Skip to main content
NCBI home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1996 Nov;55(11):798–805. doi: 10.1136/ard.55.11.798

Comparison of high and low intensity training in well controlled rheumatoid arthritis. Results of a randomised clinical trial.

C H van den Ende 1, J M Hazes 1, S le Cessie 1, W J Mulder 1, D G Belfor 1, F C Breedveld 1, B A Dijkmans 1
PMCID: PMC1010314  PMID: 8976635

Abstract

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 randomly 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.

Full text

PDF
798

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  2. Beals C. A., Lampman R. M., Banwell B. F., Braunstein E. M., Albers J. W., Castor C. W. Measurement of exercise tolerance in patients with rheumatoid arthritis and osteoarthritis. J Rheumatol. 1985 Jun;12(3):458–461. [PubMed] [Google Scholar]
  3. Branch L. G. Health practices and incident disability among the elderly. Am J Public Health. 1985 Dec;75(12):1436–1439. doi: 10.2105/ajph.75.12.1436. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Ekblom B., Lövgren O., Alderin M., Fridström M., Sätterström G. Physical performance in patients with rheumatoid arthritis. Scand J Rheumatol. 1974;3(3):121–125. doi: 10.3109/03009747409097136. [DOI] [PubMed] [Google Scholar]
  5. Ekdahl C., Andersson S. I., Moritz U., Svensson B. Dynamic versus static training in patients with rheumatoid arthritis. Scand J Rheumatol. 1990;19(1):17–26. doi: 10.3109/03009749009092618. [DOI] [PubMed] [Google Scholar]
  6. Ferraz M. B., Oliveira L. M., Araujo P. M., Atra E., Walter S. D. EPM-ROM Scale: an evaluative instrument to be used in rheumatoid arthritis trials. Clin Exp Rheumatol. 1990 Sep-Oct;8(5):491–494. [PubMed] [Google Scholar]
  7. Fitzpatrick R., Ziebland S., Jenkinson C., Mowat A., Mowat A. A comparison of the sensitivity to change of several health status instruments in rheumatoid arthritis. J Rheumatol. 1993 Mar;20(3):429–436. [PubMed] [Google Scholar]
  8. Fries J. F., Spitz P., Kraines R. G., Holman H. R. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–145. doi: 10.1002/art.1780230202. [DOI] [PubMed] [Google Scholar]
  9. Gardiner P. V., Sykes H. R., Hassey G. A., Walker D. J. An evaluation of the Health Assessment Questionnaire in long-term longitudinal follow-up of disability in rheumatoid arthritis. Br J Rheumatol. 1993 Aug;32(8):724–728. doi: 10.1093/rheumatology/32.8.724. [DOI] [PubMed] [Google Scholar]
  10. Hansen T. M., Hansen G., Langgaard A. M., Rasmussen J. O. Longterm physical training in rheumatoid arthritis. A randomized trial with different training programs and blinded observers. Scand J Rheumatol. 1993;22(3):107–112. doi: 10.3109/03009749309099253. [DOI] [PubMed] [Google Scholar]
  11. Harkcom T. M., Lampman R. M., Banwell B. F., Castor C. W. Therapeutic value of graded aerobic exercise training in rheumatoid arthritis. Arthritis Rheum. 1985 Jan;28(1):32–39. doi: 10.1002/art.1780280106. [DOI] [PubMed] [Google Scholar]
  12. Hsieh L. F., Didenko B., Schumacher H. R., Jr, Torg J. S. Isokinetic and isometric testing of knee musculature in patients with rheumatoid arthritis with mild knee involvement. Arch Phys Med Rehabil. 1987 May;68(5 Pt 1):294–297. [PubMed] [Google Scholar]
  13. Häkkinen A., Hannonen P., Häkkinen K. Muscle strength in healthy people and in patients suffering from recent-onset inflammatory arthritis. Br J Rheumatol. 1995 Apr;34(4):355–360. doi: 10.1093/rheumatology/34.4.355. [DOI] [PubMed] [Google Scholar]
  14. Kirsteins A. E., Dietz F., Hwang S. M. Evaluating the safety and potential use of a weight-bearing exercise, Tai-Chi Chuan, for rheumatoid arthritis patients. Am J Phys Med Rehabil. 1991 Jun;70(3):136–141. doi: 10.1097/00002060-199106000-00005. [DOI] [PubMed] [Google Scholar]
  15. Liang M. H., Larson M. G., Cullen K. E., Schwartz J. A. Comparative measurement efficiency and sensitivity of five health status instruments for arthritis research. Arthritis Rheum. 1985 May;28(5):542–547. doi: 10.1002/art.1780280513. [DOI] [PubMed] [Google Scholar]
  16. Lyngberg K. K., Ramsing B. U., Nawrocki A., Harreby M., Danneskiold-Samsøe B. Safe and effective isokinetic knee extension training in rheumatoid arthritis. Arthritis Rheum. 1994 May;37(5):623–628. doi: 10.1002/art.1780370504. [DOI] [PubMed] [Google Scholar]
  17. Lyngberg K., Danneskiold-Samsøe B., Halskov O. The effect of physical training on patients with rheumatoid arthritis: changes in disease activity, muscle strength and aerobic capacity. A clinically controlled minimized cross-over study. Clin Exp Rheumatol. 1988 Jul-Sep;6(3):253–260. [PubMed] [Google Scholar]
  18. Minor M. A., Hewett J. E., Webel R. R., Anderson S. K., Kay D. R. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum. 1989 Nov;32(11):1396–1405. doi: 10.1002/anr.1780321108. [DOI] [PubMed] [Google Scholar]
  19. Minor M. A., Hewett J. E., Webel R. R., Dreisinger T. E., Kay D. R. Exercise tolerance and disease related measures in patients with rheumatoid arthritis and osteoarthritis. J Rheumatol. 1988 Jun;15(6):905–911. [PubMed] [Google Scholar]
  20. Mor V., Murphy J., Masterson-Allen S., Willey C., Razmpour A., Jackson M. E., Greer D., Katz S. Risk of functional decline among well elders. J Clin Epidemiol. 1989;42(9):895–904. doi: 10.1016/0895-4356(89)90103-0. [DOI] [PubMed] [Google Scholar]
  21. Nordesjö L. O., Nordgren B., Wigren A., Kolstad K. Isometric strength and endurance in patients with severe rheumatoid arthritis or osteoarthrosis in the knee joints. A comparative study in healthy men and women. Scand J Rheumatol. 1983;12(2):152–156. doi: 10.3109/03009748309102902. [DOI] [PubMed] [Google Scholar]
  22. Noreau L., Martineau H., Roy L., Belzile M. Effects of a modified dance-based exercise on cardiorespiratory fitness, psychological state and health status of persons with rheumatoid arthritis. Am J Phys Med Rehabil. 1995 Jan-Feb;74(1):19–27. doi: 10.1097/00002060-199501000-00004. [DOI] [PubMed] [Google Scholar]
  23. Perlman S. G., Connell K. J., Clark A., Robinson M. S., Conlon P., Gecht M., Caldron P., Sinacore J. M. Dance-based aerobic exercise for rheumatoid arthritis. Arthritis Care Res. 1990 Mar;3(1):29–35. [PubMed] [Google Scholar]
  24. Semble E. L., Loeser R. F., Wise C. M. Therapeutic exercise for rheumatoid arthritis and osteoarthritis. Semin Arthritis Rheum. 1990 Aug;20(1):32–40. doi: 10.1016/0049-0172(90)90092-t. [DOI] [PubMed] [Google Scholar]
  25. Siegert C. E., Vleming L. J., Vandenbroucke J. P., Cats A. Measurement of disability in Dutch rheumatoid arthritis patients. Clin Rheumatol. 1984 Sep;3(3):305–309. doi: 10.1007/BF02032335. [DOI] [PubMed] [Google Scholar]
  26. Stenström C. H., Lindell B., Swanberg E., Swanberg P., Harms-Ringdahl K., Nordemar R. Intensive dynamic training in water for rheumatoid arthritis functional class II--a long-term study of effects. Scand J Rheumatol. 1991;20(5):358–365. doi: 10.3109/03009749109096812. [DOI] [PubMed] [Google Scholar]
  27. Sutej P. G., Hadler N. M. Current principles of rehabilitation for patients with rheumatoid arthritis. Clin Orthop Relat Res. 1991 Apr;(265):116–124. [PubMed] [Google Scholar]
  28. Taal E., Jacobs J. W., Seydel E. R., Wiegman O., Rasker J. J. Evaluation of the Dutch Arthritis Impact Measurement Scales (DUTCH-AIMS) in patients with rheumatoid arthritis. Br J Rheumatol. 1989 Dec;28(6):487–491. doi: 10.1093/rheumatology/28.6.487. [DOI] [PubMed] [Google Scholar]
  29. Vliet Vlieland T. P., van den Ende C. H., Breedveld F. C., Hazes J. M. Evaluation of joint mobility in rheumatoid arthritis trials: the value of the EPM-range of motion scale. J Rheumatol. 1993 Dec;20(12):2010–2014. [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES