The Effects of a 16-week Individualized, Intensive Strength Training Program for Patients with Rheumatoid Arthritis

Abstract

Objective. This study was designed to test the hypotheses that a 16-week, individualized, intensive strength training program in rheumatoid arthritis (RA) patients taking Remicade™ (Infliximab) would improve strength, body composition, disease activity, physical function, pain and quality of life outcomes , as compared to RA patients on Remicade™ with no strength training program. Methods. Twenty-four patients with RA taking Remicade™, participated in a randomized, controlled trial. The exercise group carried out a three time a week strength training program, with the control group continuing standard of care. Assessments were completed at baseline, 8-week, and 16-week time points . Maximal strength, physical function, disease activity, body composition, quality of life, and pain were measured with active tests and via questionnaires. Patients also completed exit evaluations on their satisfaction with the study. Results. Highly significant strength gains were seen in the exercise group according to 3 repetition maximums (3RMs) (p<.01), as well as in all 8 exercises performed in the gym (p<.01). The mean exercise attendance for the 16 weeks was 82.0±10.6%. Compared to the control group, there was a significant increase in right hand grip strength (p<.1), and lean tissue in the trunk (p<.01). Significant improvements were also seen in physical function according to 50-foot walk time (p<.01), the Arthritis Impact Measurement Scale 2 (AIMS2) hand and arm function subscales (p<.05), and the Medical Outcomes Study Short Form 36 (MOS SF-36) (p<.1), as compared to controls. The exercise group showed clinically important differences via the Health Assessment Questionnaire Disability Index (HAQ DI), with a mean change of -0.41±0.42. Significant reductions in pain, as measured by the Pain Visual Analogue Scale (VAS), also occurred (p<.1). The individualization of the strength training program and personal attention received by the patients was critical to the success of the study. Patient satisfaction with the study was high, with limitations due primarily to funding constraints. Conclusion. This 16-week high intensity strength training program led to statistically significant improvements in strength, lean soft tissue, disease activity, function, pain and quality of life in this RA population. No detrimental effects on the disease were seen in this study.