According to the Centers for Disease Control, Arthritis is the most common chronic health condition in the US with an estimated 52.5 million adults reporting physician-diagnosed arthritis. As the population ages, this number is expected to increase to 67 million by 2030.
Arthritis is primarily thought of as a disease of the joints. However, today this term is used more generically in medicine to characterize a group of more than 100 different so called ‘rheumatic’ diseases – all of which cause pain, stiffness, and swelling in the joints but can also impact other supporting body structures and systems. For the informative purpose of this article, we are going to focus on one of those diseases, Rheumatoid Arthritis (RA).
Impact of RA
The degree and prevalence of RA symptoms is of great concern to patients and medical practitioners alike because, in addition to diminished function and increased disability, RA is linked to adverse changes in body composition, including loss of muscle mass/muscle wasting, whether through cachexia or sarcopenia. This, in turn, is associated with impaired immune and pulmonary function, osteoporosis, glucose intolerance, and increased mortality. RA can also have systemic effects, impacting e.g. the cardiovascular or respiratory systems. This exacerbates already present symptoms and results in further limitations of activities of daily activities and leisure time activity. Both of these contribute to the physical and mental well-being of patients with RA and have considerable impact on maintaining and creating social relationships. Seventy five percent of patients with RA report altered leisure-time activities in the 8 years after disease onset.
Current Treatment Options for RA
If complete remission of RA cannot be achieved, Best Practice management goals are to control disease activity, alleviate pain, maintain function for activities of work/daily living and maximize quality of life. Exercise, and particularly strength training has, potentially, a major part to play in achieving these goals. However, conventional treatment has been, almost exclusively, pharmaceutical prescription.
Physical therapy and occupational therapy may help the patient who is compromised in activities of daily living. Regular participation in dynamic and even aerobic conditioning exercise programs improves joint mobility, muscle strength, aerobic fitness and function, and psychological well being without increasing fatigue or joint symptoms Treating RA with Strength Training Despite the fact that physicians do not often recommend strength training for RA patients, an increasing number of studies over more than a decade have reported that this mode of exercise is not only safe and effective, but in many cases, superior to conventionally prescribed exercise. Recent systematic reviews of the scientific literature (Hurley et al., 2011, Baillet et al., 2012) have compiled and presented compelling evidence that moderate to high intensity strength training is both safe and effective. It produces clinically significant reductions of disability, together with clinically significant increases in strength, functional capacity, pain, morning stiffness and overall health status. These reviews include studies that have also reported an anti-inflammatory effect of strength training, as well as evidence that suggests strength training decreases cardiovascular risk factors, possibly to a greater extent than aerobic exercise.
In one study, Lemmey et al, (2009) reported significant increases in strength, muscle mass, physical function and habitual daily activities following 24 weeks of twice per week of high intensity strength training (Referred to in the study as ‘progressive resistance exercise’, or PRE). No changes were found in a control group. Exercises included leg press, chest press, leg extension, seated rowing, leg curl, triceps extension, standing calf raises, and bicep curl. All exercises were performed for 1-2 sets, commencing at ~60% and progressing to ~80% of maximum over the study time period.
NOTE: This PRE approach is very similar to our ActiveRx Strength Regen and Rehab protocols.
The safety and applicability of high intensity exercise programs for patients with RA has long been questioned because of presumed harmful effects on joints, specifically, and disease activity in general. Consequently conventional programs utilizing low intensity, low impact isometric, or rubber band exercises, and ‘range of motion’ exercises were typically advocated. However, a growing body of research conducted over more than a decade has reported that high intensity PRE programs are more effective at increasing physical function and muscle strength in patients with RA compared with conventional exercise prescriptions. Such programs have also been reported to have no detrimental effects on disease activity in selected patient groups. Although low intensity and range of movement programs have been shown to be somewhat beneficial to patients with RA, high intensity PRE programs have additional potential benefits of importance to RA patients. These include optimal increases in strength, muscle mass, physical function, and bone mineral density, with consequent increases in quality of life and social and emotional wellbeing.
Recommendations for ActiveRx
The implications of this information are of major importance to ActiveRx. Both our Strengtherapy Rehab Plan of Care and our Strengtherapy Regen Sessions are in line with current research on optimal treatments for RA. This is a highly valuable connection point with both physicians and the media.
Our recommended process can be summarized as follows: after diagnosis and evaluation of RA, patients are assigned to a PRE-oriented Plan of Care. On completion, they are offered the choice of graduating to our Strengtherapy Regen Sessions. Through the advocacy of the entire Strengtherapy Center team, members will, by this time, have been made aware that continuing with our process is the optimal path to ameliorating their symptoms. Graduation rates will increase accordingly. In addition we will collaborate with the member’s physician where necessary so that progress, both medical and functional is best monitored and coordinated. Our PT/PTA and Strengtherapy Coaches will always be present to oversee safety and effectiveness.
To learn more about the benefits of strength training as a treatment for osteoporosis, call 352-430-0473.