Exercise as it relates to Disease/The Benefits of Strength and Endurance Training for Individuals with Rheumatoid Arthritis

What Is The Background To The Research?
Rheumatoid Arthritis is a chronic inflammatory auto immune disease that causes joint pain and is prevalent in approximately 2-3% of the adult population. It causes damage to the musculoskeletal system, reduces joint function and can also lead to muscle loss and reduce muscle strength.

The purpose of this study was to evaluate the effects of combined strength and endurance training on disease activity and functional ability in patients with Rheumatoid Arthritis and also to investigate the benefits of a 6-month supervised combined training program on muscle strength, cardio-respiratory fitness and body composition.

Where Is The Research From?
This study was featured in the Clinical Rheumatology - Journal of the International League of Associations for Rheumatology.

What Kind Of Research Was This?
This study was a 6-month fitness training study that involved two different groups. Both groups had Rheumatoid Arthritis although one group completed a training program over the 6 months and the other group was a control group.

What Did The Research Involve?
The research in this study involved 40 patients from the Rheumatology Unit in the Wilhelminen Hospital in Vienna.

Each individual was examined immediately before and after each training session. These examinations included:

Measurements

 * Medical History
 * Clinical Health Status
 * Functional Ability
 * Ergometry
 * Dynamometry
 * Anthropometric Measures

Training Program
The 40 patients were divided into two groups of 20. One group was considered a control group whilst the other group was the 'combined strength and endurance training program' group.

Combined Strength and Endurance Training Program Group
This group completed a 6-month combined strength and endurance training program that involved two sessions a week on non-consecutive days. A ten minute warm up period was performed before each training session that involved stretching exercises.

Strength Training The first two weeks of strength training were performed with minimal weight in order for the individuals to learn correct technique and allow their bodies to adapt to the new forms of exercise. From the third week the exercises focused on muscle hypertrophy. This was done by assigning two sets of exercises per muscle group each week. Each set had 10-15 reps with the weight set as 70% of their 1RM until they reached severe fatigue. Once the individuals were able to complete 15 repetitions comfortably, the weight is then increased until the athlete could complete ten repetitions. The amount of sets were increased every 6 weeks from two sets up to four sets. The training program consisted of exercises that targeted major muscle groups. Upper body exercises included; bench press, chest cross, shoulder press, pull downs, bicep curls, tricep extensions as well as abdominal exercises. A leg press was used for lower body strength.

Endurance Training

The endurance training session was completed on a cycle ergometer with the individuals completing two 15 minute sessions a week for the first 4 weeks. The sessions from the 5th week onwards were increased by 5 minutes every 4 weeks. During the last 4 weeks, the total session time (not including warm up and cool down) added up to 80 minutes. The individuals heart rate was monitored throughout the entire session. The training rate was controlled by the heart rate whilst the individual is at 60% of their VO2max.

Control Group
The control group was asked to complete some stretching exercises twice a week in order to maintain their joint mobility. This group was permitted to continue with any recreational exercise they would like to complete as long as it was not strength training and systematic endurance training.

What Were The Basic Results?
The results indicated that disease activity improved with the training program although the change was not considered a significant. The individuals commented on a significant reduction in pain along with an improvement in general health and a 16% improvement in functional capacity. Cardio-respiratory endurance (maximum workload) improved by 10%, leg press maximum strength increased by 22%, bench press maximum strength improved by 11% and their bench pull improved by 9%. The training group also showed changes in their body composition. The individuals had a significant reduction of 1.6 kg in body weight. The training groups lean body mass increased whilst their percentage of body fat decreased significantly in comparison to the control group.

How Did The Researchers Interpret The Results?
The researchers concluded that long term combined training is considered effective in reducing disease activity and pain as well as increased strength shows decreases in pain and increased function. They also interpreted that as C-Reactive Protein (CRP) may play a role in the atherosclerotic process, the decrease of 54% of CRP which may indicate reduced inflammation in the trained sites. These results correlate to the systematic review by de Carvalho et al. which also showed a reduction in CRP levels after strength training.

What Conclusions Should Be Taken Away From This Research?
The aim of the study was to assess whether combined strength and endurance training would effect disease activity and functional ability. The results of the study show that a 6-month strength and endurance program is beneficial for those with Rheumatoid Arthritis in terms of joint pain, mobility and also body composition and functional ability. Engaging in regular strength and endurance training is an important element in relieving joint pain and inflammation for individuals that have Rheumatoid Arthritis.

What Are The Implications Of This Research?
The study had several implications, which may have had a significant impact on the results. These limitations include;
 * The limited number of subjects
 * There was no follow up control data for the outcome measures
 * The study focused more on pre/post data comparison and did not focus on comparisons between the two groups
 * The study was limited as some individuals had to be excluded due to severe disability and also those with active Rheumatoid Arthritis which thus means that the results can not be generalised to the sub groups