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without authorization.
The management of
.
A growing body of research confirms that exercise therapy is an active and effective treatment that not only relieves pain symptoms in RA patients, effectively improves muscle strength and endurance, but also increases range of motion2
.
The effects of exercise therapy in patients with RA, appropriate exercise patterns and intensities, and considerations
during exercise will be described here.
New research reconfirms the role of exercise therapy
The positive role of exercise in inflammatory rheumatic disease is well documented1
.
A 2019 review of different non-pharmacological modalities for RA concluded that only exercise interventions appear to be effective
in reducing the global impact of the disease and improving quality of life.
The objectives of RA exercise interventions are multifaceted and include increasing endurance, agility, increasing muscle strength and mass, reducing joint/soft tissue pain and swelling, improving musculoskeletal function, reducing cardiovascular risk, and improving self-efficacy and quality of life
.
Currently, aerobic exercise and muscle strengthening exercise have positive effects on pain, limb function, fatigue and quality of life, as well as some data suggest positive effects on DAS28 scores and inflammatory markers (ESR); The efficacy of yoga or tai chi for RA is uncertain or poorly
evidenced.
Exercise not only benefits the musculoskeletal symptoms of RA, but also has a positive effect on comorbidities such as
.
Suitable form of exercise
The specific choice of exercise modality for patients with RA should consider a variety of factors, such as age, physique, previous exercise level, disease activity status, and the presence or absence of structural joint injury
.
Light to moderate exercise (slightly breathless but able to talk) is often recommended, such as walking, swimming, and avoiding high-intensity weight-bearing exercises and repetitive high-impact activities such as running and playing ball
.
Patients with RA can choose 3 exercise methods:
➤ Joint range of motion training: hand, wrist joint and other joint range of motion exercise
➤ Isometric contraction exercise: isometric movement of the muscles of the limbs
➤ Flexibility training: yoga, water sports (there should be a slight stretch, but no pain)
➤ Balance training: tai chi, heel toe walking, water sports
➤ Strength training: bodyweight or weight-bearing exercises, resistance training, water sports
➤ Aerobic exercise: walking, dancing, swimming, cycling
In addition, RA patients should warm up before exercise to avoid joint and muscle damage, and take gentle aerobic exercise, such as slow walking, standing still, for 5~10 minutes; Light aerobic exercise can be done after exercise to prevent muscle
5 minutes.
Reasonable exercise intensity
First of all, exercise therapy for patients with RA should be based on the principle
that there is no increase in symptoms of disease such as pain after exercise.
Second, aerobic exercise intensity is recommended to be at least 55% of maximum heart rate, or 40% to 50%
of maximum oxygen uptake.
For patients with RA who are exercise-oriented, high-intensity training can be encouraged, i.
e.
, the maximum heart rate during exercise is 90%
of the maximum heart rate.
The resistance movement load should be gradually increased, starting with 30%-50% of the maximum load and gradually increasing to 80%
of the maximum load.
For the number of exercises, hand function exercises are recommended 2 times a day; Low- to moderate-intensity dynamic strength training, recreational physical activity, range of motion, and stretching are recommended 2-3 times a week for 30-45 minutes
.
Precautions in motion
For RA patients with hip, knee, foot, and ankle problems, exercise on flat ground is recommended
.
If there is slight pain at the beginning of the exercise, there is no need to be nervous, this is normal
.
However, if the pain is severe or persists 2 hours after exercise, a change in
exercise may be required.
If the following symptoms occur during exercise, stop exercising immediately and contact a healthcare professional: (1) pain or pressure in the chest, back, neck or arms; (2) dizziness or fainting; (3) nausea and
.
In addition, during exercise, patients with RA also pay attention to some problems, such as wearing well-fitting shoes and properly replenishing water after exercise3
.
With the advent of new biologically targeted therapies, complete remission of RA has become an achievable goal, but some patients still fail to achieve treatment goals
in accordance with the principle of standard treatment.
Non-drug treatments such as exercise therapy and psychological intervention have complex effects and can have synergistic and additive effects
with targeted drug therapy.
Therefore, it is an important adjunct to the treatment of RA
.
Due to its safety and broad effectiveness, exercise therapy may play a greater role
in the management of RA in the future.
References:
1.
Majnik J, Császár-Nagy N, Böcskei G,et al.
Non-pharmacological treatment in difficult-to-treat rheumatoid arthritis[J].
Front Med (Lausanne).
2022 Aug 29; 9:991677.
doi: 10.
3389/fmed.
2022.
991677.
PMID: 36106320; PMCID: PMC9465607.
2.
XIE Xia,CHEN Hong.
Application status of exercise therapy in patients with rheumatoid arthritis[J].
Chinese Journal of Nursing,2015,50(9):1100-1103.
DOI:10.
3761/j.
issn.
0254-1769.
2015.
09.
017.
3.
FANG Linkai, HUANG Caihong, XIE Ya, et al.
Practice guidelines for patients with rheumatoid arthritis[J].
Chinese Journal of Internal Medicine,2020,59(10):772-780.
DOI:10.
3760/cma.
j.
cn112138-20200807-00734.
4.
GAO Chao, WU Xue, XU Anqi, et al.
Summary of the best evidence on exercise intervention in patients with rheumatoid arthritis[J].
PLA Journal of Nursing,2020,37(10):43-47.
DOI:10.
3969/j.
issn.
1008-9993.
2020.
10.
011.
