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.


Home-Based Exercise Therapy in Patients with Rheumatoid Arthritis: A Systematic Review.

Hurkmans3,  Emalie J., van der Giesen2,  Florus J., Vlieland1,  Thea P. M. Vliet, Schoones5,  Jan W., van den Ende4,  Cornelia H. M.

Department of Rheumatology and Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
Department of Rheumatology, Groene Hart Ziekenhuis, Gouda, The Netherlands
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
Walaeus Library, LUMC, Leiden, The Netherlands, The Netherlands

Objective:

To assess the effectiveness and safety of home-based (HB) exercise therapy in patients with rheumatoid arthritis (RA).

Method:

A literature search up to December 2009 within various databases was performed to identify randomized controlled trials (RCTs) fulfilling the criteria: a) exercise program is performed by patients at home; b) instructions are given at least once; c) program is evaluated not more than once in two weeks; d) the program includes aerobic capacity, muscle strength, joint range of motion, and/or stretching exercises. Two blinded reviewers independently selected studies, rated the risk of bias, categorized the RCTs and extracted data regarding outcome measures of effectiveness (functional ability, aerobic capacity, muscle strength) and safety (self-reported pain, disease activity, radiological damage). A qualitative data analysis was performed.

Results:

Eleven RCTs were included; 8 had a low risk of bias. Two RCTs compared a HB program including aerobic capacity and/or muscle strength exercises (8 and 12 months, respectively) with no exercises. Qualitative analysis showed that there is low and moderate quality evidence that a HB program is more effective than no intervention with regard to functional ability and muscle strength, respectively, directly after the intervention. Four RCTs compared a HB program including aerobic capacity and/or muscle strength exercises (8, 12, 24 weeks and 24 months, respectively) with a supervised program. Qualitative analysis showed that there is low quality evidence that a HB program is less effective with regard to aerobic capacity and muscle strength than a supervised program directly after the intervention. Five RCTs compared a HB program including muscle strength exercises and/or stretching exercises (12 weeks, 3, 6, 12 and 24 months, respectively.) with another HB program. Qualitative analysis showed that there is low quality evidence that a HB program including strength and stretching exercises is more effective with regard to functional ability compared to a HB stretching program directly after the intervention. With respect to safety, there is low and moderate evidence that HB exercise programs have no deleterious effects (see Table I).

Table 1.

StudyFunctional abilityAerobic capacityMuscle strengthSelf-reported painDisease activityRadiological damage Home-based program versus no intervention
Masiero 2007++* -++*- 
Brodin 2008- +*--Home-based programs versus supervised programs
Van den Eude 1996=++**+** = 
Hansen 1993------
Hsieh 2009-+**--- 
Lemmey 2009= +** =Home-based programs versus other home-based programs
Van den Berg 2006-   - 
Stenstrom 1994-   +# 
O'Brien 2005+# = = 
Stenstrom 1996, 1997- - - 
Hakkinen 1998, 2001, 2003, 2004, 2004+# =+#==
Significant (p < 0.001) difference: ++
%Significant (p < 0.05) difference: +
%No significant difference: =
* In favor of home-based program
** In favor of supervised program
# In favor of the home-based program including strengthening and stretching exercises versus exercise programs with only stretching exercises

Conclusion:

HB exercise therapy is more effective with regard to functional ability and muscle strength than no exercise therapy. HB exercise therapy is less effective than supervised exercise with regard to aerobic capacity and muscle strength, but equally effective with regard to functional ability. When comparing different types of HB exercise programs, a combined program including strengthening exercises is more effective with regard to functional ability compared to a program without strengthening exercises. No detrimental effects were found in any of HB exercise programs. More research is needed with regard to the specific content and duration of HB exercise program.

To cite this abstract, please use the following information:
Hurkmans, Emalie J., van der Giesen, Florus J., Vlieland, Thea P. M. Vliet, Schoones, Jan W., van den Ende, Cornelia H. M.; Home-Based Exercise Therapy in Patients with Rheumatoid Arthritis: A Systematic Review. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2283
DOI: 10.1002/art.30046

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