Exercise Research: Arthritis

A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis.

Huang MH, Lin YS, Yang RC, Lee CL.
Department of Physical Medicine, Kaohsiung Medical University Hospital, Taiwan. maohuang@ms24.hinet.net Semin Arthritis Rheum. 2003 Jun;32(6):398-406.

Objective: To investigate the therapeutic effects of different muscle-strengthening exercises on the functional status of patients with knee osteoarthritis (OA).

Methods: One hundred thirty-two patients with bilateral knee OA (Altman Grade II) were sequentially divided into 4 random groups (GI to GIV). The patients in group I received isokinetic muscle-strengthening exercise, group II received isotonic muscle-strengthening exercise, group III received isometric muscle-strengthening exercise, and group IV acted as controls. The changes of muscle power of leg flexion and extension were measured with a Kinetic Communicator dynamometer, and patients’ functional status was evaluated by visual analogue scale, ambulation speed, and Lequesne index before and after treatment, and at the follow-up 1 year later.

Results: The results showed that the patients with OA in each treated group had significant improvement in pain reduction, disability reduction, and in walking speed after treatment and at follow-up when compared with their initial status. Isotonic exercise had the greatest effect on pain reduction after treatment, and fewer participants discontinued the treatment because of exercise knee pain. Isokinetic exercise caused the greatest increase of walking speed and decrease of disability after treatment and at follow-up. The greatest muscle-strength gain in 60 degrees /second angular velocity peak torques was found in the isokinetic and isotonic exercise groups. A significant muscle-strength gain in 180 degrees /second angular velocity peak torques was found only in the isokinetic group after treatment.

Conclusion and Relevance: Isotonic exercise is suggested for initial strengthening in patients with OA with exercise knee pain, and isokinetic exercise is suggested for improving joint stability or walking endurance at a later time.


Impact of an exercise and walking protocol on quality of life for elderly people with OA of the knee.

Dias RC, Dias JM, Ramos LR.
Physical Therapy Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. rosandi@metalink.com.br Physiother Res Int. 2003;8(3):121-30.

Purpose: The knee is the weight-bearing joint most commonly affected by osteoarthritis (OA). The symptoms of pain, morning stiffness of short duration and physical dysfunction in the activities of daily living (ADL) can have an effect on many aspects of health, affecting quality of life. Regular and moderate physical activity adapted to individuals’ life-styles and education, and joint protection strategies have been advocated as conservative management. The purpose of the present study was to assess the impact of an exercise and walking protocol on the quality of life of elderly people with knee OA.

Methods: The study design was a randomized controlled clinical trial. The subjects comprised 50 elderly people, aged 65 or more, with knee OA who had been referred to the geriatric outpatient unit for rehabilitation. Changes in severity of pain and quality of life were compared between a control group (CG) and an experimental group (EG). Both groups participated in an educational session and the EG also received a 12-week exercise and walking protocol. Both groups were assessed at baseline and after three and six months by an independent observer. The Lequesne Index of Knee OA Severity (LI), the Health Assessment Questionnaire (HAQ) and the Medical Outcomes Short-Form Health Survey (SF-36) were used as measurement instruments.

Results: In the CG, the measures of quality of life (SF-36), the HAQ and the LI between subjects did not yield statistically significant differences over the three measurement points. For the EG, there was a significant improvement in function, measured by HAQ, and decreasing OA symptom severity, measured by LI. For the SF-36 there were significant improvements in physical function, functional role limitation and pain. Comparisons between the groups showed statistically significant differences after three and six months for all measures, except for the SF-36 emotional domains.

Conclusion: The exercise protocol and walking programme had a positive effect on the quality of life of elderly individuals with knee OA.


Intervention programs for arthritis and other rheumatic diseases.

Brady TJ, Kruger J, Helmick CG, Callahan LF, Boutaugh ML. Health Educ Behav. 2003 Feb;30(1):44-63 Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA. tob9@cdc.gov

Disability reduction or prevention programs for people with arthritis and other rheumatic conditions reduce long-term pain and disability but reach only a fraction of their target audience. Few public health professionals are aware of these programs or their benefits. The objective of this study is to review and describe packaged (ready-to-use) arthritis self-management education and exerciselphysical activity programs that have had at least preliminary evaluation. Nine intervention programs (five self-management education programs, and four exercise/physical activity programs) met study criteria. Several of the packaged arthritis interventions reviewed help people with arthritis and other rheumatic conditions maximize their abilities and reduce pain, functional limitations, and other arthritis-related problems. Other packaged interventions show promise in reducing pain, disability, and depression and in increasing self-care behaviors, but they need to be evaluated more extensively.


Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial.

de Jong Z, Munneke M, Zwinderman AH, Kroon HM, Jansen A, Ronday KH, van Schaardenburg D, Dijkmans BA, Van den Ende CH, Breedveld FC, Vliet Vlieland TP, Hazes JM.
Comment in: • Arthritis Rheum. 2003 Sep;48(9):2393-5.
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. z.de_jong@lumc.nl Arthritis Rheum. 2003 Sep;48(9):2415-24.

Objective: There are insufficient data on the effects of long-term intensive exercise in patients with rheumatoid arthritis (RA). We undertook this randomized, 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 Questionnaire and the Health Assessment Questionnaire [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 Questionnaire 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.


Obesity and physical inactivity among Wisconsin adults with arthritis.

Mehrotra C, Chudy N, Thomas V.
Bureau of Chronic Disease Prevention and Health Promotion, Division of Public Health, Wisconsin Department of Health and Family Services, USA. mehroc@dhfs.state.wi.us WMJ. 2003;102(7):24-8.

Background: Arthritis is the leading cause of disability in Wisconsin, and affects approximately 34% of Wisconsin adults. Obesity is an established risk factor for arthritis; however, the relationship between arthritis and obesity has not been well characterized at the population level in Wisconsin.

Objective: Describe the relationship between arthritis, obesity, physical inactivity, and efforts to lose weight among Wisconsin adults.

Methods: Wisconsin Behavioral Risk Factor Surveillance System 2000-2001. Arthritis was defined by either doctor diagnosis or self-reported chronic joint symptoms.

Results: Overall, 36% of respondents had arthritis. Among adults with arthritis, 28% were obese (BMI>30) compared to 16% without arthritis. The prevalence of leisure time physical inactivity was substantially higher among those with arthritis compared to those without arthritis (27.8% vs. 19.2%). Although prevalence of obesity was higher among those with arthritis, only 46% of adults with arthritis made an effort to lose weight.

Conclusion: A high proportion of adults with arthritis are obese and are physically inactive, even though studies have shown that weight loss and regular physical activity relieve arthritis symptoms. Efforts should be made to promote weight loss and physical activities among adults with arthritis.


The Arthritis, Diet and Activity Promotion Trial (ADAPT): design, rationale, and baseline results.

Miller GD, Rejeski WJ, Williamson JD, Morgan T, Sevick MA, Loeser RF, Ettinger WH, Messier SP; ADAPT Investigators.
Department of Health and Exercise Science Wake Forest University, Winston-Salem, North Carolina 27109, USA. millergd@wfu.edu Control Clin Trials. 2003 Aug;24(4):462-80.

Osteoarthritis (OA) of the knee leads to restrictions of physical activity and ability to perform activities of daily living. Obesity is a risk factor for knee OA and it appears to exacerbate knee pain and disability. The Arthritis, Diet, and Activity Promotion Trial (ADAPT) was developed to test the efficacy of lifestyle behavioral changes on physical function, pain, and disability in obese, sedentary older adults with knee OA. This controlled trial randomized 316 sedentary overweight and obese older adults in a two-by-two factorial design into one of four 18-month duration intervention groups: Healthy Lifestyle Control; Dietary Weight Loss; Structured Exercise; or Combined Exercise and Dietary Weight Loss. The weight-loss goal for the diet groups was a 5% loss at 18 months. The intervention was modeled from principles derived from the group dynamics literature and social cognitive theory. Exercise training consisted of aerobic and strength training for 60 minutes, three times per week in a group and home-based setting. The primary outcome measure was self-report of physical function using the Western Ontario and McMaster University Osteoarthritis Index. Other measurements included timed stair climb, distance walked in 6 minutes, strength, gait, knee pain, health-related quality of life, knee radiographs, body weight, dietary intake, and cost-effectiveness of the interventions. We report baseline data stratified by level of overweight and obesity focusing on self-reported physical function and physical performance tasks. The results from ADAPT will provide approaches clinicians should recommend for behavioral therapies that effectively reduce the incidence of disability associated with knee OA.