Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Functional Benefits Following Dynamic Exercise in Patients with RA Taking Anti-TNF Therapy Reflected in Lower Limb Function Tests but Not the HAQ.

Reid1,  Angela, Brady2,  Audrey, Cusack5,  Tara, Blake5,  Catherine, Mongey3,  Anne Barbara, Veale4,  Douglas J., FitzGerald3,  Oliver

Our Lady's Hospice, Dublin, Ireland
Our Lady's Hospice
St. Vincent's University Hospital
St. Vincent's University Hospital
University College Dublin, Ireland

Background:

The medical management of rheumatoid arthritis (RA) has advanced with the introduction of biologic drugs including anti-TNFa therapy medication. Dynamic exercise is an important non-pharmacological therapy in RA and has been shown to improve function. The effect of dynamic exercise on function for people with RA on anti-TNFa medication has not yet been described. The purpose of this study was to investigate the effect of dynamic exercise, either on land or in water, on function in people with RA taking anti-TNFa medication.

Methods:

A convenience sample of people with RA on anti-TNFa medication was recruited. Participants were randomised into one of 3 groups: a gym, a hydrotherapy or a control group. The gym and hydrotherapy interventions consisted of flexibility, strengthening and aerobic exercises. Exercise classes were undertaken for 1 hour, twice weekly for 8 weeks. The control group received no intervention. Participants were assessed by a blind assessor at baseline, 8 and 24 weeks. The primary outcome measure used was the HAQ. Secondary measures of outcome included the 50ft Walk Test (50ftWT) and the Timed Chair Stand Test (TCST). Semi-structured interviews were conducted at 24 weeks to ascertain the exercise participation levels of individuals following completion of the study.

Results:

Fifty one people (12 male / 39 female) with a mean age of 56 (± 10) years were recruited. The mean length of diagnosis was 14.1 (± 10.5) years and the mean length of time taking anti-TNFa medication was 2.9 (± 2.1) years. The 50ftWT improved significantly in both the gym and hydrotherapy groups at 8 weeks compared to the control group (gym p=0.02, hydrotherapy p=0.01). The TCST significantly improved in the gym group (p=0.02) when compared to the control group at 8 weeks. These improvements were not maintained at 24 weeks. No significant change was noted in HAQ scores. Of the 17 exercise group participants interviewed post-study, 3 had continued the exercise programmes between the eight and 24 week time-points. Reasons identified for failing to continue to exercise included lack of access to facilities and reduced motivation.

Table 1. Results

 Group (n = 17)*Baseline8 weeks24 weeks
 Gym0.79 (0.51)0.63 (0.48)0.79 (0.61)
HAQ (0–3) mean ± SDHydro1.07 (0.85)0.99 (0.85)1.03 (0.85)
 Control0.83 (0.55)0.83 (0.59)0.79 (0.56)
 Gym9.35 (1.97)8.21 (1.86)†8.6 (2.62)
50ft Walk test (s) mean ± SDHydro11.53 (3.87)10.07 (2.05)†10.24 (2.17)
 Control10.10 (3.36)10.56 (3.34)10.35 (2.60)
 Gym13 (5–19)16 (10–32)‡16 (6–32)
Timed Chair Stand Test (reps)Hydro9 (6–23)12 (8–23)12 (8–29)
  median (range)Control11 (5–20)13 (6–22)13 (0–22)
*Hydro Group n = 16 at 24 weeks.†p <= 0.05 one-way Anova,‡p <= 0.05 Mann-Whitney U Test.

Conclusion:

Participating in 8 weeks of dynamic exercise, either on land or in a hydrotherapy pool, improved function in this sample of people with RA on anti-TNFa medication as evidenced by the significant improvements in lower limb function tests at 8 weeks. This was not reflected by changes in HAQ scores. Access to facilities and support in terms of organised, suitable, supervised exercise classes may be necessary to enable this population to continue to engage in long term exercise.

To cite this abstract, please use the following information:
Reid, Angela, Brady, Audrey, Cusack, Tara, Blake, Catherine, Mongey, Anne Barbara, Veale, Douglas J., et al; Functional Benefits Following Dynamic Exercise in Patients with RA Taking Anti-TNF Therapy Reflected in Lower Limb Function Tests but Not the HAQ. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2135
DOI: 10.1002/art.29899

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