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Physical activity and Rheumatoid Arthritis: THE IMPORTANCE OF CORRECT MOVEMENT

It is widely recognized that regular exercise and physical activity provide multiple health benefits to the general population and to patients with chronic diseases.

There are those who practice it for pleasure and those for work, those who appreciate its creative side and those who, while not practicing it, recognize its emotional power and the ability to aggregate.
There are many ways in which each of us interprets and experiences sport, which remains a constant in people’s daily lives.

The improvements resulting from physical exercise translate into improvements in cardiovascular health and a reduction in the risk of coronary heart disease, stroke and type 2 diabetes by alleviating hypertension and dyslipidemia, improving insulin sensitivity and reducing adiposity [20]; reduce the risk of colon and breast cancer [21]; increase muscle strength and mechanical properties and bone mineral density [22, 23] and, finally, it is an aid in psychological well-being [25].

While there are numerous reasons why exercise is considered to be of paramount benefit, evidence suggests that the RA population is less physically active than the general population.

In a study of 8163 RA patients in New Zealand, researchers [117] investigated the factors that influence exercise participation for rheumatic individuals. Their analysis revealed that some people with arthritis believed more strongly in the benefits of physical activity, making them the most active group in the study, reporting significantly higher levels of encouragement, and having higher overall levels of self-efficacy than less active participants.

Other barriers that impacted the success of exercise recommendations in arthritis patients were highlighted: physical barriers.

Physical barriers include pain, fatigue, and reduced physical motor skills, as well as the additional complications of further comorbidities. Concern that exercise could have detrimental effects on joint health was present in RA patients.

The role of exercise in promoting joint health for a person with RA is of great importance.

Tendons are stretchable structures that transmit force from muscle to bone and deform reversibly under mechanical loads.

RA causes synovial inflammation of the tendon sheaths, leading to synovial hypertrophy and sometimes infiltration of synovial tissue within the tendon. High circulating inflammatory cytokines also affect collagen, leading to damage and disorganization of the tendon structure. Furthermore, tendons gradually lose their elasticity and stiffness with advancing age and in people who do not exercise regularly [81].

For this reason, exercise programs for RA patients should initially be supervised by an experienced exercise practitioner so that the program can be tailored to the disease activity, joint defects and symptoms of patients. Among the various types of training recommended and suggested by the experts, we find: aerobic training, resistance training and a combination of aerobic and strength exercises.

The aerobic activities most often included are walking, running, cycling, and water activities. Walking is a good mode of exercise as it is safe and can be performed easily anywhere. Fast walking, even in short periods, improves aerobic capacity, oxygenation and reduces the risk of developing cardiovascular disease. Cycling is an excellent mode of aerobic activity that works on the large muscle groups of the lower limbs by improving muscle strength and joint mobility, without exacerbating the activity of the disease.

Hydrotherapy (the use of water) has proven to be very effective for RA sufferers.
Just two 30-minute sessions for 4 weeks have been shown to significantly reduce joint stiffness, improve knee motion, and improve emotional and psychological well-being [137].

With regard to resistance training, RA patients should be encouraged to perform exercises that cause hypertrophy and muscle strengthening as the loss of mass (frequent in rheumatic subjects) results in functional limitations and increasing disability.

Exercises involving the large muscle groups of the upper and lower limbs as well as hand strengthening exercises have been shown to be ameliorative and associated with reduced systemic inflammation, pain, morning stiffness and disease activity. [111].

Finally, the combination of aerobic and strength exercises would represent an optimal program for RA patients, as poor cardiovascular health is the leading cause of death in RA patients. Poor cardiorespiratory fitness presupposes the need for aerobic exercise as part of treatment. While the addition of strengthening exercises helps mitigate musculoskeletal and joint health problems and induces substantial improvements in physical function

In summary, the importance of including physical training in the treatment of RA is clear and proven. Exercise in general appears to improve overall function in RA with no proven detrimental effects on disease activity. Therefore, all RA patients should be encouraged to include some form of aerobic training and resistance exercise as part of their routine care.

References:

20. Brukner PD, Brown WJ. Is exercise good for you? Medical Journal of Australia. 2005; 183 (10): 538-541.
21. Bernstein L, Henderson BE, Hanisch R, Sullivan-Halley J, Ross RK. Exercise and breast cancer risk reduction in young women. Journal of the National Cancer Institute. 1994; 86 (18): 1403-1408.
22. Bassey EJ, Ramsdale SJ. Increased femoral bone density in young women following high impact exercises. Osteoporosis International. 1994; 4 (2): 72–75.
23. Reeves ND, Narici MV, Maganaris CN. Myotendinous plasticity to aging and endurance exercise in humans. Experimental physiology. 2006; 91 (3): 483–498.
25. Ross CE, Hayes D. Exercise and psychological well-being in the community. American Journal of Epidemiology. 1988; 127 (4): 762–771.
81. Onambele GL, Narici MV, Maganaris CN. Calf muscle-tendon properties and postural balance in old age. Journal of Applied Physiology. 2006; 100 (6): 2048-2056.
111. Brorsson S, Hilliges M, Sollerman C, Nilsdotter A. A six-week manual exercise program improves hand strength and function in patients with rheumatoid arthritis. Journal of Rehabilitation Medicine. 2009; 41 (5): 338–342.
117. Hutton I, Gamble G, McLean G, Butcher H, Gow P, Dalbeth N. What is associated with being active in arthritis? Analysis of obstacles to the study of action. Journal of Internal Medicine. 2010; 40 (7): 512-520.
137. Hall J, Skevington SM, Maddisson PJ, Chapman K. A randomized controlled trial of hydrotherapy in rheumatoid arthritis. Arthritis and rheumatism. 1996; 9: 206–215.

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