI 0 - 0.35 ) without exacerbating disease activity . All the improvements were maintained at the 6-month follow-up . There was no change during the control period . CONCLUSIONS Patients with RA that affected their lower limb had quadriceps sensorimotor deficits that were associated with lower limb disability . A clinical ly applicable rehabilitation regime increased quadriceps sensorimotor function and decreased lower limb disability without exacerbating pain or disease activity . For patients with well-controlled RA that causes lower limb involvement , the regime is effective and safe OBJECTIVE To investigate physical fitness and work capacity in women with rheumatoid arthritis ( RA ) . METHODS The 42 subjects were a subset of a prospect i ve trial of conditioning exercise in rheumatic disease . Assignment to an exercise or nonexercise group was determined by proximity to the intervention , a 3-month supervised group exercise program . Physical fitness and work capacity were assessed at baseline , 3 months , and 12 months . RESULTS At baseline , subjects were deconditioned and limited in h and function , lifting ability , and lower extremity mobility . Only the exercise group improved their aerobic capacity and exercise tolerance . There were no significant changes in measured work capacity in either group . Moderate to strong correlations were found between aerobic capacity , mobility , h and function , and work capacity . Grip strength was a strong and consistent correlate of work capacity . CONCLUSION Our findings suggest that physical capacity , particularly h and function , may be important in the complex phenomenon of work disability in RA OBJECTIVES The McMaster Toronto Arthritis patient preference question naire ( MACTAR ) is a functional index that measures change in impaired activities selected by each patient in a baseline interview , and change in rheumatoid arthritis ( RA ) disease activity . In addition , it contains questions on the state of physical , social and emotional function and overall health , and their relation to RA . We evaluated MACTAR 's feasibility and validity ( content validity , construct validity , and responsiveness ) . METHODS A r and omized trial of combined treatment in 155 patients with early RA ; patients ' mean age at baseline was 50 years and median disease duration since diagnosis was 4 months . RESULTS Feasibility : MACTAR requires trained interviewers . In the trial , interviews took about 15 min . In longer term followup , activities selected at baseline may become less relevant as the pattern of disability changes . Followup from 153 patients ( 99 % ) was available . At least 5 impaired activities were identified and ranked by 147 patients ( 95 % ) ; interviewers could follow 99 % of these . The scoring system proved complex and required amendments . Content validity : Although its main focus is physical function , the MACTAR also contains generic questions ; 75 % of the patients named at least one impaired activity from the category " mobility . " Only 48 % were covered by Health Assessment Question naire ( HAQ ) items . Construct validity : MACTAR scores correlate highly with other functional indices and with measures of disease activity . Responsiveness : At 16 weeks the st and ardized response mean for the total MACTAR score in the combined-treatment group was excellent , at 2.2 . Items that directly address change were even more responsive . CONCLUSION The MACTAR interview is a valid and highly responsive instrument to assess change in functional ability of patients with early RA with active disease . It provides insight into problems -- mainly of physical function -- that really matter to patients . For st and ard clinical trials and clinical care , feasibility of the MACTAR is limited and the simpler HAQ remains the instrument of choice OBJECTIVE To investigate at 5 years whether an initial 2 year home based strength training period imposes sustained effects on muscle strength , bone mineral density ( BMD ) , structural joint damage , and on disease activity in patients with early rheumatoid arthritis ( RA ) . METHODS Seventy patients were r and omised either to perform home based strength training with loads of 50 - 70 % of repetition maximum ( EG ) or range of motion exercises ( CG ) . Both groups were encouraged to take part in aerobic activities 2 - 3 times a week . Maximal muscle strength of different muscle groups was measured by dynamometers , and BMD at the femoral neck and lumbar spine by dual x ray densitometry . Disease activity was assessed by the 28 joint disease activity score , and joint damage by x ray findings . RESULTS 62 patients completed 2 years ' training and 59 patients attended check up at 5 years . Mean ( SD ) maximum muscle strength indices increased from baseline to 2 years-in EG from 212 ( 78 ) kg by a mean ( 95 % CI ) of 68 ( 55 to 80 ) and in CG from 195 ( 72 ) kg by 35 ( 13 to 60 ) kg- and remained at that level for the next 3 years . Development of BMD in EG tended to be more favourable than that in CG . Muscle strength training was not detrimental to joint structures or disease activity . CONCLUSION The patients ' exercise induced muscle strength gains during a 2 year training period were maintained throughout a subsequent self monitored training period of 3 years . Despite substantial training effects in muscle strength , BMD values remained relatively constant . Radiographic damage remained low even at 5 years The objective was to study the long-term effect ( 2 years ) of different training programs in patients with rheumatoid arthritis . The method was a r and omized trial with 75 patients participating . The measured variables included morning stiffness , a pain score , number of swollen joints , a health assessment score , a functional score , ESR , Hb , the cost of medicine , and progression using X-rays of h and s and feet . The results showed no effect of training on the disease activity or on the progression of the disease . The conclusion is that although most patients are in favour of training , the present study does not support that training lessons per se affect the disease activity or the progression of the disease OBJECTIVE To evaluate the effectiveness of three different physiotherapeutic approaches in the management of the  rheumatoid h and . METHODS In a r and omized controlled trial , participants with rheumatoid arthritis ( RA ) recruited from a rheumatology department in Mid-Staffordshire , UK ( February 1999 to January 2001 ) were r and omized to three groups . All received joint protection ( JP ) information delivered by a therapist at baseline . Group 1 participants received a set of additional h and -strengthening and mobilizing home exercises , group 2 a different set of additional h and -stretching exercises and group 3 the JP information alone . The primary outcome was the Arthritis Impact Measurement Scales II ( AIMS II ) ( upper limb ; h and and finger function subscales ) . Outcomes were assessed at baseline and 1 , 3 and 6 months . Analysis was by intention to treat . RESULTS Sixty-seven participants ( mean age 59.6 yr ) were recruited : group 1 n = 21 , group 2 n = 24 and group 3 n = 22 . A 78 % follow-up was achieved at 6 months . There was a mean fall ( SD ) in AIMS II upper limb function 0 - 6 month change scores in group 1 of 1.00 ( 1.07 ) . In groups 2 and 3 there was a mean increase in AIMS II scores of 0.18 ( 1.54 ) and 0.30 ( 1.22 ) , respectively . The differences in AIMS change scores between group 1 and groups 2 and 3 were statistically significant ( P = 0.007 ) and remained so after adjustment for multiple testing ( P = 0.012 ) . CONCLUSION Statistically significant improvements in arm function have been demonstrated following a programme of home-strengthening h and exercises in RA patients compared with simple stretches or advice alone OBJECTIVE To evaluate the impact of a 2-year program of strength training on muscle strength , bone mineral density ( BMD ) , physical function , joint damage , and disease activity in patients with recent-onset ( < 2 years ) rheumatoid arthritis ( RA ) . METHODS In this prospect i ve trial , 70 RA patients were r and omly assigned to perform either strength training ( all major muscle groups of the lower and upper extremities and trunk , with loads of 50 - 70 % of repetition maximum ) or range of motion exercises ( without resistance ) twice a week ; all were encouraged to engage in recreational activities 2 - 3 times a week . All patients completed training diaries  ( evaluated bi-monthly ) and were examined at 6-month intervals . All were treated with medications to achieve disease remission . Maximum strength of the knee extensors , trunk flexors and extensors , and grip strength was measured with dynamometers . BMD was measured at the femoral neck and lumbar spine by dual x-ray densitometry . Disease activity was determined by the Disease Activity Score , the extent of joint damage by the Larsen score , and functional capacity by the Health Assessment Question naire ( HAQ ) ; walking speed was also measured . RESULTS Sixty-two patients ( 31 per group ) completed the study .  Strength training  compliance averaged 1.4 - 1.5 times/week . The maximum strength of all muscle groups examined increased significantly ( 19 - 59 % ) in the strength-training group , with statistically significant improvements in clinical disease activity parameters , HAQ scores , and walking speed . While muscle strength , disease activity parameters , and physical function also improved significantly in the control group , the changes were not as great as those in the strength-training group . BMD in the femoral neck and spine increased by a mean + /- SD of 0.51 + /- 1.64 % and by 1.17 + /- 5.34 % , respectively , in the strength-training group , but decreased by 0.70 + /- 2.25 % and 0.91 + /- 4.07 % in the controls . Femoral neck BMD in the 17 patients with high initial disease activity ( and subsequent use of oral glucocorticoids ) remained constantly at a statistically significantly lower level than that in the other 45 patients . CONCLUSION Regular dynamic strength training combined with endurance-type physical activities improves muscle strength and physical function , but not BMD , in patients with early RA , without detrimental effects on disease activity Twenty-six patients with rheumatoid arthritis ( RA ) participated either in a 21 day , community sponsored , in-patient multidisciplinary rehabilitation program ( N = 20 ) or ; received traditional , out-patient physiotherapy design ed by the patient 's rheumatologist ( N = 6 ) . Clinical assessment s were made ( prior to , immediately after , and 6 months after rehabilitation ) to evaluate the response to these two quite different rehabilitative measures that included : functional classification , joint score index , subjective VAS of pain , HAQ , pain disability index , Comprehensible psychopathological rating scale , hemoglobin , and CRP measurements . Economic assessment s included salary , direct and community sponsored costs , for rehabilitation and costs for sick days and production losses . No clear-cut differences between the two rehabilitation modes were detected . Both modes showed improvement in different assessment parameters ; patients with higher education and , therefore , with a less joint-disturbing work profile appeared to profit more from an extensive in-patient rehabilitation program . Patients with less education and a more manually-oriented working profile , did worse and had a higher tendency to seek medical pensioning , in spite of rehabilitative measures . As the total costs for out-patient rehabilitation only add up to 15.8 % of the total costs for in-patient rehabilitation , this study setting cautiously suggests that out-patient rehabilitation might be an acceptable alternative to individualized patient groups that might not compromise clinical and vocational outcome . Larger patient groups are needed , however , to confirm these findings The aim of the study was to evaluate the effects of a dynamic training program versus a muscle relaxation training program as home exercise in patients with inflammatory rheumatic diseases . Fifty-four patients ( mean age 54 years , mean symptom duration 14 years ) were r and omized to one of the two programs . After personal instructions every patient exercised at home for half an hour , 5 days a week during 3 months . Before and after the interventions , all patients were assessed for health-related quality of life , joint tenderness and physical capacities . The dynamic training group had improved in perceived exertion at the walking test ( p < or = 0.05 ) , while the relaxation training group had improved their total Nottingham Health Profile ( p < or = 0.01 ) , its subscale for lack of energy ( p < or = 0.05 ) , Ritchie 's articular index ( p < or = 0.05 ) , muscle function of the lower extremities ( p < or = 0.01 ) , and arm endurance ( p < or = 0.01 ) . Regarding changes in muscle function of the lower extremities during the intervention period , there was a significant difference ( p < or = 0.05 ) between the groups in favour of the relaxation training group . The results of the study thus indicated that progressive muscle relaxation training might improve health related quality of life , reduce joint tenderness and be superior to dynamic muscle training in improving the muscle function of the lower extremities in patients with inflammatory rheumatic diseases . The clinical effects were small and the results have to be interpreted with caution Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists Thirty-nine consecutive patients with recent-onset rheumatoid or psoriatic arthritis were r and omly allotted for six months period either to the experimental progressive dynamic strength training group ( EG , 10 women and 11 men ; 41 + /- 10 yrs ) , or to the control group ( CG , 10 women and 8 men ; 45 + /- 11 yrs ) who just maintained their habitual physical activities . All patients received antirheumatic medication throughout the experimental period . During the study period significant improvements took place in the EG in maximal muscle strength of all examined muscle groups ( 31.5 % for the knee extensors , p < 0.001 ; 14.8 % and 10.7 % for the trunk flexors and extensors , p < 0.01 ; 27.8 % and 20.4 % for grip strength , p < 0.001 ) as well as in erytrocyte sedimentation rate ( p < 0.05 ) . Ritchie 's articular index ( RI ) ( p < 0.001 ) and HAQ ( p < 0.01 ) . In the CG only the decrease in RI was statistically significant ( p < 0.05 ) . Erosive changes in joints increased only slightly and less in the EG than in the CG . The present results suggest that dynamic strength training in early arthritis increases the neuromuscular performance without detrimental effects on disease activity or joint damage The effectiveness of an exercise prescription and unsupervised home exercise programme was tested on 37 subjects with rheumatoid arthritis and 34 with systemic lupus erythematosus . Subjects were r and omly assigned to control or stationary bicycling at home , using loaned bicycles . Exercise subjects ( with bicycles ) did better than controls , but not significantly , on all outcome d measures ( exercise tolerance test , fatigue , depression and helplessness ) at 3 months . Bicycles were recl aim ed at 3 months and all subjects in both groups given instructions for home exercise . Exercise in the second 3 months was predicted primarily by baseline exercise habits and fatigue . It is concluded that although safe , unsupervised home exercise programmes may benefit few patients . Future research should address methods of stimulating and maintaining unsupervised exercise programmes in patients with systemic rheumatic disease OBJECTIVE The aim of this study was to evaluate the therapeutic effects of hydrotherapy which combines elements of warm water immersion and exercise . It was predicted that hydrotherapy would result in a greater therapeutic benefit than either of these components separately . METHODS One hundred thirty-nine patients with chronic rheumatoid arthritis were r and omly assigned to hydrotherapy , seated immersion , l and exercise , or progressive relaxation . Patients attended 30-minute sessions twice weekly for 4 weeks . Physical and psychological measures were completed before and after intervention , and at a 3-month followup . RESULTS All patients improved physically and emotionally , as assessed by the Arthritis Impact Measurement Scales 2 question naire . Belief that pain was controlled by chance happenings decreased , signifying improvement . In addition , hydrotherapy patients showed significantly greater improvement in joint tenderness and in knee range of movement ( women only ) . At followup , hydrotherapy patients maintained the improvement in emotional and psychological state . CONCLUSIONS Although all patients experienced some benefit , hydrotherapy produced the greatest improvements . This study , therefore , provides some justification for the continued use of hydrotherapy The effects of 12 weeks of low-impact aerobic exercise on fatigue , aerobic fitness , and disease activity were examined in a quasi-experimental time series study of 25 adults with rheumatoid arthritis ( RA ) . Measures were obtained preintervention , midtreatment ( after 6 weeks of exercise ) , end of treatment ( after 12 weeks of exercise ) , and at a 15-week follow-up . ANOVAS for repeated measures showed that those subjects who participated more frequently reported decreased fatigue , while those who participated less frequently reported an increase in fatigue . All subjects , on average , showed increased aerobic fitness and increased right and left h and grip strength , decreased pain , and decreased walk time . There were no significant increases in joint count or sedimentation rate . Significant improvements in measures at the 15-week follow-up also were found . Findings indicate that persons with RA who participate in appropriate exercises may lessen fatigue levels and experience other positive effects without worsening their arthritis OBJECTIVE To assess the effects of 12 months ' dynamic strength training on muscle strength and bone mineral density ( BMD ) at the lumbar spine and femoral neck in patients with early rheumatoid arthritis ( RA ) . METHODS Thirty-two subjects in the training group ( EG ) and 33 in the control group ( CG ) completed the study . EG carried out strength training 2 times a week with moderate loads of 50 - 70 % of repetition maximum . They were also encouraged to do recreational physical activities . CG performed recreational physical activities and range of motion exercises .  Maximal strength of the knee extensors , trunk extensors and flexors , and grip strength were recorded with dynamometers . BMD was measured using dual x-ray absorptiometry . Modified Disease Activity Score , erythrocyte sedimentation rate , and pain were used for the estimation of disease activity , and Stanford Health Assessment Question naire to measure functional disability . RESULTS The 12 month resistance training in EG led to statistically significant mean increases of 22 - 35 % in all muscle groups examined . CG patients were also able to increase their strength to some degree ( 3 - 24 % ) , but at the end of the study strengths in CG were significantly lower than in EG . By the end of the study lumbar spine BMD had changed by + 0.19 % ( 4.24 ) in EG and by -1.14 % ( 4.36 ) in CG . The corresponding changes of femoral BMD were + 1.10 % ( 3.71 ) and -0.03 % ( 3.58 ) . The changes in BMD were minor and statistically not significant in both groups . However , femoral BMD was found to be decreased among those patients treated periodically with oral glucocorticoids ( n = 15 , 3 subjects from EG and 12 from CG ) compared with changes in BMD among those not treated with systemic glucocorticoids ( n = 50 ) . CONCLUSION Minimally supervised strength training result ed in significant improvements in muscle strength without detrimental effects on disease activity . The detected annual changes in central BMD were minor and statistically insignificant in both groups . Special attention should be focused on those patients with RA with high disease activity and concomitant glucocorticoid treatment OBJECTIVE To determine whether hydrotherapy in a thermomineral institution is superior to the same hydrotherapy in an ordinary hospital exercise-bath . DESIGN Controlled therapeutic trial . SETTING The thermomineral institution at Arcen and the exercise bath at the Maasl and Hospital in Sittard , the Netherl and s. PATIENTS AND METHODS 46 patients with rheumatoid arthritis were treated in a by a skilled physiotherapist , according to a st and ardized exercise-scheme : 27 were treated in the thermomineral institution  and 19 ( control-group ) in the hospital exercise-bath .  Each patient received 12 treatments in 12 weeks . ENDPOINTS PARAMETERS : Morning stiffness , erythrocyte sedimentation rate , Ritchie index , amount of pain , answers to 11 questions concerning the activities of daily life , and psychosocial aspects of the disease . The various subjective and objective parameters were scored by the same physician . RESULTS Statistically significant improvement was observed in both groups concerning morning stiffness . Other subjective parameters improved , but did not reach significance . Objective parameters did not change significantly . Between-group differences were not found . CONCLUSION Hydrotherapy has a positive effect on some subjective but not on objective parameters in patients with rheumatoid arthritis , whether it is applied in a thermomineral institution or an ordinary hospital exercise bath OBJECTIVE To determine the effect of a low load resistance exercise training program on muscle strength , functional outcome , and cardiovascular endurance . METHODS Forty-nine patients , 37 women and 12 men between the ages of 35 - 76 yrs ( mean 60.5 yrs ) , with definite rheumatoid arthritis ( RA ) functional class II and III ( mean disease duration of 10.5 yrs ) were r and omly assigned to exercise and control groups for a 12 wk resistive muscle training program . A circuit weight bearing form of training was incorporated using light loads with high repetitions . A video tape demonstrating the exercises was given to all exercising participants to enable them to continue the program at home at least 3 times per wk with a biweekly self-report evaluation . Baseline and post-intervention evaluations included joint activity , muscle strength , endurance , functional outcome , and self-report . Cardiovascular fitness measured by treadmill time , anaerobic threshold and peak oxygen consumption ( VO2 ) in this group were assessed at baseline and 12 wks . RESULTS A significant improvement at 12 wks was noted in the exercise group for self-reported joint count ( p = 0.02 ) , number of painful joints ( p = 0.004 ) , HAQ ( p = 0.012 ) , sit-to-st and time ( p = 0.02 ) , grip strength ( p = 0.05 ) knee extension 60 degrees ( p = 0.03 ) , Arthritis Impact Measurement Scales dexterity ( p = 0.02 ) , and time to anaerobic threshold ( p = 0.03 ) . Significant improvement in the exercise group compared to the control group was noted for self-reported joint count ( p = 0.02 ) , night time pain ( p = 0.05 ) , and sit-to-st and time ( p = 0.02 ) . Increase in treadmill time was not statistically significant nor was a change in peak oxygen consumption ( VO2 ) noted . Abnormalities on initial treadmill screening were detected in 2 of 49 asymptomatic patients . They were excluded from the study and subsequent workup revealed significant coronary artery disease . CONCLUSION Low load resistive muscle training increased functional capacity as reported by patients and is a clinical ly safe form of exercise in functional class II and III RA . Screening this population for dormant coronary artery disease is recommended OBJECTIVE To ascertain the effectiveness of the National Arthritis Foundation ( NAF ) aquatic and on-l and exercise programs on functional fitness and perceived ability to perform activities of daily living ( ADL ) measures in older adults with arthritis . DESIGN The effects of aquatic and on-l and exercise intervention programs were analyzed by repeated- measures analysis of variance by using a planned comparison approach with an independent 3 x 2 ( group by test ) design . omega(2 ) analyses were used to ascertain the relative treatment magnitude of each dependent variable . SETTING Testing in an indoor track facility ; exercise programs conducted in community setting s. PARTICIPANTS A volunteer sample of 30 men and women with arthritis ( osteoarthritis , n=22 ; rheumatoid arthritis , n=8 ) , r and omly assigned into either an aquatic exercise ( n=10 ) , on-l and exercise ( n=10 ) , or control group ( n=10 ) . INTERVENTION Eight-week on-l and and aquatic exercise program . MAIN OUTCOME MEASURES Functional fitness , ADLs , and h and -held dynamometry measures assessed on a 1-day pretest and posttest session , before and after an 8-week exercise program . RESULTS Aquatic and on-l and exercise subjects showed significant improvements on 9 of 12 functional fitness , 3 of 4 ADLs , and 7 of 8 h and -held isometric strength tests after their respective exercise programs . No significant changes were found in any of these measures for the control group . CONCLUSION Both NAF exercise programs appear to be effective in improving functional physical fitness and perceived ability to perform ADL measures in older adults with arthritis The aim was to compare static and dynamic shoulder rotator endurance training in a group of women with mild rheumatoid arthritis and to see whether such training could influence impairment , disability , and h and icap . The effects on general health were also studied . Patients were r and omly assigned to a static ( n = 17 ) ( average age 59 , median disease duration 7 ) or a dynamic training group ( n = 20 ) ( average age 56 , median disease duration 10.5 ) . Measurements were taken at the start , 10 weeks later when the training period was finished , and after a further 10 weeks . After the training both groups had fewer swollen joints in the upper extremity and less shoulder-arm pain . The dynamic group patients also improved according to the physical and overall dimensions of the Sickness Impact Profile . As impairment and aspects of disability and h and icap were influenced by training but not by the patients ' opinions regarding perceived disease activity and health , these relationships must be studied further OBJECTIVE : To investigate the benefit of intensive dynamic exercises in comparison to range of motion ( ROM ) and isometric exercises in rheumatoid arthritis . METHODS : 100 consecutive rheumatoid arthritis patients on stable medication were r and omly assigned to ( 1 ) intensive dynamic group exercises which included full weight bearing exercises and conditioning exercises on a stationary bicycle while the heart rate was maintained at 70 - 85 % of the age predicted maximum heart rate , ( 2 ) range of motion ( ROM ) exercises and isometric exercises in a group , ( 3 ) individual isometric and ROM exercises , and ( 4 ) home instructions for isometric and ROM exercises .  Variables of physical condition , muscle strength , joint mobility , daily functioning ( HAQ ) , and disease activity were assessed before and after the 12 week exercise course , and 12 weeks thereafter . An intention to treat analysis was performed . RESULTS : Increases in aerobic capacity ( n = 77 ) , muscle strength , and joint mobility in the high intensity exercise programme were respectively 17 % , 17 % and 16 % and differed significantly from the changes in aerobic capacity , muscle strength , and joint mobility in the other exercise groups . No deterioration of disease activity was observed . Twelve weeks after discontinuation of the exercise course the gain in physical capacity had disappeared . CONCLUSIONS : Intensive dynamic training is more effective in increasing aerobic capacity , joint mobility , and muscle strength than ROM exercises and isometric training in rheumatoid arthritis patients with well controlled disease This study aim ed at evaluating the effects of a dynamic physical training programme on circulating levels of corticotropin-releasing hormone ( CRH ) , beta-lipotropin ( beta-LPH ) , and beta-endorphin ( beta-EP ) after high-intensity training for 6 weeks ( 60 min twice a week ) and after low-intensity training ( home-training ) for another 6 months in patients with rheumatoid arthritis ( RA ) and in healthy subjects . Additionally , differences in neuropeptide levels between the two groups were studied . A total of 30 patients with RA were r and omly allocated to the study , 15 in the training group ( TG ) and 15 in the control group ( CG ) . In addition , 20 healthy subjects ( 10 in TG ; 10 in CG ) participated . In addition to the biochemical analyses , the following variables were assessed for the RA group : pain and disability ( Stanford health assessment question naire ) , joint tenderness ( Ritchie articular index ) , disease activity , muscle function , aerobic capacity , sociodemographic data and attitudes . The results obtained at the start revealed significant differences ( p < 0.05 ) between RA patients and healthy subjects concerning CRH levels , RA patients showing the lower levels ( RA-group Md = 24 pmol/L , healthy group Md = 29 pmol/L ) . No significant differences concerning beta-LPH and beta-EP were found here . After the high-intensity training period , a significant increase of the CRH levels were found for the RA-TG ( pretest Md = 24 pmol/L , after 6 weeks Md = 27 pmol/L , p < 0.05 ) . No such results were found for the healthy-TG or the control groups . Concerning beta-EP , significant differences between the RA-TG and healthy-TG were found after the training . RA patients generally showing higher levels as compared with the healthy ( RA-group Md = 42 pmol/L , healthy group Md = 36 pmol/L , p < 0.05 ) . The same pattern was found for the beta-LPH levels . In conclusion , the effects of physical training on circulating neuropeptides remain still incompletely examined , and there is no definite answer to the question whether increased beta-EP levels are good or bad OBJECTIVE Patients with rheumatoid arthritis ( RA ) are more at risk for the development of osteoporosis and osteoporotic fractures than are their healthy peers . In this r and omized , controlled , multicenter trial , the effectiveness of a 2-year high-intensity weight-bearing exercise program ( the Rheumatoid-Arthritis- Patients -In-Training [ RAPIT ] program ) on bone mineral density ( BMD ) was compared with usual care physical therapy , and the exercise modalities associated with changes in BMD were determined . METHODS Three hundred nine patients with RA were assigned to an intervention group , either the RAPIT program or usual care physical therapy . The primary end points were BMD of the hip and spine . The exercise modalities examined were aerobic fitness , muscle strength , and , as a surrogate for those effects not directly measured by the RAPIT program , attendance rate . RESULTS The data on the 136  RAPIT participants and 145 usual care participants who completed the study were analyzed . The mean rate of decrease in hip BMD , but not in lumbar spine BMD , was smaller in patients participating in the RAPIT program when compared with that in the usual care group , with a mean decrease of 1.6 % ( 95 % confidence interval [ 95 % CI ] 0.8 - 2.5 ) over the first year and 0.5 % ( 95 % CI 1.1 - 2.0 ) over the second year . The change in hip BMD was significantly and independently associated with changes in both muscle strength ( multivariate odds ratio [ OR ] 1.75 , 95 % CI 1.07 - 2.86 ) and aerobic fitness ( OR 1.79 , 95 % CI 1.10 - 2.90 ) , but not with the attendance rate ( OR 1.00 , 95 % CI 0.99 - 1.00 ) . CONCLUSION A long-term high-intensity weight-bearing exercise program for RA patients is effective in slowing down the loss of BMD at the hip . The exercise modalities associated with this effect are muscle strength and aerobic fitness A group of 120 patients with rheumatoid arthritis or osteoarthritis volunteered to be subjects for this study of aerobic versus nonaerobic exercise . Patients were stratified by diagnosis and r and omized into an exercise program of aerobic walking , aerobic aquatics , or nonaerobic range of motion ( controls ) . The retention rate for the 12-week program was 83 % . Exercise tolerance , disease-related measures , and self-reported health status were assessed . The aquatics and walking exercise groups showed significant improvement over the control group in aerobic capacity , 50-foot walking time , depression , anxiety , and physical activity after the 12-week exercise program . There were no significant between-group group differences in the change scores for flexibility , number of clinical ly active joints , duration of morning stiffness , or grip strength . Our findings document the feasibility and efficacy of conditioning exercise for people who have rheumatoid arthritis or osteoarthritis OBJECTIVE . A Phase II trial was performed as a preliminary test of the efficacy and safety of progressive resistance training ( PRT ) as adjunct treatment for rheumatoid cachexia . METHODS Ten mildly disabled patients with well-controlled rheumatoid arthritis ( RA ) trained , on average , 2.5 times per week for 12 weeks . Ten age and sex matched RA patients with similar disease characteristics were non-r and omly assigned to a control group .  Body composition , physical function , and disease activity were assessed pre and post intervention period . RESULTS Between group comparisons at followup by ANCOVA using baseline scores as covariate showed significant increases in fat-free mass ( + 1253 g , p = 0.004 ) , total body protein ( + 1063 g , p = 0.044 ) , and arm ( + 280 g , p = 0.005 ) and leg ( + 839 g , p = 0.001 ) lean mass ( a proxy measure of total body skeletal muscle mass ) in response to PRT with no exacerbation of disease activity . There was also a trend for loss of fat mass in the trunk ( -752 g , p = 0.084 ) and a significant reduction in percent body fat ( -1.1 % , p = 0.047 ) . Changes in body composition were associated with improvements in various measures of physical function . CONCLUSION Intense PRT with adequate volume seems to be an effective and safe intervention for stimulating muscle growth in patients with RA . Pending confirmation of these results in a larger r and omized controlled trial that includes patients with more active and severe disease , a similar PRT program should be included in the management of RA as adjunct treatment for cachexia OBJECTIVE To evaluate the impact of a 2-year home-based strength-training program on physical function in patients with early rheumatoid arthritis ( RA ) after a subsequent 3-year followup . METHODS Seventy patients with early RA were r and omized to perform either strength training ( experimental group [ EG ] ) or range-of-motion exercises ( control group [ CG ] ) . Maximal strength values were recorded by dynamometers . The Modified Disease Activity Score ( DAS28 ) , pain , Health Assessment Question naire ( HAQ ) , walking speed , and stair-climbing speed were also measured . RESULTS The maximum strength of assessed muscle groups increased by 19 - 59 % in the EG during the training period and remained at the reached level throughout the subsequent 3 years . Muscle strength improved in the CG by 1 - 31 % , but less compared with the EG . During the 2-year training period , DAS28 decreased by 50 % and 45 % and pain by 67 % and 39 % in the EG and CG , respectively . The differences in muscle strength , DAS28 , and HAQ were significantly in favor of the EG both at the 2-year and 5-year followup assessment s. CONCLUSIONS The improvements achieved during the 2-year strength-training period were sustained for 3 years in patients with early RA Twenty-three patients with rheumatoid arthritis ( RA ) have been given physical training for 4 to 8 years . To compare , we have had a control group of equal size and with the same disease severity . The training program consisted of home-training and for most of the patients also group-training led by a physiotherapist . During the observation period we have found a significantly less pronounced progress of X-ray changes in the joints of the active patients compared with control patients . Physiological tests and clinical parameters , including sick-pension and sick-leave , show unanimously a better disease outcome in the active group of patients . There is probably a risk of overuse or disuse of the joints in RA but we believe that it is better to be overactive rather than the reverse . As in many other diseases , the general prescription of rest in RA is not adequate BACKGROUND AND PURPOSE Rheumatoid arthritis frequently results in functional impairment . This study investigated the effect of a specific exercise regimen on function . METHOD A r and omized controlled assessor-blinded ( N = 36 ) compared the effect of knee extensor and flexor muscle training on pain , the timed up and go ( TUG ) test and the Health Assessment Question naire in subjects with non-acute rheumatoid arthritis . RESULTS Knee extensor and flexor muscle training increased isokinetic torques at speeds of 60 degrees/sec-1 and 120 degrees/sec-1 as measured by an isokinetic dynamometer ( p = 0.02 - 0.003 ) . The experimental group experienced a reduction in pain ( p = 0.03 ) , an improvement in TUG time ( p = 0.01 ) and in function as measured by the Health Assessment Question naire ( p = 0.04 ) . CONCLUSIONS Specific knee muscle training can be administered safely in people with non-acute rheumatoid arthritis , and may produce functional benefits For decades , physical training of rheumatoid arthritis (RA)- patients has been controversial , especially for patients with active disease . The aim of this study was to investigate whether RA- patients could receive graduated training without increasing the activity of the disease . In a controlled cross-over study the effect of graduated progressive training has been evaluated in 18 RA- patients with moderately active disease . The training was performed twice weekly with aerobic conditioning and strength exercises progressing to strenuous exercises over an 8-week period . The design was a crossover project with two groups obtained by minimisation . After training the patients had significantly fewer swollen joints than before . Training of the muscles acting over the swollen joints result ed in more than a 35 % decrease in the number of swollen joints . The hemoglobin level increased significantly after the training period . The erythrocyte sedimentation rate , the complement factor C3d , and the number of sore joints remained unchanged . A decrease in the need for medicine was non-significant . From this study it appears that RA- patients with some activity are trainable without aggravating the disease , even in the chronically swollen joints . The rheumatoid arthritis activity decreased with fewer swollen joints and higher hemoglobin level after training OBJECTIVE To study the short-term effects of physical therapy ( ice massage or wax packs , thermal baths , and faradic h and baths ) and exercise therapy on the rheumatoid h and . METHODS The effect of individual physical therapy and exercise therapy programs was evaluated in 50 r and omly selected rheumatoid arthritis in patients ( 38 women and 12 men ) . Mean patient age ( + /- SD ) was 47.94 + /- 11.22 years , and mean disease duration was 5.04 + /- 4.80 years . The control group consisted of 50 r and omly selected rheumatoid arthritis out patients ( 37 women and 13 men ; mean age 48.46 + /- 10.65 years , mean duration of disease 5.23 + /- 4.89 years ) who at the time of the investigation were not receiving any physical or exercise therapy .  The clinical indices used for evaluation of inflammation included erythrocyte sedimentation rate ( ESR ) , pain intensity , proximal interphalangeal ( PIP ) joint size , and Ritchie articular index . H and grip strength , palmar tip-to-tip and key pinch finger strength , finger range of motion , and activities of daily living ( ADL ) were the parameters used to assess the functional h and status . The study was single-blinded and of 3 weeks duration . RESULTS In the physical therapy treated group , there was an improvement for most of the observed indices from baseline parameters that achieved statistical significance ( P < 0.01 and P < 0.005 ) after the 3-week study period . ESR and PIP joint size improved clinical ly but failed to reach statistical significance . Patients had a more significant improvement in h and pain , joint tenderness , and ADL score ( P < 0.005 ) than in range of motion ( P < 0.01 ) . All parameters in the control group slightly deteriorated over the study period . CONCLUSION At least in the short term , physical and , particularly , exercise therapy produce a favorable improvement in the functional status of the rheumatoid h and Objective : The objective was to prospect ively evaluate the short as well as the long‐term effects of intensive physiotherapy in a stable , sunny and warm climate on physical function and health related quality of life in patients with rheumatoid arthritis ( RA ) and spondylarthropathies ( SpA ) . Methods : Ninety‐three Swedish patients with RA and SpA receiving physiotherapy for 4 weeks in Israel or Tenerife were followed for 6 months . Physical function was evaluated by the Swedish version of Stanford Health Assessment Question naire ( HAQ ) and quality of life by the  Nottingham Health Profile ( NHP )  question naire . Results : There were significant improvements in HAQ‐scores and global NHP‐scores as well as all subcategories of NHP immediately after the treatment abroad , effects that were still measurable after six months . At that time point nearly half of the patients had clinical ly meaningful reduction of HAQ‐scores ( ≥0.25 ) . Conclusion : Physiotherapy in a warm and stable climate , with many hours of daily sunshine , is a valuable treatment complement for Swedish patients with RA and OBJECTIVE To investigate the effects of a dynamic , intensive exercise regimen on pain , disease activity , and physical functioning in active rheumatoid arthritis ( RA ) . METHODS 64 patients with RA with a mean age of 60 ( 13 ) years and mean disease duration of 8 ( 8) years , admitted to hospital because of active disease , were r and omly assigned to an  intensive exercise programme or to a  conservative exercise programme during their period in hospital with a mean length of 30 ( 14 ) days . The intensive exercise programme consisted of knee and shoulder dynamic and isometric muscle strengthening exercises against resistance five times a week and conditioning bicycle training three times a week and was supplemental to the conservative exercise programme of range of motion and isometric exercises . Indices of disease activity , pain , muscle strength , and functional ability were assessed at 0 , 3 , 6 , 12 , and 24 weeks by a blinded observer . RESULTS The medical treatment during the study was the same in both groups . Both groups improved in measures of disease activity , differences between groups were not statistically significant . The mean improvement in disease activity score at 24 weeks in the intensive and conservative exercise group was −1.4 ( 1.5 ) and −0.7 ( 1.4 ) , respectively . Measures of physical functioning improved significantly for patients in the intensive exercise group , and differences between groups were statistically significant for measures of muscle strength . CONCLUSION A short term intensive exercise programme in active RA is more effective in improving muscle strength than a conservative exercise programme and does not have deleterious effects on disease activity Sixty-seven patients with classical or definite rheumatoid arthritis ( RA ) were studied concerning the effects of st and ardized physical training on muscle function in the lower extremities . The patients were r and omly assigned to four different training groups and were given 6 weeks of training supervised by a physiotherapist at a health care centre . The groups differed according to type ( dynamic or static ) and extent ( 12 or 4 times ) of training . During this training period as well as for an additional 3 months , the patients carried out programs of exercise at home ( either dynamic or static ) . A significantly greater increase in function during the 6-week period as regards muscle strength , endurance , aerobic capacity , and functional ability was found for the dynamic as compared with the static groups . The findings at follow-up 3 months later were similar . The effectiveness of the programs did not vary with the extent of training . In conclusion , in RA patients , dynamic training gives a greater increase in physical capacity than does static training OBJECTIVE There are insufficient data on the effects of long-term intensive exercise in patients with rheumatoid arthritis ( RA ) . We undertook this r and omized , controlled , multicenter trial to compare the effectiveness and safety of a 2-year intensive exercise program ( Rheumatoid Arthritis Patients In Training [ RAPIT ] ) with those of physical therapy ( termed usual care [ UC ] ) . METHODS Three hundred nine RA patients were assigned to either the RAPIT program or UC . The primary end points were functional ability ( assessed by the McMaster Toronto Arthritis [ MACTAR ] Patient Preference Disability Question naire and the Health Assessment Question naire [ HAQ ] ) and the effects on radiographic progression in large joints . Secondary end points concerned emotional status and disease activity . RESULTS After 2 years , participants in the RAPIT program showed greater improvement in functional ability than participants in UC . The mean difference in change of the MACTAR Question naire score was 2.6 ( 95 % confidence interval [ 95 % CI ] 0.1 , 5.2 ) over the first year and 3.1 ( 95 % CI 0.7 , 5.5 ) over the second year . After 2 years , the mean difference in change of the HAQ score was -0.09 ( 95 % CI -0.18 , -0.01 ) . The median radiographic damage of the large joints did not increase in either group . In both groups , participants with considerable baseline damage showed slightly more progression in damage , and this was more obvious in the RAPIT group . The RAPIT program proved to be effective in improving emotional status . No detrimental effects on disease activity were found . CONCLUSION A long-term high-intensity exercise program is more effective than UC in improving functional ability of RA patients . Intensive exercise does not increase radiographic damage of the large joints , except possibly in patients with considerable baseline damage of the large joints OBJECTIVE To investigate whether a high-intensity exercise program accelerates the rate of radiologic damage of the large joints in predefined subgroups of patients with rheumatoid arthritis . METHODS The data of 277 participants in a 2-year r and omized controlled trial , comparing the effects of high-intensity exercises with usual care  , were used . Linear regression analysis was used to test which predefined variables at baseline ( age , disease duration , disease activity , physical capacity , functional ability , joint damage ) modified the effect of high-intensity exercise on the progression of radiologic damage of the large joints over 24 months . RESULTS Baseline radiologic joint damage was the only variable associated with the effect of high-intensity exercise on joint damage progression in large joints . In a subgroup of 218 patients with no or little joint damage ( defined as Larsen score < or = 5 ; 80 % of our study population ) the proportions of patients with an increase in joint damage were similar for the exercise and usual-care group ( 35 % versus 36 % , risk ratio [ RR ] 1.0 [ 0.7 - 1.4 ] ; P = not significant ) , whereas , in a subgroup of 59 patients who already had extensive damage of large joints ( defined as Larsen score > 5 ) the proportion was significantly higher in the exercise group ( 85 % versus 48 % , RR 1.8 [ 1.2 - 2.6 ] ; P < 0.05 ) . CONCLUSION High-intensity weight-bearing exercises appear to accelerate joint damage progression in patients with preexisting extensive damage . Patients with extensive large joint damage should , therefore , be advised to refrain from activities excessively loading the damaged joints ABSTRACT Cardiorespiratory function and exercise tolerance appear very limited in persons with rheumatoid arthritis ( RA ) . Many studies have demonstrated that aerobic exercise training is beneficial to prevent physical deconditioning without inducing adverse effects on an individual 's joints and general health . The present study was conducted to demonstrate that a dance-based exercise program is a safe and efficient activity to improve physical fitness and psychological state in persons with RA . A group of 19 persons ( mean age , 49.3 ± 13 yr ) participated in a  12-wk exercise program  ( twice weekly ) , whereas 10 persons ( mean age , 49.4 ± 12 yr ) served as controls . Health status , use of medication , joint pain and swelling , physical fitness , activity of daily living and psychological state were assessed at baseline , after the 12-wk training program and 6 mo after the end of the program . Exercise training induced a mean improvement of 13 % in aerobic power , with the highest values reaching 40 % . No significant changes were observed in joint status , even though the count of painful joints tended to decrease in the exercise group . Positive changes in depression , anxiety , fatigue and tension were observed after the 12-wk exercise program . These findings provide some evidence s in favor of aerobic exercise in individuals with RA . Furthermore , it is of primary interest to note that a weight-bearing activity with limited ground impacts do not provoke short-term adverse effects on joint status . Further studies , however , are required to determine the long-term effect of weight-bearing exercise on the health status of individuals with RA The effects of physical training on elderly , fragile patients with rheumatoid arthritis ( RA ) who are on low-dose steroids were investigated . The controlled study included 24 patients who had been treated with low-dose steroids for 2 years . Each patient was assigned either to a treatment group receiving training or to an untrained control group . The training took place over a 3-month period and was based on a protocol using progressive interval training consisting of bicycle exercises , heel lifts , and step-climbing . The exercises were performed twice weekly for 45 minutes . Comparison of the two groups showed that disease activity did not increase in the trained group and that fewer , but not significantly fewer , swollen joints were observed in this group ( p = 0.06 ) . No significant changes were noticed in erythrocyte sedimentation rate , tender joints , or morning stiffness . The work capacity of the trained patients were doubled and the numbers of repetitions increased 76 % . Individually adapted exercise programs can therefore be recommended for elderly rheumatoid arthritis patients on steroid treatment
target: 3 ) short-term , water-based aerobic capacity training , which results show limited evidence for a positive effect on functional ability and aerobic capacity .
  ( 4 ) long-term , l and -based aerobic capacity and muscle strength training , which results show moderate evidence for a positive effect on aerobic capacity and muscle strength .
  With respect to safety , no deleterious effects were found in any of the included studies .
  Based on the evidence , aerobic capacity training combined with muscle strength training is recommended as routine practice in patients with RA
background: BACKGROUND An up-to- date overview of the effectiveness and safety of dynamic exercise therapy ( exercise therapy with a sufficient intensity , duration , and frequency to establish improvement in aerobic capacity and /or muscle strength ) is lacking .
  OBJECTIVES To assess the effectiveness and safety of short-term ( < three months ) and long-term ( > three months ) dynamic exercise therapy programs ( aerobic capacity and /or muscle strength training ) , either l and or water-based , for people with RA .
  To do this we up date d a previous Cochrane review ( van den Ende 1998 ) and made categories for the different forms of dynamic exercise programs .