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Ann Rheum Dis. 2004 November; 63(11): 1399–1405. doi: 10.1136/ard.2003.015826. | PMCID: PMC1754798 |
Long term high intensity exercise and damage of small joints in rheumatoid arthritis Z de Jong, M Munneke, A Zwinderman, H Kroon, K Ronday, W Lems, B Dijkmans, F Breedveld, V Vliet, J Hazes, and T Huizinga Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands. Email: z.de_jong/at/lumc.nl Objective: To investigate the effect of long term high intensity weightbearing exercises on radiological damage of the joints of the hands and feet in patients with rheumatoid arthritis (RA). Methods: Data of the 281 completers of a 2 year randomised controlled trial comparing the effects of usual care physical therapy (UC) with high intensity weightbearing exercises were analysed for the rate of radiological joint damage (Larsen score) of the hands and feet. Potential determinants of outcome were defined: disease activity, use of drugs, change in physical capacity and in bone mineral density, and attendance rate at exercise sessions. Results: After 2 years, the 136 participants in high intensity weightbearing exercises developed significantly less radiological damage than the 145 participants in UC. The mean (SD) increase in damage was 3.5 (7.9) in the exercise group and 5.7 (10.2) in the UC group, p = 0.045. Separate analysis of the damage to the hands and feet suggests that this difference in rate of increase of damage is more pronounced in the joints of the feet than in the hands. The rate of damage was independently associated with less disease activity, less frequent use of glucocorticoids, and with an improvement in aerobic fitness. Conclusion: The progression of radiological joint damage of the hands and feet in patients with RA is not increased by long term high intensity weightbearing exercises. These exercises may have a protective effect on the joints of the feet. The Full Text of this article is available as a PDF (126K). These references are in PubMed. This may not be the complete list of references from this article. - Laan RF, van Riel PL, van de Putte LB. Bone mass in patients with rheumatoid arthritis. Ann Rheum Dis. 1992 Jun;51(6):826–832. [PubMed]
- Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK. Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum. 2000 Mar;43(3):522–530. [PubMed]
- Laan RF, Buijs WC, Verbeek AL, Draad MP, Corstens FH, van de Putte LB, van Riel PL. Bone mineral density in patients with recent onset rheumatoid arthritis: influence of disease activity and functional capacity. Ann Rheum Dis. 1993 Jan;52(1):21–26. [PubMed]
- Gough AK, Lilley J, Eyre S, Holder RL, Emery P. Generalised bone loss in patients with early rheumatoid arthritis. Lancet. 1994 Jul 2;344(8914):23–27. [PubMed]
- Saario R, Sonninen P, Möttönen T, Viikari J, Toivanen A. Bone mineral density of the lumbar spine in patients with advanced rheumatoid arthritis. Influence of functional capacity and corticosteroid use. Scand J Rheumatol. 1999;28(6):363–367. [PubMed]
- Lodder Mariette C, Haugeberg Glenn, Lems Willem F, Uhlig Till, Orstavik Ragnhild E, Kostense Piet J, Dijkmans Ben A C, Kvien Tore K, Woolf Anthony D. Radiographic damage associated with low bone mineral density and vertebral deformities in rheumatoid arthritis: the Oslo-Truro-Amsterdam (OSTRA) collaborative study. Arthritis Rheum. 2003 Apr 15;49(2):209–215. [PubMed]
- Forsblad D'Elia H, Larsen A, Waltbrand E, Kvist G, Mellström D, Saxne T, Ohlsson C, Nordborg E, Carlsten H. Radiographic joint destruction in postmenopausal rheumatoid arthritis is strongly associated with generalised osteoporosis. Ann Rheum Dis. 2003 Jul;62(7):617–623. [PubMed]
- Gough A, Sambrook P, Devlin J, Huissoon A, Njeh C, Robbins S, Nguyen T, Emery P. Osteoclastic activation is the principal mechanism leading to secondary osteoporosis in rheumatoid arthritis. J Rheumatol. 1998 Jul;25(7):1282–1289. [PubMed]
- Romas E, Gillespie MT, Martin TJ. Involvement of receptor activator of NFkappaB ligand and tumor necrosis factor-alpha in bone destruction in rheumatoid arthritis. Bone. 2002 Feb;30(2):340–346. [PubMed]
- Redlich Kurt, Hayer Silvia, Ricci Romeo, David Jean-Pierre, Tohidast-Akrad Makiyeh, Kollias George, Steiner Günter, Smolen Josef S, Wagner Erwin F, Schett Georg. Osteoclasts are essential for TNF-alpha-mediated joint destruction. J Clin Invest. 2002 Nov;110(10):1419–1427. [PubMed]
- de Jong Zuzana, Munneke Marten, Zwinderman Aeilko H, Kroon Herman M, Jansen Annemarie, Ronday Karel H, van Schaardenburg Dirkjan, Dijkmans Ben A C, Van den Ende Cornelia H M, Breedveld Ferdinand C, Vliet Vlieland Theodora P M, Hazes Johanna M W. Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial. Arthritis Rheum. 2003 Sep;48(9):2415–2424. [PubMed]
- de Jong Zuzana, Munneke Marten, Lems Willem F, Zwinderman Aeilko H, Kroon Herman M, Pauwels Ernest K J, Jansen Annemarie, Ronday Karel H, Dijkmans Ben A C, Breedveld Ferdinand C, Vliet Vlieland Theodora P M, Hazes Johanna M W. Slowing of bone loss in patients with rheumatoid arthritis by long-term high-intensity exercise: results of a randomized, controlled trial. Arthritis Rheum. 2004 Apr;50(4):1066–1076. [PubMed]
- Nordemar R, Ekblom B, Zachrisson L, Lundqvist K. Physical training in rheumatoid arthritis: a controlled long-term study. I. Scand J Rheumatol. 1981;10(1):17–23. [PubMed]
- Hansen TM, Hansen G, Langgaard AM, Rasmussen JO. Longterm physical training in rheumatoid arthritis. A randomized trial with different training programs and blinded observers. Scand J Rheumatol. 1993;22(3):107–112. [PubMed]
- Stenström CH, Lindell B, Swanberg E, Swanberg P, Harms-Ringdahl K, Nordemar R. Intensive dynamic training in water for rheumatoid arthritis functional class II--a long-term study of effects. Scand J Rheumatol. 1991;20(5):358–365. [PubMed]
- Häkkinen A, Sokka T, Kotaniemi A, Hannonen P. A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis. Arthritis Rheum. 2001 Mar;44(3):515–522. [PubMed]
- Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. [PubMed]
- Hochberg MC, Chang RW, Dwosh I, Lindsey S, Pincus T, Wolfe F. The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis. Arthritis Rheum. 1992 May;35(5):498–502. [PubMed]
- Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh). 1977 Jul;18(4):481–491. [PubMed]
- Scott DL, Houssien DA, Laasonen L. Proposed modification to Larsen's scoring methods for hand and wrist radiographs. Br J Rheumatol. 1995 Jan;34(1):56. [PubMed]
- Wallin L, Brudin LH. Physical working capacity determined by different types of bicycle exercise tests. Clin Physiol. 1988 Oct;8(5):529–537. [PubMed]
- van den Ende CH, Hazes JM, le Cessie S, Mulder WJ, Belfor DG, Breedveld FC, Dijkmans BA. Comparison of high and low intensity training in well controlled rheumatoid arthritis. Results of a randomised clinical trial. Ann Rheum Dis. 1996 Nov;55(11):798–805. [PubMed]
- Wells GA, Tugwell P, Kraag GR, Baker PR, Groh J, Redelmeier DA. Minimum important difference between patients with rheumatoid arthritis: the patient's perspective. J Rheumatol. 1993 Mar;20(3):557–560. [PubMed]
- Lassere M, Boers M, van der Heijde D, Boonen A, Edmonds J, Saudan A, Verhoeven AC. Smallest detectable difference in radiological progression. J Rheumatol. 1999 Mar;26(3):731–739. [PubMed]
- Heinonen A, Kannus P, Sievänen H, Oja P, Pasanen M, Rinne M, Uusi-Rasi K, Vuori I. Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures. Lancet. 1996 Nov 16;348(9038):1343–1347. [PubMed]
- Heinonen A, Sievänen H, Kannus P, Oja P, Vuori I. Site-specific skeletal response to long-term weight training seems to be attributable to principal loading modality: a pQCT study of female weightlifters. Calcif Tissue Int. 2002 Jun;70(6):469–474. [PubMed]
- Pettit AR, Ji H, von Stechow D, Müller R, Goldring SR, Choi Y, Benoist C, Gravallese EM. TRANCE/RANKL knockout mice are protected from bone erosion in a serum transfer model of arthritis. Am J Pathol. 2001 Nov;159(5):1689–1699. [PubMed]
- Goldring SR, Gravallese EM. Mechanisms of bone loss in inflammatory arthritis: diagnosis and therapeutic implications. Arthritis Res. 2000;2(1):33–37. [PubMed]
- Gravallese EM, Manning C, Tsay A, Naito A, Pan C, Amento E, Goldring SR. Synovial tissue in rheumatoid arthritis is a source of osteoclast differentiation factor. Arthritis Rheum. 2000 Feb;43(2):250–258. [PubMed]
- Khosla S. Minireview: the OPG/RANKL/RANK system. Endocrinology. 2001 Dec;142(12):5050–5055. [PubMed]
- Jones D Holstead, Kong Y-Y, Penninger JM. Role of RANKL and RANK in bone loss and arthritis. Ann Rheum Dis. 2002 Nov;61(Suppl 2):ii32–ii39. [PubMed]
- Drossaers-Bakker KW, de Buck M, van Zeben D, Zwinderman AH, Breedveld FC, Hazes JM. Long-term course and outcome of functional capacity in rheumatoid arthritis: the effect of disease activity and radiologic damage over time. Arthritis Rheum. 1999 Sep;42(9):1854–1860. [PubMed]
- van der Heijde Désirée, Simon Lee, Smolen Josef, Strand Vibeke, Sharp John, Boers Maarten, Breedveld Ferdinand, Weisman Michael, Weinblatt Michael, Rau Rolf, Lipsky Peter. How to report radiographic data in randomized clinical trials in rheumatoid arthritis: guidelines from a roundtable discussion. Arthritis Rheum. 2002 Apr 15;47(2):215–218. [PubMed]
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