trengthening exercises on the functional ability, fatigue, psychological
status as well as disease activity in patients with RA.
Methods: This study comprised 30 female patients with RAwho were
selected from the outpatient-clinics and in-patients of the departments of
Rheumatology and Rehabilitation, Benha University Hospitals and Benha
Teaching Hospital These patients were randomly divided into 2 groups,
each group consisted of 15 patients, where group CO was allocated to an
intensive exercise program twice weekly for 12 week. Group (II) patients
were on a usual care program of range motion exercises. Both groups
were matched as regard age (P = 0.23), duration of the disease (P = 0.15),
weight (P = 0.3) and height (P = 0.9). All patients were almost on the same
treatment regimen were subjected to a full history taking, thorough clini
cal examination, laboratory investigations and other clinical data (includ
ing: Multidimensional Assessment of Fatigue (MAF), Health Assessment
Questionnaire (HAQ) and Disease Activity Score of 28 Joint Count
(DAS28), walk test time, stair test time, depression and anxiety scores),
that were obtained at presentation and after 12 weeks.
Results: By comparison between the two groups after 12 week, clini
cal evaluation data and laboratory data showed statistically significant
differences as regard morning stiffness (P = 0.001), MAF (P = 0.001) and
ESR (P = 0.002), and highly statistically significant differences as regard,
HAQ, walk and stair tests, depression and anxiety scores (P<0.001) infavor
of group (I). However, there were no statistically significant differenc-
843
Benha M J
844
ture, diminished muscle strength
and endurance, with loss of inde
pendence (Axel et al., 2003).
RA patients therefore are en
couraged to exercise in order to
increase muscle strength and
joints mobility and owing to a
fear of enhancing joint inflamma
tion and accelerating cartilage de
struction, it has been advocated
that exercise treatment in RA
should be restricted to gentle as
sisted range of motion (ROM) exer
cises (Vanden et al., 2000). Inten
sive weight-bearing exercises
improve muscle strength and
functional ability without increase
in disease activity (Zuzana et al,
2003).
The aim of this work is to in
vestigate the effectiveness and
safety of intensive dynamic exer
cises in patients with rheumatoid
arthritis in comparison to usual
care regimens of range of motion
and isometric exercises as regards
Introduction
RA is the most common inflam
matory arthritis, often resulting in
structural damage that can lead
to severe disability (Paul et al.,
2001). Pain and inflamed joints
lead to diminished level of physi
cal activity. Apart from damaging
consequence of the disease on
joints and muscles, physical inac
tivity contributes to contractures,
muscles atrophy and poor physi
cal fitness (Hakkinen et al., 1995).
Disability is the most common
complication associated with RA.
As regard traditional trends in the
management of RA which suggest
joint rest and splintage; joint rest
may contribute to increased mus
cle weakness and joints contracture
which are caused also by the
disease process of RA (Edward
and Harts, 2001).
Exercise prevents the vicious
cycle of joint pain that leads to
joint stiffness, soft tissue contraces
in DAS (P - 0.07) parameter between the two |
