Fear and lack of information can hinder you from making important and potentially beneficial health-related decisions, both for yourself and/or the people you care for. But as the saying goes, “Knowledge is power.” Therefore, seeking out information to help you stay up to date on the condition that you or a loved one is working to manage, as well as the diverse treatment options available, can help to quell worries, encourage reflection on needs and preferences, and assist with making informed decisions. Take, for example, the case with rheumatoid arthritis.
Rheumatoid arthritis is a disease marked by chronic inflammation (1;2). It causes fatigue and joint pain, stiffness, and swelling; and generally worsens over time (1;3-6). Eventually, rheumatoid arthritis can lead to joints becoming deformed and damaged (3;5-6). Together, these symptoms and complications reduce physical function, increase the risk for disability, impact a person’s ability to act independently, and lower quality of life (1;3-7). Be it disease progression or function, a variety of drug and non-drug treatments that aim to alleviate, slow, or prevent symptoms and complications and improve certain aspects of health and well-being do exist (1;3;8-9). One of which is exercise (1;3).
Unfortunately, the role and significance of exercise within a rheumatoid arthritis treatment plan does not appear to be clear to patients and their caregivers (3). When we loop back to our earlier discussion of barriers, it becomes more clear why. The almost 20 million individuals with rheumatoid arthritis worldwide—including over 370 thousand Canadians—and their caregivers are no strangers to experiencing barriers like fear and lack of information (3;10-12). Here, fear relates to the fear of causing further joint damage, and lack of information is linked to not knowing enough about exercise as a treatment option (3;11-12). Combine these with symptoms and complications associated with the disease, and we have an environment that can make it easy to justify not engaging in exercise.
With the help of a recent systematic review, gaps in knowledge about different exercise options and their effects may be addressed for people with rheumatoid arthritis and their caregivers. (3). This evidence may go on to help patients, and their caregivers, come to a decision about if and how to incorporate exercise into the treatment plan.
What the research tells us
The review looked at adults with rheumatoid arthritis engaging in aerobic exercise, strength training, aerobic exercise plus strength training, aquatic exercise, or hand exercise. These folks were compared to those completing other types of exercise, mobility exercise, usual care, or on a waitlist (meaning study participants were on a list waiting to engage in exercise but not yet doing so). Evidence ranging in quality from very low to moderate suggests that exercise may help to improve some symptoms and outcomes related to rheumatoid arthritis. Let’s breakdown the results of the three exercise types that yielded benefits.
First up, we have aerobic exercise, which includes: cycling, walking on a treadmill, rowing, tai chi, and more. Overall, this form of exercise showed the potential to improve one outcome by a large amount, and that’s aerobic capacity. Aerobic capacity is an indicator of how well our body uses oxygen when we are exercising at full-intensity. It can speak to our fitness level and risk for a variety of diseases, including heart disease. Second in line, we have strength training. This type of exercise demonstrated that it may improve three symptoms and outcomes, namely pain and erythrocyte sedimentation rate by moderate amounts, and 50-foot walking time by a small amount. For those unfamiliar, erythrocyte sedimentation rate is an indicator of inflammation. Last up, we have combined aerobic exercise and strength training, which appeared to provide small improvements in fatigue and physical function.
Although more research that enhances the quality of the evidence and provides specific prescriptions around the frequency, intensity, and duration of exercise is needed, currently, exercise seems to hold some promise for people with rheumatoid arthritis (3). Patients, in collaboration with their caregivers and health care professionals, should consider needs (e.g., symptoms of concern), preferences (e.g., exercises they find enjoyable and comfortable), and safety (e.g., physical limitations, disease status, etc.) when deciding on the most appropriate exercise type(s) to incorporate into a treatment plan.