THURSDAY, Sept. 25, 2003 (HealthDayNews) --Regular, intensive exercise for patients with rheumatoid arthritis builds muscle strength and aerobic capacity, improves the ability to do daily tasks and fosters a sense of emotional well-being.
That's the conclusion of a new study by Dutch researchers who tracked 300 people with rheumatoid arthritis (RA) for two years. About half the patients participated in a one-hour exercise regimen twice weekly; the rest received traditional treatment, including physical therapy, if prescribed by their physicians.
The findings, appearing in the latest issue of Arthritis & Rheumatism, suggest high-intensity exercise programs can benefit many RA patients, says researcher Dr. Thea P.M. Vliet Vlieland of Leiden University Medical Center.
"The positive effects on muscle strength and aerobic capacity could be translated into an improvement in the activities of daily living, and this is what really makes a difference in your life," Vlieland says.
Despite the benefits of exercise, many people with rheumatoid arthritis are wary of strenuous activity. And physicians often advise patients against intensive exercise, in part because of fears of damaging large joints and worsening inflammation, the researchers say.
But the study found that prolonged, rigorous exercise had no significant detrimental effect on weight-bearing joints, except in cases of patients who already had considerable large joint damage.
These patients can still exercise, but should have individually designed regimens that spare the damaged joints, says the study, which was led by Dr. Zuzana de Jong, a rheumatologist at Leiden University Medical Center.
Vlieland stresses that before beginning an exercise program, all RA patients should receive their doctor's advice.
Rheumatoid arthritis affects about 2.1 million Americans, mostly women, according to the Arthritis Foundation. It can cause painful and debilitating inflammation and deformities in joints and tendons. RA is triggered by an autoimmune malfunction, and the disease is most often treated with medicines to reduce the inflammation.
For years, conventional wisdom in medical circles had suggested that people with RA should not exercise because doing so could damage joints, the Arthritis Foundation says. But more recent research has shown exercise is an "essential tool" in managing arthritis, the foundation says.
The Dutch researchers found almost all the patients in the exercise group stuck with the program. Of the 150 patients who started the program, all but 14 attended exercise classes for the full two years.
"The majority of patients enjoyed participating in the high-intensity exercise program very much," Vlieland says.
Indeed, she adds, many of the patients reported having more physical activity outside of the exercise program.
Each exercise session consisted of 20 minutes of bicycling; 20 minutes of exercises to build muscle strength, endurance and joint mobility; and 20 minutes of sports such as badminton, volleyball, soccer and basketball. Participants also had 15 minutes of required warm-up and post-exercise "cool-down."
Participants in both groups -- with a median age of 54 -- had similar RA characteristics. They were evaluated at the start of the study and every six months for functional ability, damage to shoulders, elbows, hips, knees and ankles, and general health and emotional well-being.
The researchers say they found no significant difference between the two groups in RA symptoms such as joint swelling or pain or in use of anti-rheumatic drugs and painkillers.
Compared with patients who did not exercise, those who did had greater improvement in functional ability -- from walking up stairs to more complex tasks -- during both years, the researchers found. Those who exercised also had significant improvement in physical capacity during the first year, but the gains leveled off in the second year.
The exercise group also fared better emotionally, as measured by responses to questions about depressive feelings and anxiety, the researchers say.
Other experts share the study's upbeat view of exercise for RA patients.
"Regular exercise is known to reduce arthritis-related symptoms and improve function," says Joan C. Rogers, a professor and chairwoman of the University of Pittsburgh's Department of Occupational Therapy.
"By keeping up with favorite activities such as gardening, patients can improve their strength, range of motion and balance and also relieve stress," she says.
For more on exercise and arthritis, visit the Arthritis Foundation or the University of Washington Department of Orthopaedics and Sports Medicine.