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Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006853. doi: 10.1002/14651858.CD006853.pub2.

Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis.

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  • 1Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, Leiden, Zuid-Holland, Netherlands, 2333 ZA.

Abstract

BACKGROUND:

An up-to-date overview of the effectiveness and safety of dynamic exercise therapy (exercise therapy with a sufficient intensity, duration, and frequency to establish improvement in aerobic capacity and/or muscle strength) is lacking.

OBJECTIVES:

To assess the effectiveness and safety of short-term (< three months) and long-term (> three months) dynamic exercise therapy programs (aerobic capacity and/or muscle strength training), either land or water-based, for people with RA. To do this we updated a previous Cochrane review (van den Ende 1998) and made categories for the different forms of dynamic exercise programs.

SEARCH STRATEGY:

A literature search (to December 2008) within various databases was performed in order to identify randomised controlled trials (RCTs).

SELECTION CRITERIA:

RCTs that included an exercise program fulfilling the following criteria were selected: a) frequency at least twice weekly for > 20 minutes; b) duration > 6 weeks; c) aerobic exercise intensity > 55% of the maximum heart rate and/or muscle strengthening exercises starting at 30% to 50% of one repetition maximum; and d) performed under supervision. Moreover, the RCT included one or more of the following outcome measures: functional ability, aerobic capacity, muscle strength, pain, disease activity or radiological damage.

DATA COLLECTION AND ANALYSIS:

Two review authors independently selected eligible studies, rated the methodological quality, and extracted data. A qualitative analysis (best-evidence synthesis) was performed and, where appropriate, a quantitative data analysis (pooled effect sizes).

MAIN RESULTS:

In total, eight studies were included in this updated review (two additional studies). Four of the eight studies fulfilled at least 8/10 methodological criteria. In this updated review four different dynamic exercise programs were found: (1) short-term, land-based aerobic capacity training, which results show moderate evidence for a positive effect on aerobic capacity (pooled effect size 0.99 (95% CI 0.29 to 1.68). (2) short-term, land-based aerobic capacity and muscle strength training, which results show moderate evidence for a positive effect on aerobic capacity and muscle strength (pooled effect size 0.47 (95% CI 0.01 to 0.93). (3) short-term, water-based aerobic capacity training, which results show limited evidence for a positive effect on functional ability and aerobic capacity. (4) long-term, land-based aerobic capacity and muscle strength training, which results show moderate evidence for a positive effect on aerobic capacity and muscle strength. With respect to safety, no deleterious effects were found in any of the included studies.

AUTHORS' CONCLUSIONS:

Based on the evidence, aerobic capacity training combined with muscle strength training is recommended as routine practice in patients with RA.

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