Physical activity for osteoarthritis and reumathoid arthritis patients: concepts related to reduction of pain, endurance and strength exercises
Atividade física para pacientes com osteoartrite e artrite reumatóide:
conceitos relacionados à redução da dor e exercícios de força e endurance
Actividades físicas para pacientes con osteoartritis y artritis reumatoide:
conceptos relacionados con la reducción del dolor y ejercicios de fuerza y resistencia
*Catholic Faculty Rainha do Sertão, Quixadá, Brazil
**PhD. student in Sports Sciences at Faculty of Sports Sciences
and Physical Education, University of Coimbra, Portugal
MsC. in Sports Sciences at University of Trás-os-Montes e Alto Douro, Portugal
****Researcher at Center of Educational Assessment (NAVE/UFC/CNPq)
Federal University of Ceará, Brazil
Post-doctorate researcher at
University of Minho, Braga, Portugal
Rubens Vinícius Letieri* **
Messias Bezerra de Oliveira*
Tadeu de Almeida Alves Júnior*
Francisco Cristiano da Silva Sousa* ***
Paulo Marcelo Nogueira Barros*
Francisco Jeci de Holanda*
Jose Airton de Freitas Pontes Jr* ****
This review briefly indicates the effects of physical-motor intervention in reducing the pain and the benefits provided by aerobic activity and resistance exercises as well. Physical activity may be an effective factor in the constant struggle of RA and OA patients against pain, and regardless the age group, exercise can bring significant improvements in long-term in people with this disease. It can be seen that there are still gaps in knowledge with regard to the most effective training program in the treatment of RA, OA and other degenerative diseases, but actually, physical exercise acts as a non-pharmacological tool effective in reducing symptoms related to RA and OA.
Keywords: Osteoarthritis. Rheumatoid arthritis. Exercise. Pain.
Esta breve revisão indica, sinteticamente, os efeitos da intervenção físico-motora na redução da dor e os benefícios das atividades aeróbicas e de força em indivíduos com ósteoartitrite (OA) e artrite reumatóide (RA). A atividade física pode ser um fator efetivo na luta constante de pacientes com OA e RA contra a dor e independente da faixa etária, o exercício pode trazer melhoras significativas em indivíduos acometidos com tais doenças. Pode ser visto que ainda existem lacunas no conhecimento no que diz respeito ao programa de treinamento mais eficaz no tratamento da RA, OA e outras doenças degenerativas, mas na verdade, a atuação do exercício físico como uma ferramenta não-farmacológica parece ser eficaz na redução dos sintomas relacionados à AR e OA.
Unitermos: Ósteoartrite. Artrite reumatóide. Exercício. Dor.
Reception: 09/10/2015 - Acceptance: 23/11/2015
|EFDeportes.com, Revista Digital. Buenos Aires, Año 20, Nº 211, Diciembre de 2015. http://www.efdeportes.com/||
1 / 1
Rheumatoid Arthritis (RA) is a chronic, systemic disease, with local inflammatory action and which directly affects individuals’ quality of life affected by it. People with RA suffer the increase of morbidity and mortality from cardiovascular diseases, due to a high rate of atherosclerosis (Cairns & McVeigh, 2009). In relation to Osteoarthritis (OA), this a chronic disease, degenerative and disabling, characterized by deterioration of the articular cartilage, synovitis and changes in subchondral bone periarticular structures (Goldring & Goldring, 2007).
Physical exercise has been used as a helping factor in the treatment of RA patients (Cairns & McVeigh, 2007; Germanou et al., 2013; Burrows et al., 2014). Among many benefits, reduction in pain levels, increase aerobic capacity and improvement in levels of muscle strength can be highlighted (Germanou et al., 2013; Wilcox et al., 2015). Therefore, this brief review aims to point out some of the main effects of the different forms of physical exercise as a helping factor in non-pharmacological treatment of individuals with RA and OA. Also, this review briefly indicates the effects of physical-motor intervention in reducing the pain and the benefits provided by aerobic activity and resistance exercises as well.
Physical exercises and pain in RA and osteoarthritis patients
In a study carried out by Germanou et al. (2013), the authors examined the influence of isokinetic exercises in acute inflammatory responses of middle-aged obese women with knee osteoarthritis. The participants were divided into two groups, a control group and the group that performed the isokinetic exercise protocol. The torque of the knee (extension/ flexion), delayed onset muscle soreness (DOMS), knee flexibility and pain have been evaluated. Blood samples were taken pre-exercise, post-exercise and 24h post-exercise. Blood tests were conducted in order to verify the activity of creatine kinase (CK), lactate dehydrogenase activity (LDH), CRP, leukocytes, uric acid, IL-6, TBARS, lipid hydroperoxide (LPX), protein carbonyls (PC) oxidized (GSH) and reduced glutathione (GSSG), total antioxidant capacity (TAC), the activity of catalase and glutathione peroxidase activity (GPX). The authors found that the isokinetic exercise induces only a mild inflammatory response of short duration (<24h) without impairment of physical function and pain in patients with knee osteoarthritis, suggesting that moderate physical exercise, strengthening type can be safe for this group of patients. Isokinetic exercises can improve the quality of life in patients with knee osteoarthritis as in the regulation, the antioxidant system provides the patient with little inflammation pain because it is light and of short duration. Therefore, it is quite interesting in patients who are becoming active again, and the possibility of holding sessions every rest period of 48 hours.
In another study, Burrows et al. (2014) used three groups of 11 people: a group with knee osteoarthritis, another group of elderly but healthy people, and a final group of healthy young ones. The goal was to determine whether a single session of resistance exercise can produce analgesic effect in individuals with knee osteoarthritis. The research results showed that the pressure pain thresholds increased after exercise for the three groups, indicating reduced sensitivity to pain. This reduction of sensitivity to pain after resistance exercise can be assigned to changes in the pain threshold, not to a greater tolerance of it. Therefore, it can be seen that physical activity may be an effective factor in the constant struggle of RA and osteoarthritis patients against pain, and regardless the age group, exercise can bring significant improvements in long-term in people with this diseases.
Modalities of exercise and its implications in the treatment of RA and osteoarthritis
The benefits of physical exercise for an individual with RA go far beyond from the treatment of osteo-articular pathology in case, it is about the individual functionality before society. RA not only compromises skeletal muscle performance, but also prevents the practice of physical exercise, but in general, the physical exercises are recommended and safe for patients with RA and other rheumatic diseases (Silva et al., 2008; Gualano et al., 2011). RA patients present an increased risk for cardiovascular disease. Studies show that exercise restrictions for RA patients are mainly related to the significant deterioration of the articular symptoms, impeding the training of aerobic capacity, with consequences for the increased cardiovascular risk (Teixeira et al., 2012).
According to Oliveira et al. (2012), osteoarthritis results from degeneration in the joints causing changes in the mechanoreceptors and muscle strength, triggering pain and affecting functional capacity, which can cause damage and affect the joint functionality while performing the movements. Carriers of the condition are likely to live with muscle pain and a poor quality of life (Rosa, 2012).
Aerobic and strength exercise
Looking at an individual with RA in a perspective of quality of life (QOL), it can be considered that aerobic training works significantly in reducing depressive symptoms in people with this disease. Depression and mood disorders are commonly reported, and fighting against them influences on the QOL of this population (Pincus et al., 1996; Blixen & Kippes, 1999; Rejeski & Mihalko, 2001; Pennix et al., 2002).
In a study carried out by Harkcom et al. (1985) the authors investigated the response of aerobic exercise in women diagnosed with rheumatoid arthritis. The experimental design of the study consisted of three low intensity aerobic exercise protocol (15, 25 and 35 minutes) 3 times per week for 12 weeks. A group who did not train was used as control one. All groups who followed the exercise program increased aerobic capacity, exercise time and joint counts. The study participants reported improvements in their daily activities, reduction of joint pain and decreased fatigue. In this study, the authors report that aerobic exercise performed up to 35 minutes may be a therapeutic alternative in the treatment of rheumatoid arthritis, and also conducted exercises in less time (15 minutes) 3 times a week may be enough to improve aerobic capacity in patients with rheumatoid arthritis and severe constraints.
In a systematic review with meta-analysis by Baillet et al. (2010), the authors performed a search in Medline, Embase, and Cochrane. Screenings which used intervention with aerobic exercise in patients with RA were included. Outcomes studied were post intervention quality of life, function evaluated by the Health Assessment Questionnaire (HAQ), the visual analog scale pain (VAS), joint count, the Disease Activity Score in 28 joints (DAS28), and radiological damage. Efficacy was evaluated by standardized mean differences (SMDs; difference between groups of mean outcome variation from baseline/ SD at baseline) of aerobic exercises. Fourteen randomized controlled trials were included, in which it was obtained a total of 1040 patients who met the inclusion criteria of the meta-analysis. Exercise improved the post intervention quality of life (SMD 0:39, p<0.0001), HAQ score (SMD 0:24, p=0.0009), and pain VAS (SMD 0:31, p=0:02). Exercise in this RA population seemed to be safe, since global compliance, DAS28, and joint count were similar in both groups. The authors concluded through this study that aerobic exercise in stable RA seems to be safe and may increase some of the most important variables related to health, quality of life and pain in this specific population.
Studies have shown that strength exercises also help to reduce the problems related to RA. According to the study Beckwée et al. (2013), in its qualitative analysis of several studies related to RA, it was found out that the conclusions of these ones converge to the positive role of an exercise intervention to reduce problems related to RA. The energy absorption capacity, stability, joint components, bone connective tissue, intra-articular components, cartilage, inflammation reducing, joint lubrication, bone loss, functionality increase, and welfare have been improved with the exercise program.
The aerobic exercise is being used as a non-pharmacological treatment in patients with OA of the knee, recent research showed the benefits of aerobic exercise on the functional quality of life for individuals with OA. In a study by Freitas et al. (2012) showed health parameters of the population and physiological benefits of aerobic exercise in the treatment of OA, in other study made by Dadalto et al. (2013), the authors used resistance exercise for increasing of the muscle strength of knee extensors muscles in patients with OA, the authors found improvements in motor mobility and muscle strength in this patients.
Based on the statements above, it can be seen that there are still gaps in knowledge with regard to the most effective training program in the treatment of RA and other degenerative diseases, but actually, physical exercise acts as a non-pharmacological tool effective in reducing symptoms related to RA.
Baillet A, Zeboulon N, Gossec L, Combescure C, Bodin L et al. (2010). Efficacy of Cardiorespiratory Aerobic Exercise in Rheumatoid Arthritis: Meta-Analysis of Randomized Controlled Trials. Arthritis Care & Research, Vol. 62, No. 7,984 –992.
Beckwée D et al. (2013). Osteoarthritis of the knee: Why does exercise work? A qualitative study of the literature. Ageing Research Reviews 12: 226– 236.
Blixen CE, Kippes C. (1999). Depression, social support, and quality of life in older adults with osteoarthritis. J NursSchol. 31:221-226.
Burrows NJ, Booth J, Sturnieks DL, Barry BK (2014). Acute resistance exercise and pressure pain sensitivity in knee osteoarthritis: a randomised crossover trial. 22:407-414.
Cairns AP, McVeigh JG (2009). A systematic review of the effects of dynamic exercise in rheumatoid arthritis. Rheumatol Int. 30:147–158.
Dadalto TV, de Souza CP, da Silva EB (2013). Eletroestimulação neuromuscular, exercícios contra resistência, força muscular, dor e função motora em pacientes com osteoartrite primária de joelho. Fisioter Mov; 26(4): 777-789.
Freitas DA, Guedes MBO, Fonseca SF, Amorim MR, Gomes WF, Melo GEBA, Guimarães PSS, Lacerda ACR, (2012). Efeito de um programa de treinamento aeróbio na dor, desempenho físico e funcional e na resposta inflamatória em idosos com osteoartrite de joelho- Resultados preliminares. Revista terapia manual posturologia; 10(47): 52-59.
Germanou EI, Chatzinikolaou A, Malliou P, Beneka A, Jamurtas AZ et al.(2013). Oxidative stress and inflammatory responses following an acute bout of isokinetic exercise in obese women with knee osteoarthritis. The Knee. 20:581-590.
Goldring MB, Goldring SR (2007) Osteoarthritis. J. Cell. Physiol. 213: 626–634.
Gualano B, Pinto AL, Perondi MB, Roschel H, Sallum AME et al.(2011). Therapeutic effects of exercise training in patients with pediatric rheumatic diseases. Rev Bras Reumatol. 51:490–6
Harkcom T, Lampman R, Banwell B, Castor C (1985). Therapeutic value of graded aerobic exercise training in rheumatoid arthritis. Arthritis Rheum. Jan; 28: 32–39
Oliveira AMI, Peccin MS, Silva KNG, Teixeira LEPP, Trevisani VF (2012). Impacto dos exercícios na capacidade funcional e dor em pacientes com osteoartrite de joelhos: ensaio clínico randomizado. Rev Bras Reumatol; 52(6):870-882.
Penninx BWJH, Rejeski WJ, Pandya J et al. (2002). Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. J Geron. 57B:124e132.
Pincus T, Griffith J, Pearce S, Isenberg D (1996). Prevalence of self-reported depression in patients with rheumatoid arthritis. Br J Rheumatol. 35:879e883.
Rejeski WJ, Mihalko SL (2001). Physical activity and quality of life in older adults. J Gerontol. 56A:23-35.
Rosa, UH (2012). Comparison of the Effectiveness of Isokinetic vs Isometric Therapeutic Exercise in Patients with Osteoarthritis of Knee, Reumatol Clin; 8(1):10–14.
Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S et al. (2008). Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial. PhysTher. 88:12–21.
Teixeira V de O, Filippin LI, Xavier RM (2012). Mechanisms of muscle wasting in sarcopenia. Rev Bras Reumatol. 52:252–9.
Wilcox S, McClenaghan B, Sharpe PA, Baruth, Hootman JM et al. (2015). The Steps to Health Randomized Trial for Arthritis A Self-Directed Exercise Versus Nutrition Control Program. American Journal of Preventive Medicine.48:1-12.
Another articles in English
Digital · Año 20 · N° 211 | Buenos Aires,
Diciembre de 2015