Cardiorespiratory Aerobic Exercise May Be Helpful in Rheumatoid Arthritis

From MedscapeCME Clinical Briefs

News Author: Laurie Barclay, MD
CME Author: Laurie Barclay, MD

Arthritis Care Res. 2010;62:984-992.

Clinical Context
June 30, 2010 — Cardiorespiratory aerobic exercise may be safe and modestly beneficial in patients with rheumatoid arthritis (RA), according to the results of a meta-analysis of randomized controlled trials (RCTs) reported in the July issue of Arthritis Care & Research.

"Several lines of evidence have emphasized an improvement in aerobic capacity and muscle strength after physical exercise programs in ...RA patients," write Athan Baillet, MS, from University of Grenoble Medical School in Grenoble, France, and colleagues. "Our objective was to evaluate the efficacy of aerobic exercises in RA on quality of life, function, and clinical and radiological outcomes by a systematic literature review and a meta-analysis."

The reviewers searched MEDLINE, EMBASE, and Cochrane databases up to July 2009, as well as abstracts presented in the past 5 years at rheumatology scientific meetings, for RCTs of aerobic exercises vs nonaerobic interventions in patients with RA. Study endpoints included postintervention quality of life, Health Assessment Questionnaire (HAQ) evaluation of function, pain measured with a visual analog scale (VAS), joint count, Disease Activity Score in 28 joints (DAS28), and radiologic damage.

Efficacy of aerobic exercises vs nonaerobic interventions was determined with use of standardized mean differences (SMDs). The investigators assessed the heterogeneity of included trials and pooled SMDs for meta-analysis using the inverse of variance model.

There were 14 RCTs, enrolling a total of 1040 patients, meeting selection criteria. Benefits associated with the exercise intervention included improved postintervention quality of life (SMD, 0.39; P < .0001), better HAQ score (SMD, 0.24; P = .0009), lower pain VAS (SMD, 0.31; P = .02), and less radiologic damage. Both groups had similar global compliance, DAS28, adverse events, and joint count, suggesting safety of the exercise intervention.

"Cardiorespiratory aerobic conditioning in stable RA appears to be safe and improves some of the most important outcome measures," the review authors write. "However, the degree of the effect of aerobic exercise on the abovementioned parameters is small."

Limitations of this review include potential bias related to data extraction by a single reviewer, lack of blinding of outcome evaluators in some studies, and lack of analysis of the effect of baseline activity. In addition, this review could not determine optimal exercise intensity, duration, frequency, and type, and the findings could not be generalized to older patients with RA.

"Besides the positive effect of the intervention on patients' psychological well-being, aerobic exercise should be considered as a safe therapy, the efficacy of which has been underestimated," the review authors conclude. "The clinically meaningful and economic impact of such treatment must be investigated in further trials in order to clearly define the place of aerobic exercises in RA management."

An unrestricted educational grant from Abbott France supported this review.

Arthritis Care Res. 2010;62:984-992.

Although pharmacotherapy is the mainstay of RA treatment, physical therapy is important in maintaining joint mobility and muscle strength. In patients with RA, evidence to date suggests that physical exercise programs may improve aerobic capacity as well as muscle strength.

Previously, patients with RA were not encouraged to participate in weight-bearing exercise, which was thought to increase disease activity and joint damage. However, an RCT showed that an exercise program was more beneficial than conventional joint therapy in disability and quality of life.