title: Outcome of an education and home-based exercise programme for patients with ankylosing spondylitis: a nationwide randomized study. Long-Term Effect of Exercise Therapy and Patient Education on Impairments and Activity Limitations in People With Hip Osteoarthritis: Secondary Outcome Analysis of a Randomized Clinical Trial Effects of different stretching techniques on the outcomes of isokinetic exercise in patients with knee osteoarthritis. Effectiveness of sensorimotor training in patients with rheumatoid arthritis: a randomized controlled trial Effect of 8 wk of bicycle training on the immune system of patients with rheumatoid arthritis. The effects of strength and endurance training in patients with rheumatoid arthritis Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol A Community-Based Physical Activity Counselling Program for People With Knee Osteoarthritis: Feasibility and Preliminary Efficacy of the Track-OA Study Supervised aerobic exercise is more effective than home aerobic exercise in female chinese patients with rheumatoid arthritis. Long-term follow-up of a high-intensity exercise program in patients with rheumatoid arthritis A randomized controlled trial to evaluate the effectiveness of an exercise program in women with rheumatoid arthritis taking low dose prednisone. Are swimming or aerobic exercise better than conventional exercise in ankylosing spondylitis patients? A randomized controlled study. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. Efficacy of High Intensity Exercise on Disease Activity and Cardiovascular Risk in Active Axial Spondyloarthritis: A Randomized Controlled Pilot Study Randomized clinical trials as reflexive–interpretative process in patients with rheumatoid arthritis: a qualitative study Physiotherapy in knee osteoarthrosis: effect on pain and walking. Maintenance of physical activity after Internet-based physical activity interventions in patients with rheumatoid arthritis. Effects of home-based resistance training and neuromuscular electrical stimulation in knee osteoarthritis: a randomized controlled trial Engagement and satisfaction with an Internet-based physical activity intervention in patients with rheumatoid arthritis. The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis: A knowledge translation randomized controlled trial: Part II: Clinical outcomes A four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance: a randomized controlled trial Longterm physical training in rheumatoid arthritis. A randomized trial with different training programs and blinded observers. Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Comparable effect of partly supervised and self-administered exercise programme in early rheumatoid arthritis--a randomised, controlled trial. Effects of strength training on neuromuscular function and disease activity in patients with recent-onset inflammatory arthritis. Investigation of Clinical Effects of High- and Low-Resistance Training for Patients With Knee Osteoarthritis: A Randomized Controlled Trial A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). Effect of Pilates training on people with ankylosing spondylitis Targeting motivation and self-regulation to increase physical activity among patients with rheumatoid arthritis: a randomised controlled trial Effects of aerobic exercise on hematologic indices of women with rheumatoid arthritis: A randomized clinical trial Efficacy of 2 non-weight-bearing interventions, proprioception training versus strength training, for patients with knee osteoarthritis: a randomized clinical trial. Behaviour change intervention increases physical activity, spinal mobility and quality of life in adults with ankylosing spondylitis: a randomised trial. Effects of a multimodal exercise program for people with ankylosing spondylitis. Effects of strength training on the incidence and progression of knee osteoarthritis. Efficacy of low load resistive muscle training in patients with rheumatoid arthritis functional class II and III. Predictors of exercise and effects of exercise on symptoms, function, aerobic fitness, and disease outcomes of rheumatoid arthritis. Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. Lower limb muscle strengthening does not change frontal plane moments in women with knee osteoarthritis: A randomized controlled trial. A three-week multidisciplinary in-patient rehabilitation programme had positive long-term effects in patients with ankylosing spondylitis: randomized controlled trial. Coaching patients with early rheumatoid arthritis to healthy physical activity: a multicenter, randomized, controlled study. Comparison of high and low intensity training in well controlled rheumatoid arthritis. Results of a randomised clinical trial. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Physical activity coaching of patients with rheumatoid arthritis in everyday practice: a long-term follow-up. Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. Exercise therapy in patients with hip osteoarthritis: Effect on hip muscle strength and safety aspects of exercise—results of a randomized controlled trial Preoperative progressive explosive-type resistance training is feasible and effective in patients with hip osteoarthritis scheduled for total hip arthroplasty--a randomized controlled trial. Effectiveness of exercise with or without thermal therapy for community-dwelling elderly Japanese women with non-specific knee pain: a randomized controlled trial. Effects of Aerobic Training in Patients with Ankylosing Spondylitis The effects of a physical training program on patients with osteoarthritis of the knees. Assessment of a Sixteen-Week Training Program on Strength, Pain, and Function in Rheumatoid Arthritis Patients Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial. Effectiveness of Aquatic Exercises in Women With Rheumatoid Arthritis: A Randomized, Controlled, 16-Week Intervention—The HydRA Trial Elderly rheumatoid arthritis patients on steroid treatment tolerate physical training without an increase in disease activity. Is Home-Based, High-Intensity Interval Training Cycling Feasible and Safe for Patients With Knee Osteoarthritis? A dynamic exercise programme to improve patients' disability in rheumatoid arthritis: a prospective randomized controlled trial. Effects of weight-bearing versus nonweight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial. A pragmatic randomized controlled study of the effectiveness and cost consequences of exercise therapy in hip osteoarthritis Effectiveness of aquatic exercise for obese patients with knee osteoarthritis: a randomized controlled trial.
abstract: OBJECTIVES This study aims to assess the impact of a structured education and home exercise programme in daily practice patients with ankylosing spondylitis . METHODS A total of 756 patients with ankylosing spondylitis ( 72 % males , mean age 45 years ) participated in a 6-month prospect i ve multicentre controlled study , 381 of whom were r and omised to an education intervention ( a 2-hour informative session about the disease and the implementation of a non-supervised physical activity programme at home ) and 375 to st and ard care ( controls ) . Main outcome measures included Bath Ankylosing Spondylitis Disease Activity and Functional Index ( BASDAI , BASFI ) . Secondary outcome measures were 0 - 10 cm visual analog scale ( VAS ) for total pain , nocturnal pain and global disease activity and quality of life ( ASQoL ) , knowledge of disease ( self-evaluation ordinal scale ) and daily exercise ( diary card ) . RESULTS At 6 months , the adjusted mean difference between control and educational groups for BASDAI was 0.32 , 95 % confidence interval ( CI ) 0.10 - 0.54 , p=0.005 , and for BASFI 0.31 , 95%CI 0.12 - 0.51 , p=0.002 . Significant differences were found also in VAS for total pain , patient´s global assessment and in ASQoL. Patients in the education group increased their knowledge about the disease and its treatments significantly ( p<0.001 ) and practised more regular exercise than controls ( p<0.001 ) . CONCLUSIONS A structured education and home exercise programme for patients with ankylosing spondylitis in daily practice was feasible and helped to increase knowledge and exercise . Although statistically significant , the magnitudes of the clinical benefits in terms of disease activity and physical function were poor Background The effect of exercise on specific impairments and activity limitations in people with hip osteoarthritis ( OA ) is limited . Objective The study objective was to evaluate the long-term effect of exercise therapy and patient education on range of motion ( ROM ) , muscle strength , physical fitness , walking capacity , and pain during walking in people with hip OA . Design This was a secondary outcome analysis of a r and omized clinical trial . Setting The setting was a university hospital . Participants One hundred nine people with clinical ly and radiographically evident hip OA were r and omly allocated to receive both exercise therapy and patient education ( exercise group ) or patient education only ( control group ) . Intervention All participants attended a patient education program consisting of 3 group meetings led by 2 physical therapists . Two other physical therapists were responsible for providing the exercise therapy program , consisting of 2 or 3 weekly sessions of strengthening , functional , and stretching exercises over 12 weeks . Both interventions were conducted at a sports medicine clinic . Measurements Outcome measures included ROM , isokinetic muscle strength , predicted maximal oxygen consumption determined with the Astr and bicycle ergometer test , and distance and pain during the Six-Minute Walk Test ( 6MWT ) . Follow-up assessment s were conducted 4 , 10 , and 29 months after enrollment by 5 physical therapists who were unaware of group allocations . Results No significant group differences were found for ROM , muscle strength , predicted maximal oxygen consumption , or distance during the 6MWT over the follow-up period , but the exercise group had less pain during the 6MWT than the control group at 10 months ( mean difference=−8.5 mm ; 95 % confidence interval=−16.1 , −0.9 ) and 29 months ( mean difference=−9.3 mm ; 95 % confidence interval=−18.1 , −0.6 ) . Limitations Limitations of the study were reduced statistical power and 53 % rate of adherence to the exercise therapy program . Conclusions The previously described effect of exercise on self-reported function was not reflected by beneficial results for ROM , muscle strength , physical fitness , and walking capacity , but exercise in addition to patient education result ed in less pain during walking in the long term We recruited 132 subjects with bilateral knee osteoarthritis ( Altman Grade II ) to compare the effects of different stretching techniques on the outcomes of isokinetic muscle strengthening exercises . Patients were r and omly divided into four groups ( I-IV ) . The patients in Group I received isokinetic muscular strengthening exercises , Group II received bilateral knee static stretching and isokinetic exercises , Group III received proprioceptive neuromuscular facilitation ( PNF ) stretching and isokinetic exercises , and Group IV acted as controls . Outcomes were measured by changes in Lequesne 's index , range of knee motion , visual analog pain scale , and peak muscle torques during knee flexion and extension . Patients in all the treated groups experienced significant reductions in knee pain and disability , and increased peak muscle torques after treatment and at follow-up . However , only patients in Groups II and III had significant improvements in range of motion and muscle strength gain during 60 degrees/second angular velocity peak torques . Group III demonstrated the greatest increase in muscle strength gain during 180 degrees/second angular velocity peak torques . In conclusion , stretching therapy could increase the effectiveness of isokinetic exercise in terms of functional improvement in patients with knee osteoarthritis . PNF techniques were more effective than static stretching The objective of this study was to evaluate the effectiveness of a sensorimotor training in patients with rheumatoid arthritis on the improvement of functional skills and quality of life , a double-blinded , prospect i ve , r and omized controlled trial . One hundred two participants with rheumatoid arthritis were selected . After the baseline evaluation , the participants were r and omized to two different groups : sensorimotor group ( 2 sessions per week , 30–50 min each session , besides continuing taking the same drugs as the control group ) and control group ( control group was only su bmi tted to the clinical drug treatment with Methotrexate , Leflunomide and /or Prednisone ( 5 mg ) , being then evaluated 4 months later ) . Functional capacity [ Health Assessment Question naire ( HAQ ) and Timed Up & Go Test ( TU > ) ] , Balance and Gait ( Berg Balance Scale ( BBS ) and Tinetti Test ) and Quality of Life ( Short Form Health Survey — SF-36 ) . The study had been concluded with ninety-one participants , and a statistically significant improvement was found in all variables assessed : HAQ ( P < .01 ) , TU > ( P < .01 ) , BBS ( P < .01 ) , Tinetti Test ( P < .01 ) and improvement in the subscales of SF-36 ( P < .01 ) in the sensorimotor group in comparison with the baseline evaluation and control group . No significant difference was found related to the pre- and post-evaluation in the control group . Therefore , the sensorimotor training is effective in the improvement of the functional capacity and quality of life of patients with rheumatoid arthritis 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 Patients with rheumatoid arthritis ( RA ) suffer from muscle loss , causing reduced muscle strength and endurance . The current study aim ed to : ( 1 ) evaluate the effects of combined strength and endurance training ( CT ) on disease activity and functional ability in patients with RA and ( 2 ) investigate the benefits of a 6-month supervised CT program on muscle strength , cardio-respiratory fitness , and body composition of RA patients . Forty patients with RA , aged 41–73 years , were recruited for the current study . Twenty of these patients ( 19 females , one male ) were r and omly assigned to a 6-month supervised CT program ; 20 patients ( 17 females , three males ) served as controls . Within the CT program , strength training consisted of sets of weight bearing exercises for all major muscle groups . In addition to strength training , systematic endurance training was performed on a cycle ergometer two times per week . For RA patients involved in CT , disease activity ( p = 0.06 ) and pain ( p = 0.05 ) were reduced after the 6-month training period while general health ( p = 0.04 ) and functional ability ( p = 0.06 ) improved . Cardio-respiratory endurance was found to have improved significantly ( by 10 % ) after 6 months of CT ( p < 0.001 ) . The overall strength of patients undertaking CT increased by an average of 14 % . Lean body mass increased , and the percentage of body fat was found to decrease significantly ( p < 0.05 ) . A combination of strength and endurance training result ed in considerable improvements in RA  patients ’ muscle strength and cardio-respiratory endurance , accompanied by positive changes in body composition and functional ability . Long-term training appears to be effective in reducing disease activity and associated pain and was found to have no deleterious effects Background Hip osteoarthritis ( OA ) is a common condition leading to pain , disability and reduced quality of life . There is currently limited evidence to support the use of conservative , non-pharmacological treatments for hip OA . Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA . The aim of this r and omised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function . Methods The trial will be conducted at the University of Melbourne Centre for Health , Exercise and Sports Medicine . 128 participants with hip pain greater or equal to 40/100 on visual analogue scale ( VAS ) and evidence of OA on x-ray will be recruited . Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region . The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice . The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel . The participants and the study assessor will be blinded to the treatment allocation . Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) immediately after the 12 week intervention . Participants will also be followed up at 36 weeks post baseline . Conclusions The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice . The findings from this r and omised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA.Trial Registration Australian New Zeal and Clinical Trials Registry reference : Background Physical activity can improve health outcomes in people with knee osteoarthritis ( OA ) ; however , participation in physical activity is very low in this population . Objective The objective of our study was to assess the feasibility and preliminary efficacy of the use of wearables ( Fitbit Flex ) and telephone counselling by a physical therapist ( PT ) for improving physical activity in people with a physician-confirmed diagnosis of knee OA , or who have passed 2 vali date d criteria for early OA . Methods We conducted a community-based feasibility r and omized controlled trial . The immediate group ( n=17 ) received a brief education session by a physical therapist , a Fitbit Flex activity tracker , and a weekly telephone call for activity counselling with the physical therapist . The delayed group ( n=17 ) received the same intervention 1 month later . All participants were assessed at baseline ( T0 ) , and the end of 1 month ( T1 ) and 2 months ( T2 ) . Outcomes were ( 1 ) mean moderate to vigorous physical activity time , ( 2 ) mean time spent on sedentary behavior , ( 3 ) Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , and ( 4 ) Partners in Health Scale . Feasibility data were summarized with descriptive statistics . We used analysis of covariance to evaluate the effect of the group type on the outcome measures at T1 and T2 , after adjusting for blocking and T0 . We assessed planned contrasts of changes in outcome measures over measurement periods . Results We identified 46 eligible individuals ; of those , 34 ( 74 % ) enrolled and no one dropped out . All but 1 participant adhered to the intervention protocol . We found a significant effect , with the immediate intervention group having improved in the moderate to vigorous physical activity time and in the Partners in Health Scale at T0 to T1 compared with the delayed intervention group . The planned contrast of the immediate intervention group at T0 to T1 versus the delayed group at T1 to T2 showed a significant effect in the sedentary time and the KOOS symptoms subscale , favoring the delayed group . Conclusions This study demonstrated the feasibility of a behavioral intervention , supported by the use of a wearable device , to promote physical activity among people with knee OA . Trial Registration Clinical Trials.gov NCT02313506 ; https:// clinical trials.gov/ct2/show/NCT02313506 ( Archived by WebCite at http://www.webcitation.org/6r4P3Bub0 OBJECTIVE To compare the effectiveness and safety of supervised aerobic exercise and home aerobic exercise in female Chinese patients with rheumatoid arthritis . DESIGN Single-blind r and omized controlled trial . SUBJECTS Thirty female Chinese patients with rheumatoid arthritis were assigned to either supervised aerobic exercise or home aerobic exercise groups . METHODS The supervised aerobic exercise programme was supervised by a physical therapist , while the home aerobic exercise programme was performed at home after one session of exercise instruction . Each programme consisted of 1 h of aerobic exercise conducted 3 times per week for 8 weeks . Aerobic capacity and disease-related variables , including pain intensity , functional ability , psychological status and joint function , were measured . RESULTS Significant difference in changed score between pre- and post-exercise data was observed between the supervised aerobic exercise and home aerobic exercise groups regarding aerobic capacity ( p < 0.0001 ) . Pre- and post-exercise within-group comparisons showed significant improvement ( 20 % ) in aerobic capacity only in the supervised aerobic exercise group . Pre- and post-exercise within-group comparison showed significant improvement in 5 and 3 items of disease-related variables in supervised aerobic exercise and home aerobic exercise groups , respectively . CONCLUSION An 8-week supervised aerobic exercise programme induced significant improvement in the aerobic capacity of female Chinese patients with rheumatoid arthritis , and was superior to a home aerobic exercise programme . Both programmes of aerobic exercise were safe for female Chinese patients with rheumatoid arthritis 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 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 AIM The aim of the study was to compare the effects of conventional exercise ( CE ) , swimming and walking on the pulmonary functions , aerobic capacity , quality of life , Bath indexes and psychological symptoms in patients with ankylosing spondylitis ( AS ) . METHODS Forty-five patients were r and omised into either swimming ( group 1 ) , walking ( group 2 ) , CE group ( group 3 ) . Patients in Group 1 performed CE and swimming , patients in Group 2 performed CE and walking and patients in Group 3 performed CE only . Exercise sessions were performed three times a week for a period of six weeks . Patients were assessed before and after the rehabilitation program , with respect to , pulmonary function test ( forced vital capacity [ FVC , mL ] , forced expiration volume in one second [ FEV1 , mL ] , FEV1/FVC ( % ) and vital capacity [ VC , mL ] ) , maximal oxygen uptake ( pV.O2 ) , 6-minute walking test ( 6MWT ) , Bath Ankylosing Spondylitis Functional Index , Bath Ankylosing Spondylitis Disease Activity Index , Bath Ankylosing Spondylitis Metrology Index , Nottingham Health Profile and Beck Depression Inventory . RESULTS There were significant increases in pVO2 and 6MWT after treatment in Groups 1 and 2 ( P<0.05 ) . FeV1 , FVC and VC improved significantly with treatment in all three groups ( P<0.05 ) . A statistically significant improvement was observed in energy , emotional reaction and physical mobility sub-scores of NHP in three exercise groups after completion of the exercise program ( P<0.05 ) . CONCLUSIONS Swimming , walking and CE had beneficial effects on the quality of life and pulmonary functions . Aerobic exercises such as swimming and walking in addition to CE increased functional capacities of patients OBJECTIVE To test the effects of a high intensity home-based progressive strength training program on the clinical signs and symptoms of osteoarthritis ( OA ) of the knee . METHODS Forty-six community dwelling patients , aged 55 years or older with knee pain and radiographic evidence of knee OA , were r and omized to a 4 month home based progressive strength training program or a nutrition education program ( attention control ) .  Thirty-eight patients completed the trial with an adherence of 84 % to the intervention and 65 % to the attention control . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index pain and physical function subscales . Secondary outcomes included clinical knee examination , muscle strength , physical performance measures , and question naires to measure quality of life variables . RESULTS Patients in the strength training group who completed the trial had a 71 % improvement in knee extension strength in the leg reported as most painful versus a 3 % improvement in the control group ( p < 0.01 ) . In a modified intent to treat analysis , self-reported pain improved by 36 % and physical function by 38 % in the strength training group versus 11 and 21 % , respectively , in the control group ( p = 0.01 for between group comparison ) . In addition , those patients in the strength training group who completed the trial had a 43 % mean reduction in pain ( p = 0.01 vs controls ) , a 44 % mean improvement in self-reported physical function ( p < 0.01 vs controls ) , and improvements in physical performance , quality of life , and self-efficacy when compared to the control group . CONCLUSION High intensity , home based strength training can produce substantial improvements in strength , pain , physical function and quality of life in patients with knee OA Background Physical therapy is recommended for the management of axial spondyloarthritis ( axSpA ) and flexibility exercises have traditionally been the main focus . Cardiovascular ( CV ) diseases are considered as a major health concern in axSpA and there is strong evidence that endurance and strength exercise protects against CV diseases . Therefore , the aim of this study was to investigate the efficacy of high intensity endurance and strength exercise on disease activity and CV health in patients with active axSpA. Methods In a single blinded r and omized controlled pilot study the exercise group ( EG ) performed 12 weeks of endurance and strength exercise while the control group ( CG ) received treatment as usual . The primary outcome was the Ankylosing Spondylitis ( AS ) Disease Activity Score ( ASDAS ) . Secondary outcomes included patient reported disease activity ( Bath AS Disease Activity Index [ BASDAI ] ) , physical function ( Bath AS Functional Index [ BASFI ] ) , and CV risk factors measured by arterial stiffness ( Augmentation Index [ Alx ] ) and Pulse Wave Velocity [ PWV ] ) , cardiorespiratory fitness ( VO2 peak ) and body composition . ANCOVA on the post intervention values with baseline values as covariates was used to assess group differences , and Mann Whitney U-test was used for outcomes with skewed residuals . Results Twenty-eight patients were included and 24 ( EG , n = 10 , CG , n = 14 ) completed the study . A mean treatment effect of −0.7 ( 95%CI : −1.4 , 0.1 ) was seen in ASDAS score . Treatment effects were also observed in secondary outcomes ( mean group difference [ 95%CI ] ) : BASDAI : −2.0 ( −3.6 , −0.4 ) , BASFI : −1.4 ( −2.6 , −0.3 ) , arterial stiffness ( estimated median group differences [ 95 % CI ] ) : AIx ( % ) : −5.3 ( −11.0 , −0.5 ) , and for PVW ( m/s ) : −0.3 ( −0.7 , 0.0 ) , VO2 peak ( ml/kg/min ) ( mean group difference [ 95%CI ] : 3.7 ( 2.1 , 5.2 ) and trunk fat ( % ) : −1.8 ( −3.0 , −0.6 ) . No adverse events occurred . Conclusion High intensity exercise  improved disease activity and reduced CV risk factors in patients with active axSpA. These effects will be further explored in a larger trial . Trial Registration Clinical Trials.gov Abstract Patients in r and omized clinical trials have to adapt themselves to a restricted language to capture the necessary information to determine the safety and efficacy of a new treatment . The aim of this study was to explore the experience of patients with rheumatoid arthritis after completing their participation in a biologic therapy r and omized clinical trial for a period of 3 years . A qualitative approach was used . The information was collected using 15 semi-structured interviews  of patients with rheumatoid arthritis . Data collection was guided by the emergent analysis until no more relevant variations in the categories were found . The data were analysed using the grounded theory method . The objective of the patients when entering the study was to improve their quality of life by initiating the treatment . However , the experience changed the significance of the illness as they acquired skills and practical knowledge related to the management of their disease . The category “ Interactional Empowerment ” emerged as core category , as it represented the participative experience in a clinical trial . The process integrates the follow categories : “ weight of systematisation ” , “ working together ” , and the significance of the experience : “ the duties ” . Simultaneously these categories evolved . The clinical trial monitoring activities enabled patients to engage in a reflexive – interpretative mechanism that transformed the emotional and symbolic significance of their disease and improved the empowerment of the patient . A better communicative strategy with the health professionals , the relatives of the patients , and the community was also achieved Patients with knee osteoarthrosis are often referred for physiotherapy and many different types of treatment are given . The value of many of these treatments has been question ed . This study was intended to evaluate the effect of commonly used physiotherapy treatments in a training programme on patients with medial knee osteoarthrosis , scheduled for surgery . The results from this study also provide useful data for further evaluation of different physiotherapy treatments to this patient group . Thirty-four patients were r and omised to physiotherapy three times a week for 5 weeks and the other 34 received no treatment . The training programme is described in detail . The patients were evaluated by clinical examination , step test , gait analysis and isokinetic measurements of thigh muscle strength before and after treatment . The patients in the treatment group experienced a feeling of overall improvement in the knee and the ability to descend steps improved when compared to the control group . There were no significant differences in gait , range of motion or isokinetic measurements of muscle strength between the groups . We conclude that physiotherapy as given here made our patients feel better and their ability to descend stairs improved . These improvements are beneficial to the patients and support the positive effects of exercises and activity . Whilst the objective improvements were small , suggesting that this treatment may not be justified , patients in the treatment group believed that they were improved OBJECTIVES To investigate the maintenance of physical activity 12 months after two 1-year Internet-based physical activity interventions in patients with RA . METHODS This follow-up study was a r and omized comparison of an Internet-based individualized training ( IT ) and a general training ( GT ) programme in sedentary RA patients . Outcome measures included physical activity ( meeting public health recommendations for moderate physical activity , i.e. 30 min for at least 5 days/week ; or vigorous physical activity , i.e. 20 min for at least 3 days/week ) , functional ability and quality of life ( QoL ) . RESULTS Of the 152 RA patients who completed the initial study , 110 ( 72 % ) were available at follow-up . At 24 months , the proportions of patients meeting public health recommendations for moderate intensity physical activity were significantly higher compared with baseline in both the IT and GT groups ( 19 and 24 % , respectively , P < 0.05 ) , whereas the proportions of patients meeting the recommendation for vigorous activity was only significantly higher compared with baseline in the IT group ( P < 0.05 ) but not in the GT group . There were no differences between the IT and GT groups concerning proportions of patients meeting moderate or vigorous physical activity recommendations at 24 months . Apart from a significantly higher RAQoL score in the IT group at 24 months compared with baseline , there were no significant differences within or between the programmes regarding functional ability or QoL. CONCLUSION In RA patients , the effectiveness of both an individualized and a general 1-year Internet-based physical activity programme is sustained with respect to moderate intensity physical activity up to 12 months after the interventions Background Quadriceps femoris muscle ( QFM ) weakness is a feature of knee osteoarthritis ( OA ) and exercise programs that strengthen this muscle group can improve function , disability and pain . Traditional supervised resistance exercise is however re source intensive and dependent on good adherence which can be challenging to achieve in patients with significant knee OA . Because of the limitations of traditional exercise programs , interest has been shown in the use of neuromuscular electrical stimulation ( NMES ) to strengthen the QFM . We conducted a single-blind , prospect i ve r and omized controlled study to compare the effects of home-based resistance training ( RT ) and NMES on patients with moderate to severe knee OA . Methods 41 patients aged 55 to 75 years were r and omised to 6 week programs of RT , NMES or a control group receiving st and ard care . The primary outcome was functional capacity measured using a walk test , stair climb test and chair rise test . Additional outcomes were self-reported disability , quadriceps strength and cross-sectional area . Outcomes were assessed pre- and post-intervention and at 6 weeks post-intervention ( weeks 1 , 8 and 14 respectively ) . Results There were similar , significant improvements in functional capacity for the RT and NMES groups at week 8 compared to week 1 ( p≤0.001 ) and compared to the control group ( p < 0.005 ) , and the improvements were maintained at week 14 ( p≤0.001 ) . Cross sectional area of the QFM increased in both training groups ( NMES : + 5.4 % ; RT : + 4.3 % ; p = 0.404 ) . Adherence was 91 % and 83 % in the NMES and RT groups respectively ( p = 0.324 ) . Conclusions Home-based NMES is an acceptable alternative to exercise therapy in the management of knee OA , producing similar improvements in functional capacity . Trial registration : Current Controlled Trials IS RCT OBJECTIVE To assess the engagement in and satisfaction with an Internet-mediated physical activity intervention with individual supervision in patients with rheumatoid arthritis ( RA ) . METHODS The intervention studied was one of the two strategies aim ed at enhancing physical activity in RA patients that were being compared in a r and omized controlled trial . A total of 82 patients , all experienced in using Internet and e-mail and registered at three different rheumatology out-patient clinics , were r and omly allocated to the Internet-mediated individualized intervention ( 52 weeks ) . They had access to personal physical activity schedules and received individual supervision by a physical therapist by means of weekly e-mail feedback . In addition , telephone contacts , an online discussion forum , six face-to-face group meetings and electronic newsletters were offered . Besides registration of returned physical activity schedules , engagement and satisfaction were measured through question naires . RESULTS The median physical activity schedule return rate of the 82 participants was 55 % . The mean number of patients logging into the website at least once a week was 53 ( 70 % ) over 12 months . Of all patients , 69 returned the question naires ( response 84 % ) . Telephone contacts were used by 38/67 patients ( 57 % ) , the mean ( SD ) number of attended group meetings was 3.1 ( 1.5 ) and the discussion forum comprised 15 posted messages . Overall , the proportions of patients being ( very ) satisfied with the amount of e-mail contacts , telephone contacts , usefulness of website information , physical activity schedules , group meetings and website layout were > /=85 % . A smaller proportion of patients were satisfied with the links to other websites ( 68 % ) , the newsletters ( 55 % ) and the online discussion forum ( 32 % ) . CONCLUSION Physical activity schedules with weekly feedback by e-mail , telephone contacts and a limited number of group meetings were frequently used website tools and modes of communication of an Internet-based physical activity intervention , with high-satisfaction rates from RA patients . Discussion forum and newsletters were less used and appreciated . Caution should be taken when extrapolating the results found to groups of patients who are not experienced Internet and e-mail users or patients with more severe physical disabilities Background Osteoarthritis ( OA ) is the most common joint disorder in the world , as it is appears to be prevalent among 80 % of individuals over the age of 75 . Although physical activities such as walking have been scientifically proven to improve physical function and arthritic symptoms , individuals with OA tend to adopt a sedentary lifestyle . There is therefore a need to improve knowledge translation in order to influence individuals to adopt effective self-management interventions , such as an adapted walking program . Methods A single-blind , r and omized control trial was conducted . Subjects ( n = 222 ) were r and omized to one of three knowledge translation groups : 1 ) Walking and Behavioural intervention ( WB ) ( 18 males , 57 females ) which included the supervised community-based aerobic walking program combined with a behavioural intervention and an educational pamphlet on the benefits of walking ;  2 )  Walking intervention ( W ) ( 24 males , 57 females ) wherein participants only received the supervised community-based aerobic walking program intervention and the educational pamphlet ; 3 ) Self-directed control ( C ) ( 32 males , 52 females ) wherein participants only received the educational pamphlet . One-way analyses of variance were used to test for differences in quality of life , adherence , confidence , and clinical outcomes among the study groups at each 3 month assessment during the 12-month intervention period and 6-month follow-up period . Results The clinical and quality of life outcomes improved among participants in each of the three comparative groups . However , there were few statistically significant differences observed for quality of life and clinical outcomes at long-term measurements at 12-months end of intervention and at 6- months post intervention ( 18-month follow-up ) . Outcome results varied among the three groups . Conclusion The three groups were equivalent when determining the effectiveness of knowledge uptake and improvements in quality of life and other clinical outcomes . OA can be managed through the implementation of a proven effective walking program in existing community-based walking clubs . Trial registration Current Controlled Trials Objective : To investigate whether a four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance in older adults with knee osteoarthritis . Design : A r and omized controlled trial with two groups : a walking group and a control group . Subjects : Forty older adults with knee osteoarthritis , 20 participants in each group . Intervention : The walking intervention was design ed to increase the number of steps walked daily . The walking group was instructed to increase their number of steps to 3000 steps more than before the intervention . Main outcome measures : Dual-task performance was computed by an automaticity index : the walking velocity under single-task condition/under dual-task conditions × 100 ( % ) , defined as automaticity . The nearer to 100 % automaticity , the better the dual-task performance . Decrease of the Trail Making Test ( TMT ) performance was defined as ΔTMT . ΔTMT was calculated as the difference between times ( part B – part A ) as a measure of executive function . In addition , functional ability was measured by the Japanese Knee Osteoarthritis Measure . Results : The walking group improved significantly in automaticity ( P < 0.001 , from 75.2 ( 7.6 ) to 86.9 ( 10.4 ) , ΔTMT ( P < 0.001 , from 63.4 ( 43.1 ) to 48.3 ( 29.6 ) ) and Japanese Knee Osteoarthritis Measure score ( P < 0.001 , from 54.4 to 51.9 ) compared with before the intervention , while the control group displayed no significant differences . Conclusions : We found that walking exercise improves executive function and dual-task performance 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 determine whether hip abductor and adductor muscle strengthening reduces medial compartment knee load and improves symptoms in people with medial tibiofemoral OA and varus malalignment . METHODS In a r and omised controlled trial , 89 participants were r and omly allocated to a hip strengthening group or to a control group with no intervention . The strengthening group performed a physiotherapist-supervised home exercise program targeting the hip abductor and adductor muscles for 12 weeks . The primary outcome was the peak external knee adduction moment measured using three-dimensional gait analysis by a blinded assessor . Secondary outcomes included a pain numeric rating scale , Western Ontario and McMaster Universities Osteoarthritis Index , step test , stair climb test , maximum isometric strength of hip and quadriceps muscles and participant-perceived rating of overall change . Intention-to-treat analyses were performed using linear regression modelling adjusting for baseline outcomes and other characteristics . RESULTS The trial was completed by 76/89 participants ( 85 % ) . There was no significant between-group difference in change in the knee adduction moment [ mean difference ( 95 % confidence interval ( CI ) ) 0.134 ( -0.069 to 0.337 ) Nm/BW x HT% ] . All pain , physical function and muscle strength measures showed significantly greater improvement in the strengthening group ( all P<0.05 ) . The relative risk ( 95 % CI ) of participant-perceived overall improvement in the strengthening group compared to the control group was 20.02 ( 6.21 - 64.47 ) . CONCLUSIONS Although strengthening the hip muscles improved symptoms and function in this patient group , it did not affect medial knee load as measured by the knee adduction moment . Thus it is unlikely that hip muscle strengthening influences structural disease progression . TRIAL REGISTRATION ACTR12607000001493 INTRODUCTION There is a need to establish a framework and exercise level for patients with early rheumatoid arthritis ( RA ) . The aim of this study was to compare the effect of a partly supervised and a self-administered exercise programme for patients with early RA . METHODS A total of 51 patients with early ( ≤ 5 years ) RA were r and omised to either a six-week supervised , progressive , high-intensity exercise programme followed by a six-week self-administered exercise programme or a 12-week self-administered exercise programme . RESULTS A total of 36 patients completed the study . Following the 12 weeks of exercises , patients in the two groups had improved both their muscle strength and their physical fitness . There was a significant difference in Disease Activity Score in 28 joints calculated with C-reactive protein between the two exercise groups , but no significant differences in physical fitness , pain perception , Health Assessment Question naire , Short Form 36 health survey question naire , Fear-Avoidance Beliefs Question naire , or in muscle strength , except from a significant difference in trunk extensors . The dropout was 40 % in the supervised group versus 20 % in the self-administered group . CONCLUSION A progressive , high-intensity exercise programme is feasible for patients with early RA , although we observed an elevated number of dropouts for reasons not related to the intervention . The partly supervised exercise programme with follow-up after 12 weeks does not seem to be more effective than the self-administered exercise programme . FUNDING none . TRIAL REGISTRATION The trial was registered with www . clinical trials.gov ( NCT01553305 ) 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 Background and Purpose : Muscle strength training is important for people with knee osteoarthritis ( OA ) .  High-resistance exercise has been demonstrated to be more beneficial than low-resistance exercise for young subjects . The purpose of this study was to compare the effects of high- and low-resistance strength training in elderly subjects with knee OA . Subjects and Methods : One hundred two subjects were r and omly assigned to groups that received 8 weeks of high-resistance exercise ( HR group ) , 8 weeks of low-resistance exercise ( LR group ) , or no exercise ( control group ) . Pain , function , walking time , and muscle torque were examined before and after intervention . Results : Significant improvement for all measures was observed in both exercise groups . There was no significant difference in any measures between HR and LR groups . However , based on effect size between exercise and control groups , the HR group improved more than the LR group . Discussion and Conclusion : Both high- and low-resistance strength training significantly improved clinical effects in this study . The effects of high-resistance strength training appear to be larger than those of low-resistance strength training for people with mild to moderate knee OA , although the differences between the HR and LR groups were not statistically significant OBJECTIVE To determine the effects of structured exercise programs on  self-reported disability in older adults with knee osteoarthritis . SETTING AND DESIGN A r and omized , single-blind clinical trial lasting 18 months conducted at 2 academic medical centers . PARTICIPANTS A total of 439 community-dwelling adults , aged 60 years or older , with radiographically evident knee osteoarthritis , pain , and self-reported physical disability .  INTERVENTIONS An aerobic exercise program , a resistance exercise program , and a health education program . MAIN OUTCOME MEASURES The primary outcome was self-reported disability score ( range , 1 - 5 ) . The secondary outcomes were knee pain score ( range , 1 - 6 ) , performance measures of physical function , x-ray score , aerobic capacity , and knee muscle strength . RESULTS A total of 365 ( 83 % ) participants completed the trial . Overall compliance with the exercise prescription was 68 % in the aerobic training group and 70 % in the resistance training group . Postr and omization , participants in the aerobic exercise group had a 10 % lower adjusted mean ( + /- SE ) score on the physical disability question naire ( 1.71 + /- 0.03 vs 1.90 + /- 0.04 units ; P<.001 ) , a 12 % lower score on the knee pain question naire ( 2.1 + /- 0.05 vs 2.4 + /- 0.05 units ; P=.001 ) , and performed better ( mean [ + /- SE ] ) on the 6-minute walk test ( 1507 + /- 16 vs 1349 + /- 16 ft ; P<.001 ) , mean ( + /-SE ) time to climb and descend stairs ( 12.7 + /- 0.4 vs 13.9 + /- 0.4 seconds ; P=.05 ) , time to lift and carry 10 pounds ( 9.1 + /- 0.2 vs 10.0 + /- 0.1 seconds ; P<.001 ) , and mean ( + /-SE ) time to get in and out of a car ( 8.7 + /- 0.3 vs 10.6 + /- 0.3 seconds ; P<.001 ) than the health education group . The resistance exercise group had an 8 % lower score on the physical disability question naire ( 1.74 + /- 0.04 vs 1.90 + /- 0.03 units ; P=.003 ) , 8 % lower pain score ( 2.2 + /- 0.06 vs 2.4 + /- 0.05 units ; P=.02 ) , greater distance on the 6-minute walk ( 1406 + /- 17 vs 1349 + /- 16 ft ; P=.02 ) , faster times on the lifting and carrying task ( 9.3 + /- 0.1 vs 10.0 + /- 0.16 seconds ; P=.001 ) , and the car task ( 9.0 + /- 0.3 vs 10.6 + /- 0.3 seconds ; P=.003 ) than the health education group . There were no differences in x-ray scores between either exercise group and the health education group . CONCLUSIONS Older disabled persons with osteoarthritis of the knee had modest improvements in measures of disability , physical performance , and pain from participating in either an aerobic or a resistance exercise program . These data suggest that exercise should be prescribed as part of the treatment for knee osteoarthritis The objective of this study was to investigate the effects of Pilates on pain , functional status , and quality of life in patients with ankylosing spondylitis . The study was performed as a r and omized , prospect i ve , controlled , and single-blind trial . Fifty-five participants ( 30 men , 25 women ) who were under a regular follow-up protocol in our Rheumatology Clinic with the diagnosis of AS according to the modified New York criteria were included in the study . The participants were r and omly assigned into two groups : in group I , Pilates exercise program of 1 h was given by a certified trainer to 30 participants 3 times a week for 12 weeks , and in group II , design ed as the control group , 25 participants continued previous st and ard treatment programs . In groups , pre-(week 0 ) and post treatment ( week 12 and week 24 ) evaluation was performed by one of the authors who was blind to the group allocation . Primary outcome measure was functional capacity . Evaluation was done using the Bath Ankylosing Spondylitis Functional Index ( BASFI ) . Exploratory outcome measures were Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , Bath Ankylosing Spondylitis Metrology Index ( BASMI ) , Chest expansion , and ankylosing spondylitis quality of life ( ASQOL ) question naire . In group I , BASFI showed significant improvement at week 12 ( P = 0.031 ) and week 24 ( P = 0.007 ) . In group II , this parameter was not found to have significantly changed at week 12 and week 24 . Comparison of the groups showed significantly superior results for group I at week 24 ( P = 0.023 ) . We suggest Pilates exercises as an effective and safe method to improve physical capacity in AS patients . Our study is the first clinical study design ed to investigate the role of Pilates method in AS treatment . We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method in AS The purpose of this study is to evaluate the effects of targeting both the motivation and action phases of behaviour change in a 5-week intervention to increase physical activity ( PA )  among patients with rheumatoid arthritis ( RA ) not meeting current PA recommendations . In a r and omised controlled trial , a control group — which received a group-based patient education session led by a physical therapist — was compared to a treatment group which received the education session plus a motivational interview from a physical therapist and two self-regulation coaching sessions from a rheumatology nurse . Outcomes included  leisure-time PA , days per week with at least 30 min of moderate-intensity PA , self-efficacy and autonomous motivation ( cognitions which predict PA initiation and maintenance ) , disease activity , functional status , depressive symptoms and fatigue . Effects were assessed using mixed models repeated measures . Of the 78 patients r and omised , 76 and 67 completed the post-treatment and follow-up assessment s , respectively . Significant treatment effects were found for leisure-time PA  ( p = 0.022 ) , active days/week ( p = 0.016 ) , self-efficacy ( p = 0.008 ) and autonomous motivation ( p = 0.001 ) . At post-treatment and 6-months follow-up , significantly more treated patients than controls met current PA recommendations . No significant effects were found for disease activity , functional status , depressive symptoms or fatigue . Combining motivation- and action-focused intervention approaches improved PA-related cognitions and led to improved uptake and maintenance of leisure-time PA . However , further research is necessary to identify ways of helping patients with RA transition to— and maintain — more intensive forms of PA which are more likely to improve disease activity and functional status Background : To investigate the effects of moderate aerobic exercise on the hemoglobin , hematocrit , and red blood cell ( RBC ) mass of women with rheumatoid arthritis ( RA ) . Material s and Methods : This r and omized clinical trial was conducted at the Specialized Clinic of Physical Medicine and Rehabilitation , Al-Zahra Hospital of Isfahan , during a 4-month period in 2014 . We included patients with RA who did not have any malignancy and hematologic disorder . Two groups — one group receiving aerobic therapy along with medical therapy ( N = 16 ) and the other group receiving medical therapy alone ( N = 17 ) both for a period of 8 weeks . The levels of RBC mass , Hb , and HCT were measured before and after the intervention . The changes in these parameters were compared between the two study groups . Results : There was no significant difference between the two study groups regarding the baseline characteristics . The aerobic exercise result ed in increased RBC mass ( P < 0.001 ) , Hb ( P < 0.001 ) , and HCT ( P < 0.001 ) . However , those who received medical therapy alone did not experience any significant changes in these parameters . We found that the RBC mass ( P = 0.581 ) , Hb ( P = 0.882 ) , and HCT ( P = 0.471 ) were comparable between the two study groups after 8 weeks of intervention . Conclusion : Although the aerobic exercise results in increased Hb , HCT , and RBC mass in patients with RA , the increase was not significant when compared to that in controls . Thus , the increase in the HB , HCT , and RBC could not be attributable to aerobic exercise STUDY DESIGN R and omized clinical trial . OBJECTIVE To investigate the clinical and functional efficacy of 2 different non-weight-bearing exercise regimens , proprioceptive training ( PrT ) versus strength training ( ST ) , for patients with knee osteoarthritis ( OA ) . BACKGROUND Both strength and proprioceptive training are important interventions for individuals with knee OA . The benefits of weight-bearing exercises are generally recognized in the clinical setting . However , exercising in a st and ing or weight-bearing position may aggravate symptoms in patients with knee OA . METHODS AND MEASURES One hundred eight patients were r and omly assigned to the PrT , ST , or no exercise ( control ) group for an 8-week intervention . Both the PrT and ST interventions consisted of non-weight-bearing exercises .  Western Ontario and McMaster Universities Osteoarthritis Index-pain ( WOMAC-pain ) and -function scores , walking time on 3 different terrains , knee strength , and absolute knee reposition error were assessed before and after intervention . Data were analyzed using mixed-model ANOVAs . RESULTS Both PrT and ST significantly improved WOMAC-pain and -function score after intervention ( P<.008 ) . The improvement secondary to ST in the WOMAC-function scores ( 17.2 points ) and for knee extension strength ( 10.3 - 14.9 Nm ) was greater than the minimally clinical ly important difference for these measurements . The PrT group demonstrated greater improvement in walking time on a spongy surface and knee reposition error than the other 2 groups . No improvements were apparent in the control group . CONCLUSION Both types of non-weight-bearing exercises ( PrT and ST ) significantly improved outcomes in this study . PrT led to greater improvements in proprioceptive function , while ST result ed in a greater increase in knee extensor muscle strength QUESTIONS Does a 3-month behaviour change intervention targeting physical activity ( PA ) increase habitual physical activity in adults with ankylosing spondylitis ( AS ) ? Does the intervention improve health-related physical fitness , AS-related features , and attitude to exercise ? Are any gains maintained over a 3-month follow-up ? DESIGN Parallel-group , r and omised , controlled trial with concealed allocation , assessor blinding and intention-to-treat analysis . PARTICIPANTS Forty adults with a diagnosis of AS , on stable medication , and without PA-limiting comorbidities . INTERVENTION Over a 3-month period , the experimental group engaged in individually-tailored , semi-structured consultations aim ing to motivate and support individuals in participating in PA . The control group continued with usual care . OUTCOME MEASURES The primary outcome was PA measured by accelerometry over 1 week . Secondary outcomes included clinical question naires and measures of health-related physical fitness . Measures were taken at baseline , post-intervention , and after a 3-month follow-up period . RESULTS Baseline characteristics were similar across groups , except age and body composition . There were statistically significant , moderate-to-large time-by-group effects  in health-enhancing PA  ( mixed- design ANOVA for overall effect F(2 , 76)=14.826 , p<0.001 ) , spinal mobility ( F(2 , 76)=5.691 , p<0.005 ) and quality of life ( χ2(2)=8.400 , p<0.015 ) favouring the intervention group ; post-intervention improvements were sustained 3 months later . No significant effects were seen in other physical fitness outcomes or on clinical question naires . No adverse effects were reported during the study .  CONCLUSION Health-enhancing PA , spinal mobility and quality of life were significantly improved after the intervention , and improvements were maintained at 3-month follow-up . TRIAL REGISTRATION NCT02374502 . [ O'Dwyer T , Monaghan A , Moran J , O'Shea F , Wilson F ( 2016 ) Behaviour change intervention  increases physical activity , spinal mobility and quality of life in adults with ankylosing spondylitis : a r and omised trial . Journal of PhysiotherapyXX : XX-XX ] BACKGROUND AND PURPOSE Few r and omized controlled studies have examined the effects of exercise in patients with ankylosing spondylitis ( AS ) . This study investigated the effects of a 12-week , multimodal exercise program in patients with AS . SUBJECTS A convenience sample of 30 patients with AS ( 18 male , 12 female ) , with a mean age of 34.9 years ( SD=6.28 ) , participated in the study . Twenty-six subjects were classified as having stage I AS and 4 subjects were classified as having stage II AS according to the modified New York Criteria . METHODS This study was a r and omized controlled trial . Subjects were assigned to either a group that received an exercise program or to a control group . The exercise program consisted of 50 minutes of multimodal exercise , including aerobic , stretching , and pulmonary exercises , 3 times a week for 3 months . Subjects in both groups received medical treatment for AS , but the exercise group received the exercise program in addition to the medical treatment . All subjects received a physical examination at baseline and at 12 weeks . The examinations were conducted under the supervision of a physician who specialized in physical medicine and rehabilitation and included the assessment of spinal mobility using 2 methods : clinical measurements ( chin-to-chest distance , Modified Schober Flexion Test , occiput-to-wall distance , finger-to-floor distance , and chest expansion ) and inclinometer measurements ( gross hip flexion , gross lumbar flexion , and gross thoracic flexion ) . In addition , vital capacity was measured by a physiologist , and physical work capacity was evaluated by a doctorally prepared exercise instructor . RESULTS The measurements of the exercise group for chest expansion , chin-to-chest distance , Modified Schober Flexion Test , and occiput-to-wall distance were significantly better than those of the control group after the 3-month exercise period . The spinal movements of the exercise group improved significantly at the end of exercise program , but those of the control group showed no significant change . In addition , the results showed that the posttraining value of gross thoracic flexion of the exercise group was significantly higher than that of the control group . Physical work capacity and vital capacity values improved in the exercise group but decreased in the control group . DISCUSSION AND CONCLUSION In this study , a multimodal exercise program including aerobic , stretching , and pulmonary exercises provided in conjunction with routine medical management yielded greater improvements in spinal mobility , work capacity , and chest expansion OBJECTIVE Quadriceps weakness is a risk factor for incident knee osteoarthritis ( OA ) . We describe a r and omized controlled trial of effects of lower-extremity strength training on incidence and progression of knee OA . METHODS A total of 221 older adults ( mean age 69 years ) were stratified by sex , presence of radiographic knee OA , and severity of knee pain , and were r and omized to strength training ( ST ) or range-of-motion ( ROM ) exercises . Subjects exercised 3 times per week ( twice at a fitness facility , once at home ) for 12 weeks , followed by transition to home-based exercise after 12 months . Assessment s of isokinetic lower-extremity strength and highly st and ardized knee radiographs were obtained at baseline and 30 months . RESULTS Subjects in both groups lost lower-extremity strength over 30 months ; however , the rate of loss was slower with ST than with ROM . Compared with ROM , ST decreased the mean rate of joint space narrowing ( JSN ) in osteoarthritic knees by 26 % ( P = not significant ) . However , the difference between ST and ROM groups with respect to frequency of knee OA progression in JSN consensus ratings was marginally significant ( 18 % versus 28 % ; P = 0.094 ) . In knees that were radiographically normal at baseline , JSN > 0.50 mm was more common in ST than in ROM ( 34 % versus 19 % ; P = 0.038 ) . Incident JSN was unrelated to exercise adherence or changes in quadriceps strength or knee pain . CONCLUSION The ST group retained more strength and exhibited less frequent progressive JSN over 30 months than the ROM group . The increase in incident JSN > 0.50 mm in ST is unexplained and requires confirmation 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 determine the effects of participation in a low-impact aerobic exercise program on fatigue , pain , and depression ; to examine whether intervention groups compared with a control group differed on functional ( grip strength and walk time ) and disease activity ( total joint count , erythrocyte sedimentation rate , and C-reactive protein ) measures and aerobic fitness at the end of the intervention ; and to test which factors predicted exercise participation . METHODS A convenience sample of 220 adults with rheumatoid arthritis ( RA ) , ages 40 - 70 , was r and omized to 1 of 3 groups : class exercise , home exercise using a videotape , and control group . Measures were obtained at baseline ( T1 ) , after 6 weeks of exercise ( T2 ) , and after 12 weeks of exercise ( T3 ) . RESULTS Using structural equation modeling , overall symptoms ( latent variable for pain , fatigue , and depression ) decreased significantly at T3 ( P < 0.04 ) for the class exercise group compared with the control group . There were significant interaction effects of time and group for the functional measures of walk time and grip strength : the treatment groups improved more than the control group ( P < or= 0.005 ) . There were no significant increases in measures of disease activity . Fatigue and perceptions of benefits and barriers to exercise affected participants ' amount of exercise , supporting previous research . CONCLUSION This study supported the positive effects of exercise on walk time and grip strength , and demonstrated that fatigue and perceived benefits /barriers to exercise influenced exercise participation . Furthermore , overall symptoms of fatigue , pain , and depression were positively influenced in this selective group of patients with RA ages 40 - 70 years AIM This paper reports a study of the effects of aquatic exercise on physical fitness ( flexibility , strength and aerobic fitness ) , self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee . BACKGROUND Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement . Exercise is important for preventing and /or managing the functional limitations associated with joint disease . Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis ; however , few studies have examined the effects on people with osteoarthritis , and these have yielded inconsistent results . METHODS A two-group r and omized controlled trial with a convenience sample was used . Participants were recruited from community sources and r and omly assigned to a 12-week aquatic programme or a non-exercise control condition . Data for 38 participants were collected at baseline , week 6 , and week 12 during 2003 and 2004 . Instruments were a st and ard plastic goniometer , a h and held dynamometer , the 6-minute walk test , the multidimensional Health Assessment Question naire , and a visual analogue scale for pain . RESULTS Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility , strength and aerobic fitness , but had no effect on self-reported physical functioning and pain . The exercise adherence rate was 81.7 % , and no exercise-related adverse effect was observed or reported . CONCLUSIONS Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee . Although the programme may not offer pain relief or self-reported improvements in physical functioning , results suggest that aquatic exercise does not worsen the joint condition or result in injury . Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients BACKGROUND Osteoarthritis is a common musculo-skeletal problem accompanied with muscle weakness . Muscle weakness may be readily improved by resistance training . Greater muscle strength has been associated with a lower knee joint loading rate . METHODS We conducted a single-blind r and omized controlled trial of 54 female patients with osteoarthritis in at least one knee , according to the American College of Rheumatology clinical criteria . Patients were r and omized into a 6-month high intensity progressive resistance training or a sham-exercise program . The primary outcomes were first peak knee and hip adduction moment measured using three-dimensional gait analysis at self-selected habitual and maximal speeds . Secondary outcomes were sagittal plane knee and hip moments , peak muscle strength , gait speed , and self-reported knee osteoarthritis symptoms measured by the Western Ontario and McMaster Osteoarthritis Index ( WOMAC ) . FINDINGS Six months of high intensity resistance training did not change the first peak knee or hip adduction moment at either habitual or maximum walking speeds ( P>0.413 ) compared to the sham-exercise . However , the second peak hip adduction moment ( P=0.025 ) and WOMAC pain score ( P<0.001 ) were reduced significantly in both groups over time , but there was no group effect . The changes in the second peak hip adduction moment were inversely related to the changes in the WOMAC pain score ( r=-0.394 , P=0.009 ) . INTERPRETATIONS Muscle strength training in women with osteoarthritis , while effective for reducing osteoarthritis symptoms , appeared to operate through mechanisms other than improved knee or hip joint loading , as paradoxically , improved symptoms were related to decreases of hip adduction moment in late stance OBJECTIVE To evaluate the mean overall effects over a 1-year period of a multidisciplinary in-patient rehabilitation programme for patients with ankylosing spondylitis . DESIGN Observer-blinded , r and omized controlled trial , with assessment s made after 4 and 12 months . PATIENTS Forty-six patients received a 3-week in-patient rehabilitation programme and 49 patients received treatment as usual .  METHODS Primary outcomes were disease activity measured with the Bath Ankylosing Spondylitis Disease Activity Scale ( BASDAI ) , and function measured with the Bath Ankylosing Spondylitis Functional Index ( BASFI ) . Secondary outcomes included well-being , spinal and hip mobility , and health-related quality of life measured with the Medical Outcome Study Short Form-36 . Overall treatment effects were estimated with Mixed models repeated measures analyses . RESULTS Significant overall treatment effects in favour of the rehabilitation group were found in the BASDAI score ( mean difference over the 1-year period -10.0 , 95 % confidence interval : -3.7 to -16.3 ) , in well-being ( -7.3 , 95 % confidence interval : -1.0 to -14.7 ) , and in the Medical Outcome Study Short Form-36 variables social functioning , role physical , role mental and bodily pain ( mean differences ranging from 5.8 ( pain ) to 10.7 ( role physical ) ) . CONCLUSION A 3-week in-patient rehabilitation programme had positive overall effects on disease activity , pain , function and well-being , and should be considered an important complement to medical disease management in persons with ankylosing spondylitis OBJECTIVE To investigate the effect of a 1-year coaching program for healthy physical activity on perceived health status , body function , and activity limitation in patients with early rheumatoid arthritis . METHODS A total of 228 patients ( 169 women , 59 men , mean age 55 years , mean time since diagnosis 21 months ) were r and omized to 2 groups after assessment s with the EuroQol visual analog scale ( VAS ) , Grippit , Timed-St and s Test , Escola Paulista de Medicina Range of Motion scale , walking in a figure-of-8 , a visual analog scale for pain , the Health Assessment Question naire disability index , a self-reported physical activity question naire , and the Disease Activity Score in 28 joints . All patients were regularly seen by rheumatologists and underwent rehabilitation as prescribed . Those in the intervention group were further individually coached by a physical therapist to reach or maintain healthy physical activity ( > or = 30 minutes , moderately intensive activity , most days of the week ) . RESULTS The retention rates after 1 year were 82 % in the intervention group and 85 % in the control group . The percentages of individuals in the intervention and control groups fulfilling the requirements for healthy physical activity were similar before ( 47 % versus 51 % ; P > 0.05 ) and after ( 54 % versus 44 % ; P > 0.05 ) the intervention . Analyses of outcome variables indicated improvements in the intervention group over the control group in the EuroQol VAS ( P = 0.025 ) and muscle strength ( Timed-St and s Test ; P = 0.000 ) ( Grippit ; P = 0.003 ) , but not in any other variables assessed . CONCLUSION A 1-year coaching program for healthy physical activity result ed in improved perceived health status and muscle strength , but the mechanisms remain unclear , as self-reported physical activity at healthy level did not change 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 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 OBJECTIVES To investigate the long-term effects on perceived general health , disease activity , pain , activity limitation and cognitive behavioural factors of a one-year coaching programme performed in ordinary physical therapy practice to promote the adoption of health-enhancing physical activity in patients with early rheumatoid arthritis ( RA ) . METHODS A total of 228 patients with early RA , from 10 rheumatology clinics in Sweden , were r and omly assigned to an intervention group ( IG ; n = 94 ) or a control group ( CG ; n = 134 ) . The IG was coached by physical therapists during the first year to adopt health-enhancing levels of physical activity ( 30 minutes/day , moderately intensive , ≥ 4 days/week ) . No coaching was given during the subsequent year between post-intervention and follow-up . Follow-up assessment consisted of a postal question naire on physical activity and of visual analogue scales for ratings of general health perception and pain . The Health Assessment Question naire Disability Index ( HAQ ) and the Disease Activity Score in 28 joints ( DAS 28 ) were collected at regular medical check-ups . RESULTS Sixty-five ( 69 % ) participants in the IG and 92 ( 69 % ) in the CG completed the entire study period by filling in the follow-up question naire on physical activity two years after baseline . The intervention seemed to lack any significant influence on long-term outcome . However , different patterns of change in physical activity behaviour were observed in the two groups . CONCLUSIONS No long-term improvement in perceived general health or other outcomes were found in the follow-up . This may partly be because the intervention lacked several important behavioural elements for physical activity maintenance OBJECTIVE To confirm , in a r and omized controlled trial ( RCT ) , the efficacy of high-intensity progressive resistance training ( PRT ) in restoring muscle mass and function in patients with rheumatoid arthritis ( RA ) . Additionally , to investigate the role of the insulin-like growth factor ( IGF ) system in exercise-induced muscle hypertrophy in the context of RA . METHODS Twenty-eight patients with established , controlled RA were r and omized to either 24 weeks of twice-weekly PRT ( n = 13 ) or a range of movement home exercise control group ( n = 15 ) . Dual x-ray absorptiometry-assessed  body composition ( including lean body mass [ LBM ] , appendicular lean mass [ ALM ] , and fat mass ) ; objective physical function ; disease activity ; and muscle IGFs were assessed at weeks 0 and 24 . RESULTS Analyses of variance revealed that PRT increased LBM and ALM ( P < 0.01 ) ; reduced trunk fat mass by 2.5 kg ( not significant ) ; and improved training-specific strength by 119 % , chair st and s by 30 % , knee extensor strength by 25 % , arm curls by 23 % , and walk time by 17 % ( for objective function tests , P values ranged from 0.027 to 0.001 versus controls ) . In contrast , body composition and physical function remained unchanged in control patients . Changes in LBM and regional lean mass were associated with changes in objective function ( P values ranged from 0.126 to < 0.0001 ) . Coinciding with muscle hypertrophy , previously diminished muscle levels of IGF-1 and IGF binding protein 3 both increased following PRT ( P < 0.05 ) . CONCLUSION In an RCT , 24 weeks of PRT proved safe and effective in restoring lean mass and function in patients with RA . Muscle hypertrophy coincided with significant elevations of attenuated muscle IGF levels , revealing a possible contributory mechanism for rheumatoid cachexia . PRT should feature in disease management Abstract Purpose : To evaluate the effect of an exercise therapy concept ( the Tübingen exercise therapy approach THüKo ) for increasing hip muscle strength ( HMS ) in patients with hip osteoarthritis ( OA ) , and to investigate whether patients do adhere to the intervention and if there are any adverse events related to the intervention . Methods : A total of 210 hip OA patients ( 89 females , 121 males ) were r and omized into a 12-week exercise intervention ( THüKo ) including group sessions ( 1/week ) and home exercising ( 2/week ) , a placebo ultrasound group ( 1/week ) or a control group ( no treatment ) . HMS was measured as isometric peak torque of hip abduction , adduction , flexion , and extension . Adherence to exercise and safety aspects were monitored as additional outcomes . Results : Baseline adjusted post intervention HMS of the THüKo group were higher compared to the control group ( differences of 0.11–0.27 Nm/kg , p < 0.01 ) and to the placebo ultrasound group ( differences of 0.09–0.19 Nm/kg , p < 0.01 ) . Adherence to exercise was high ( about 90 % ) . No subject had to refuse from training because of an exercise related adverse event and exercise related pain was only of intermittent nature without sustainable adverse effects . Conclusions : The Tübingen exercise therapy approach has shown to have a significant positive effect on HMS . Its implementation has shown to be feasible and safe according to the percentage of exercise participation and the absence of sustainable adverse events OBJECTIVE To investigate the efficacy and feasibility of progressive explosive-type resistance training ( RT ) in patients with osteoarthritis ( OA ) of the hip scheduled for total hip arthroplasty ( THA ) . METHOD R and omized controlled trial ( 1:1 ) in patients diagnosed with hip OA and scheduled for THA . The intervention group ( IG ) performed supervised preoperative progressive explosive-type RT twice a week for 10 weeks ; four exercises ( hip/thigh ) performed in three series each ( 8 - 12 repetition maximum ) . The control group ( CG ) received ' care as usual ' .  Efficacy was reported as the between-group difference in the Hip Osteoarthritis Outcome Score ( HOOS ) ( primary endpoint ; ADL function ) , and leg muscle power at post intervention follow-up immediate before surgery . Intention-to-treat analyses were performed in a multilevel regression model adjusting for baseline , sex , age and weight . Feasibility was reported as adherence , exercise related pain and adverse effects . Post-surgical follow up will be reported separately . Clinical Trials.gov registration : NCT01164111 . RESULTS Eighty patients ( age 70.4 ± 7.6 years , BMI 27.8 ± 4.6 , 52 females ( 65 % ) were included .  Adherence was high ( 93 % ) with acceptable exercise related pain ( VAS score ≤ 5 ) reported in 83 % of sessions and no adverse events . Changes in HOOS ' function ' was 10.0 points 95%CI [ 4.7 ; 15.3 ] higher in IG compared to CG ( P < 0.001 ) . For all the remaining HOOS subscales IG scored significantly better ( P < 0.03 ) and had higher leg extension muscle power ( P < 0.0001 ) compared to CG . CONCLUSION Progressive explosive-type RT was feasible in the included group of hip OA patients scheduled for THA and result ed in significant improvement in self-reported outcomes and increased leg muscle power UNLABELLED Knee pain is a common health problem in the elderly population , for which non-invasive treatments are recommended as a first line treatment in the management of knee pain . A r and omized controlled trial was conducted to determine the effects of exercise with or without thermal therapy in community-dwelling elderly women with chronic knee pain . Women over 75 years of age with knee pain ( n=150 ) were r and omly assigned into four groups ; exercise ( Ex ) and heat/steam generating sheet ( HSGS ) ( n=38 ) , Ex ( n=37 ) , HSGS ( n=38 ) , or health education ( HE ) ( n=37 ) . The Ex group attended a 60-min comprehensive training program twice a week for 3-months . The HSGS group placed two sheets on the knee for five hours per day . Functional fitness , visual analog scale ( VAS ) , and Japanese knee osteoarthritis measure ( JKOM ) were assessed at baseline and post-intervention . The results showed VAS improvements in the Ex+HSGS and HSGS groups . Total JKOM score , muscle strength , and functional mobility significantly improved in the Ex+HSGS group compared with the HE group . The odds ratio ( OR ) for VAS and functional mobility improvement was more than eight times as great in the Ex+HSGS group ( OR=8.60 , 95 % confidence interval (CI)=2.82 - 32.73 ) compared with the education group . Ex or HSGS alone were insufficient in enhancing functional fitness or improving pain and quality of life . The combined effects of both Ex and heat therapy seems to have an added benefit of decreasing pain , improving physical function and increasing quality of life . TRIAL REGISTRATION NUMBER JMA-IIA00110 Objective . To evaluate the effects of aerobic exercise in patients with ankylosing spondylitis ( AS ) . Methods . Seventy patients classified with AS by the modified New York criteria were included . The patients were r and omly assigned into 2 groups . The intervention group ( IG ) performed 50 min of walking followed by stretching exercises 3 times a week for 12 weeks . The control group ( CG ) performed only stretching exercises . The outcome measurements were the Bath indexes [ Bath AS Functional Index ( BASFI ) , Bath AS Disease Activity Index ( BASDAI ) , and Bath AS Metrology Index ( BASMI ) ] , Health Assessment Question naire for the Spondyloarthropathies ( HAQ-S ) , AS Disease Activity Score ( ASDAS ) , the 6-min walk test ( 6MWT ) , chest expansion , and the Medical Outcomes Study Short Form-36 . Aerobic capacity was assessed by ergospirometry on a treadmill . Routine laboratory techniques were used in determining lipid levels . Assessment s were performed immediately before r and omization and after 6 , 12 , and 24 weeks . Results . Thirty-five patients were r and omized to the IG and 35 to the CG . There was significant improvement in the BASFI , HAQ-S , BASMI , BASDAI , and ASDAS in both groups ( p < 0.05 ) , but did not differ between groups . There was a significant increase in the walking distance in the 6MWT in the IG compared with CG ( p < 0.001 ) . The IG showed significant improvement in cardiopulmonary capacity compared with CG . Cholesterol and triglyceride levels did not change in either group . Conclusion . In patients with AS , aerobic training improved walking distance and aerobic capacity . Aerobic training did not provide additional benefits in functional capacity , mobility , disease activity , quality of life , and lipid levels when compared with stretching exercises alone OBJECTIVE To investigate physical function in patients with severe osteoarthritis ( OA ) of the knees during and after a general physical training program .  DESIGN R and omized control trial , blinded observer , follow-up at 3 months and 1 year . SETTING Outpatient clinic . PATIENTS Consecutive sample of 25 patients ( 3 men , 22 women ) with OA of the knees according to the criteria of the American College of Rheumatology ( ACR ) . Two patients ( 8 % ) failed to complete the study . There were no withdrawals for adverse effects . INTERVENTION Twelve patients received training in groups of 6 , twice a week for 3 months . Training focused on general fitness , balance , coordination , stretching , and lower extremity muscle strength , and included a daily home exercise program . MAIN OUTCOME MEASURES Muscle strength across the knee ( extension and flexion ) , Algofunctional Index ( AFI ) , pain ( 0 to 10 point scale ) , walking speed , clinical findings . RESULTS Patients participated in 96 of 96 assessment s ( 100 % ) and in 218 of 280 training sessions ( 77.9 % ) . From baseline to 3 months , isokinetic quadriceps strength ( 30 degrees/sec ) improved 20 % ( confidence interval [ CI ] 2alpha = .05 , 8 % to 50 % ) in the least affected leg ; isometric strength improved 21 % . By 1 year , AFI had decreased 3.8 points ( CI2alpha = .05 , 1.0 to 7.0 ) , pain had decreased 2.0 points ( CI2alpha = 05 , 0.0 to 4.0 ) , and walking speed had increased 13 % ( CI2alpha = .05 , 4 % to 23 % ) . There was an increase in the frequency of palpable joint effusions ( p < .01 ) on the most affected side . Frequency of crepitus decreased on the least affected side ( p < .01 ) . CONCLUSIONS General physical training appears to be beneficial to patients with OA of the knee . As shown by the high compliance and low dropout frequency , such a program is feasible even in patients with severe OA of the knee Objective : To assess the effects of a 16-week progressive , individualized , high-intensity strength training program on muscle strength , pain , and function in patients with rheumatoid arthritis ( RA ) . Methods : Twenty-four RA patients ( men , n = 5 ; women , n = 19 ) receiving infliximab participated in a r and omized controlled trial . The strength training ( ST ) group ( n = 16 ) participated in a supervised program 3 times per week , and the control ( C ) group ( n = 8) continued with st and ard of care as overseen by their rheumatologist . Assessment s were completed at baseline and at weeks 8 and 16 . Strength was measured by 3 repetition maximum ( 3RM ) , isometric h and dynamometer , and isokinetic dynamometer . A 100-mm visual analogue scale was used to assess pain . Functional performance was derived from a timed 50-foot walk and the Health Assessment Question naire Disability Index . Results : The mean percent increase in strength ( 3RM ) for the ST group from baseline to week 16 was 46.1 % ± 31.6 % ( P < 0.01 ) ( mean of all three 3RM exercises : hammer curl , leg press , and incline dumbbell press ) , with mean gains in strength up to 4 times that of baseline values reported in all strength training exercises ( upper and lower body ) performed during exercise sessions . On average , right-h and grip strength increased by 2.9 ± 4.0 kg in the ST group , in comparison with a loss of 1.2 ± 3.0 kg in the C group over 16 weeks . The ST group had a 53 % reduction in pain , in comparison with almost no change in the C group . The ST group had a significant improvement in 50-foot walk time , with a mean reduction of −1.2 ± 1.6 seconds , in comparison with the C group ( mean increase of 0.8 ± 1.0 seconds ; P = 0.01 ) over the 16 weeks . There was a clinical ly important difference ( predefined as mean change ±0.25 ) in the Health Assessment Question naire Disability Index in the ST group ( −0.4 ± 0.4 ) but not in the C group ( −0.1 ± 0.4 ) . Conclusion : High-intensity strength training in RA patients with varying levels of disease activity and joint damage had a large , significant effect on strength , and led to improvements in pain and function , with additive patient benefits beyond the effect of their infliximab use 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 The purpose of this study was to compare the effectiveness of l and -based ( LB ) and water-based ( WB ) aerobic exercises in women with rheumatoid arthritis ( RA ) . Design A total of 133 women with RA were included in this r and omized , blinded , prospect i ve , 16-week controlled trial . The subjects were r and omized into 3 groups : WB ( n = 33 ) , LB ( n = 33 ) , and control ( n = 34 ) .  Muscle strength ( MS ) was measured using an isokinetic dynamometer .  Disease activity ( DAS-28 ) and functional ability ( health assessment question naire ) were measured by an expert rheumatologist . Total body densitometry was used to assess body composition . The intervention was performed 3 times per week , and all groups were evaluated at baseline and after 8 and 16 weeks .  Compliance , concomitant medications , and adverse events were recorded . The data were analyzed by intention to treat . P < 0.05 was set as significant . Results Of the 133 patients recruited , 100 were r and omized and 82 completed the study . In the first evaluation , the 3 groups were matched to age , body composition , functional capacity , MS , and concomitant medications . After 16 weeks , there were no significant changes of knee MS neither body composition among the groups . However , there was a significant improvement in disease activity and functional ability in the WB after 8 and 16 weeks . Conclusion Aquatic exercises provided significant improvement in disease activity , pain , and functional capacity 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 Background : Osteoarthritis ( OA ) is a degenerative joint disease affecting the knee joint of many middle-aged and older adults . As OA symptoms typically involve knee pain and stiffness , individuals with knee OA are often insufficiently physically active , have low levels of physical function , and are at increased risk of other comorbidities and reduced quality of life . While moderate-intensity continuous training ( MICT ) cycling is often recommended , little is known about the feasibility , safety , and benefits of high-intensity interval training ( HIIT ) cycling for this population , even though the feasibility , safety , and benefits of HIIT have been demonstrated in other chronic disease groups . Purpose : The primary objective of this pilot study was to examine the feasibility and safety of home-based HIIT and MICT cycling in middle-aged and older adults with knee OA . A secondary objective was to gain some insight into the relative efficacy of HIIT and MICT for improving health status ( pain , stiffness , and disability ) , muscle function , and body composition in this population . This study protocol is being published separately to allow a detailed description of the research methods , explain the rationale for choosing the method ological details , and to stimulate consideration of the best means to simulate a research protocol that is relevant to a real-life treatment environment . Study Design : R and omized pilot study protocol . Methods : This trial sought to recruit 40 middle-aged and older adults with knee OA . Participants were r and omly allocated to either continuous ( MICT ) or HIIT home-based cycle training programs , with both programs requiring the performance of 4 cycling sessions ( approximately 25 minutes per session ) each week . Participants were measured at baseline and postintervention ( 8 weeks ) . Feasibility and safety were assessed by adherence rate , dropout rate , and number of adverse events . The relative efficacy of the cycling programs was investigated by 2 knee OA health status question naires ( Western Ontario and McMaster Universities Osteoarthritis Index scale[WOMAC ] and the Lequesne Index ) as well as the timed up and go , sit to st and , preferred gait speed , and body composition . Discussion : This pilot study appears to be the first study assessing the feasibility and safety of a home-based HIIT training program for middle-aged and older adults with knee OA . As HIIT has been demonstrated to be more effective than MICT for improving aspects of health status , body composition , and /or muscular function in other chronic disease groups , the current study has the potential to improve patient outcomes and inform the design of future r and omized controlled trials OBJECTIVE To evaluate the functional , clinical , radiological and quality of life outcomes of a 4-week dynamic exercise programme ( DEP ) in RA . METHODS Patients matched on the principal medico-social parameters were r and omly assigned to either the DEP or the conventional joint rehabilitation group . Primary end point for judging effectiveness was functional status assessed by HAQ . Secondary outcomes included Nottingham Health Profile ( NHP ) , Arthritis Impact Measurement Scale 2-Short Form ( AIMS 2-SF ) and radiological worsening measured by Simple Narrowing Erosion Score ( SENS ) . Clinical evaluation consisted of disease activity score ( DAS 28 ) , cycling aerobic fitness and dexterity . Dexterity was measured using Sequential Occupational Dexterity Assessment ( SODA ) and Duruoz H and Index ( DHI ) . Data were collected at baseline 1 , 6 and 12 months . RESULTS Fifty patients were enrolled .  HAQ improved throughout the length of the trial in the DEP group . This improvement was greater in DEP than in the st and ard joint rehabilitation group at 1 month ( -0.2 vs no variation from baseline , P = 0.04 ) , but not at 6 months ( -0.2 vs -0.1 in control group , P = 0.25 ) or 12 months ( -0.1 vs no variation in control group , P = 0.51 ) . DEP improved NHP ( -23 vs + 7 % in control group , P = 0.01 ) and aerobic fitness ( + 0.3 vs + 0.1 km per 5 min in control group , P = 0.02 ) at 1 month but the progress was not statistically significant thereafter . DEP also improved DHI , SODA , DAS 28 and AIMS 2-SF , although not significantly . CONCLUSION DEP was effective on functional status assessed by HAQ , quality of life and aerobic fitness at 1 month OBJECTIVE To investigate whether weight-bearing ( WB ) exercise enhances functional capacity to a greater extent than nonweight-bearing ( NWB ) exercise in participants with knee osteoarthritis . DESIGN R and omized controlled trial . SETTING Kinesiology laboratory . PARTICIPANTS Participants ( N=106 ) were r and omly assigned to WB exercise , NWB exercise , or a control group ( no exercise ) . INTERVENTION WB exercise and NWB exercise groups underwent an 8-week knee extension-flexion exercise program . MAIN OUTCOME MEASURES Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) function scale , walking speed , muscle torque , and knee reposition error were assessed before and after intervention . RESULTS Equally significant improvements were apparent for all outcomes after WB exercise and NWB exercise , except for reposition error , for which improvement was greater in the WB exercise group . In contrast , there were no improvements in the control group . CONCLUSIONS Simple knee flexion and extension exercises ( WB and NWB ) performed over 8 weeks result ed in significant improvement in the WOMAC function scale and knee strength compared with the control group . NWB exercise alone may be sufficient enough to improve function and muscle strength . The additional benefit of WB exercise was improved position sense , which may enhance complex walking tasks ( walking on figure of 8 route and spongy surface ) Objective : To evaluate the short- and long-term effectiveness of exercise training in relation to pain , function and direct costs to health care systems attributable to hip osteoarthritis . Design : Prospect i ve , two-year r and omized controlled trial . Setting : An outpatient primary health care setting . Subjects : One hundred and twenty men and women aged from 55 to 80 , with radiologically diagnosed hip osteoarthritis with associated clinical symptoms . Interventions : The combined exercise and general practitioner ( GP ) care group received 12 supervised ( once per week ) exercise sessions at the baseline and four additional booster sessions one year later . Both groups received st and ard GP care . Main measures : The WOMAC Osteoarthritis Index , physical functioning score of R AND -36 ( SF-36 ) , the use and health care system costs of doctor visits and physiotherapy associated with hip osteoarthritis , number of total hip replacements , the use of analgesic and non-steroidal anti-inflammatory drugs ( NSAIDs ) , performance-based outcome scores and body mass index ( BMI ) . Results : There were no differences between the groups with respect to WOMAC hip pain , physical functioning score of R AND -36 , performance-based outcome scores or BMI . The effect of the exercise intervention  on WOMAC function was statistically significant at 6 months ( mean = −7.5 ; 95 % confidence interval ( CI ) −13.9 to −1.0 ; P = 0.02 ) and 18 months ( mean = −7.9 ; 95 % CI −15.3 to −0.4 ; P = 0.04 ) . There were no statistically significant differences in the total health care system costs between the groups . Conclusion : The mostly home-based exercise training programme provided in this study did not result in reduced hip pain over the two-year follow-up period OBJECTIVE To design an aquatic exercise ( AQE ) and l and -based exercise ( LBE ) program to enhance knee function and reduce body fat in patients with obesity and knee osteoarthritis and to investigate the effectiveness of AQE and LBE on body fat , functional fitness , and functional status . SETTING Outpatient clinic at a Seoul National University Bundang Hospital . PARTICIPANTS Obese patients with knee osteoarthritis were recruited from patients who visited the rehabilitation , orthopedic surgery , and geriatric outpatient clinics at the hospital . Study participants were limited to those who met the following criteria : body mass index more than 25 kg/m(2 ) , abdominal circumference more than 90 cm ( men ) or 85 cm ( women ) , clinical ly diagnosed osteoarthritis with Kellgren-Lawrence scale 2 or higher on radiographic studies , and independent ambulation state . METHODS Participants were r and omly allocated into 3 groups : AQE ( n = 26 ) , LBE ( n = 25 ) , and the control group ( n = 24 ) . Exercise interventions were conducted 3 times a week for 8 weeks . OUTCOME MEASURES Body fat analysis , brief pain inventory , Western Ontario and McMaster Universities ' osteoarthritis index , Short Form-36 question naire , and knee isokinetic tests were evaluated to assess changes in body fat composition , pain , physical function , and quality of life before and after the exercise program . RESULTS Although no significant difference was found in general characteristics among the 3 groups before exercise , body fat proportion in the AQE group decreased significantly ( mean + /- SD , from 34.4 + /- 4.7 to 33.3 + /- 4.7 ; P = .031 ) after intervention . The body mass index was slightly reduced after intervention , but it was not statistically significant . The AQE group showed significant improvements in pain , disability , and quality of life . Notably , the change in pain interference in the AQE group ( mean + /- SD , from 25.8 + /- 15.1 to 18.8 + /- 13.1 ; P = .009 ) was greater than that of the LBE group . Both exercise groups showed significant improvements in Western Ontario and McMaster Universities ' osteoarthritis index disability compared with the control group . CONCLUSIONS AQE had an advantage in controlling the interference with activity because of pain . AQE may be an effective tool for patients with obesity who have difficulties with active exercise due to knee osteoarthritis
target: Conclusion Exercises and PA promotion according to public health recommendations  for PA improved cardiovascular fitness , muscle strength and PA behaviour , with moderate effect sizes in people with SpA , RA and HOA/KOA .
background: Objective To evaluate the effectiveness of exercise and physical activity ( PA ) promotion on cardiovascular fitness , muscle strength , flexibility , neuromotor performance ( eg , balance ) and daily PA in people with rheumatoid arthritis ( RA ) , spondyloarthritis ( SpA ) and hip/knee osteoarthritis ( HOA/KOA ) .