Long-term high-intensity exercise does not accelerate the progression of joint damage in the hands and feet of people with rheumatoid arthritis, according to a Dutch report.

Exercise known to benefit arthritis patients, increasing their physical capacity, functional ability, and emotional, the researchers explain in the Annals of the Rheumatic Diseases. However, little is known about the effects of exercise on damage to the small joints of the hands and feet.

Dr. Z. de Jong from Leiden University Medical Center and colleagues studied a total of 309 patients with rheumatoid arthritis who were divided randomly into a high-intensity exercise group or a regular physical exercise. After two years, 136 participants in the high-intensity and 145 in the control exercise group were still in the trial.

At that point, the number of damaged joints in the hands and feet increased in both groups and did not differ between them, the team reports.

For those who did experience a rapid increase in damage to these joints, three factors seemed to be key -- worse existing damage before the study started, higher disease activity during the study, and decreases rather than increases in aerobic fitness, the researchers note.

"This is the first time that improvement in aerobic fitness has been shown to predict, independently of other factors, a decrease in the rate of local bone damage," they point out.

In conclusion, "We provide evidence that participation in a long-term high-intensity weight-bearing exercise program comprising improvement in aerobic fitness and impact-generating activities does not increase the rate of radiological joint damage of the hands and feet in patients with rheumatoid arthritis," the team writes.

"On the contrary, it seems that these exercises have a protective effect for the joints of the feet," they say.

"I think the next step will be to see how safe these exercises are for people with prostheses and/or extensive damage to the large weight-bearing joints," de Jong stated. "Also, the effectiveness of cheaper alternatives like (partly) home-based training will be explored."

His advice to doctors who care for patients with rheumatoid arthritis: "Do not be afraid to advise your patients to exercises vigorously! Trust that they are able to do it."

SOURCE: Annals of the Rheumatic Diseases, November 2004.

Reference Source 89
November 5, 2004

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