Resistance Training for Arthritis Patients

Population Description- Rheumatory Arthritis is a form of inflammatory arthritis and an autoimmune disease, where the immune system, which is supposed to protect our body from outside cells like viruses and bacteria, instead attacks the body's own tissues. In RA the body attacks the synovium, the thin membrane that lines the joints. After being attacked the fluid builds up in the joints causing pain and systemic inflammation, which means it can happen throughout the body. Rheumatoid arthritis is an incurable systemic disease. RA patients may have intermittent pain bouts that are intense in pain and inflammation, called flares. Patients may experience remissions, where the disease is not active or have no symptoms. The best way to treat this disease is to diagnose it early and start progressive treatments to put the disease into remission, which will help spare joints, organs, and prevent disability.

Symptoms of the disease are different from person to person and can change on a day to day basis. Patients may notice warmth in the joints and a decreased range of motion, inflammation, swelling and pain, making daily activities harder to perform and cause great discomfort. The symptoms of RA are classified as symmetrical, so if one joint on one side of the body is swollen, the joint on the other side will be affected. Since the disease is systemic, patients are likely to feel fatigued and may become anemic, losing appetite and run a low fever. RA is a debilitating disease which affects joints, tendons, ligaments, and has even been shown to wear out ends of bones. The most common outcome is joint deformity and drastically reduced range of motion. Patients may develop lumps of tissue that form under the skin, often over bony areas exposed to pressure, called rheumatoid nodules. Over time, inflammation found in RA patients can also affect numerous organs and systems in the body. Who are these RA patients? An estimated 1.3 million people in the US have RA. That's approximately 1% of the nations adult population. Women are almost 3 times as likely to get diagnosed with this disease. In women, RA most commonly begins between the ages of 30-60. As for men, it tends to occur later in life. However, even older teens and people in their 20's have been diagnosed with RA. As many as 300,000 children have been diagnosed with similar inflammatory arthritis called juvenile arthritis. This occurs in all ethnic groups in every part of the world.

The cause of RA is still unknown. Most scientists agree that the combination of environment and genetics is to blame for the onset of the disease. More interesting is that some researchers have found genetic markers that cause a tenfold greater probability of developing RA. These genes are closely related with the immune system, chronic inflammation, or the development and progression of RA. Though the genetic markers have a probability to cause RA, people with the genetic markers don't necessarily develop the disease and there are people with RA who don't possess the genetic markers. Researchers are also investigating infectious agents, such as bacteria or viruses, which may trigger the disease in someone with a genetic propensity for it(1). While other researchers are also investigating female hormones since the majority of RA patients are women (70%). Smoking and emotional stressors or how the body reacts to these stressors may play a very important role in developing the disease. Smoking particularly not only boosts the risk of developing RA among people with a specific gene, it can also increase the disease's severity and reduce the effectiveness of treatment.

Since RA is a debilitating disease it is important to make lifestyle changes early to keep progression of the disease to a minimum. Engaging in moderate physically activity on a regular basis has been shown to help decrease fatigue, strengthen muscles, bones, tendons, ligaments, increase flexibility, stamina, and overall sense of well-being. To get the best results, you will want a well rounded routine that should include strength training, cardiovascular, and flexibility training. In you well rounded routine you should focus on overall health, weight control, muscle strength, and energy levels. Though diet does not seem to provide much relief of the symptoms, it has been shown that a wide variety of foods and a handful of supplements may have benefits for reducing inflammation or have preventative effects.

Literature Review- In this study seventy patients were chosen with early RA randomly to be part of the strength training or the control group. By the end of the reexamination period only 59 were left. The purpose of this study was to find out the long-term effects of modified resistance training to people diagnosed with RA. Patients in the strength training group were instructed to do home based training for 24 months. The training included all muscle groups including arms, legs, and trunk. They used rubber bands and dumbbells for their resistance. They were told to exercise twice a week using 50 to 70% of their repetition max, 2 sets each and 8-12 repetitions. The intensity and techniques were checked every 6 months. The control group was told to perform range of motion exercises and stretches twice a week while both groups were encouraged to engage in recreational activities 2-3 times a week. The maximum unilateral concentric strength of the knee extensors was measure by using the David 200 dynamometer. By using an isometric strain gauge dynamometer the maximal isometric trunk flexion and extension forces were measured. Using the dynamometer the isometric grip strength was measured (Haekkinen 2001).

The results were that during the 2-year strength-training period the patients averaged working out about 1.4-1.5 times per week. They were required to keep a log and mailed them to their supervisors every second month. The knee extension strength went up 59% and 31% for the experimental group and control group respectively. At the 5 year follow up the values were 49% and 29% respectively. The grip strength increased to 50% and 24% after 2 years and after five years it was at 50% and 34% for the experimental group and control group respectively. The trunk extension and flexion increased to 19% and 24% during training and 1% and 20% in the control group. After 5 years improvements compared to baseline for the experimental group were 16% and 25% and 0% and 18% for the control group. Strength increases were in favor of the strength-training group. The improvements were also sustained for 3 years after the 2-year training program (Haekkinen 2001).

This study was a randomized control style. 28 people were chosen to perform progressive resistance training (PRT) or a range of movement exercises at home. This was the control group. 13 people did the resistance