WEST MIDLANDS, UK—Individually-tailored exercise programs taking a patient's specific needs and abilities into account should become a standard part of rheumatoid arthritis (RA) treatment. Such programs can help reverse joint damage and reduce cardiovascular risk factors in this population.

"Focused research is required to identify the optimal regimens, timing, and environment for exercise, as well as educational and behavioral interventions that will facilitate long-term adherence to an active lifestyle/or structured exercise," conclude the researchers led by Giorgos S. Metsios, PhD, of the University of Wolverhampton in the West Midlands, UK. The findings appear online in Rheumatology.¹

"In the meantime, a pragmatic approach is proposed, incorporating combined range of motion, strength and aerobic training, provided in a patient-specific context as part of the multidisciplinary care of the individual with RA."

Literature search supports the value of exercise in RA

Researchers combed six databases to identify publications from 1974 to 2006 on the benefits of exercise in RA and graded the quality of the studies with the Jadad scale. They found 1342 articles, 40 of which met the inclusion criteria. There were, however, no studies concerning exercise interventions in relation to cardiovascular disease in RA.

"There is strong evidence suggesting that exercise from low to high intensity of various modes is effective in improving disease-related characteristics and functional ability in RA patients," they write. "Future studies are required to investigate the effects of exercise in improving the cardiovascular status of this patient population."

Personalized exercise regimen key in RA

There is likely no one-size-fits-all exercise regimen for RA patients, but exercise can be prescribed on the basis of an RA patient's specific needs and abilities, they note. For example, in an RA patient with little current inflammation and little accumulated permanent damage, drugs could be used to maintain the disease control, while some range of motion exercises and resistance training could be utilized to maintain the good level of musculoskeletal system mobility and function. "The main focus should be aerobic training aiming at optimizing cardiovascular fitness, to the degree determined by their current levels of fitness and allowed by their cardiovascular risk stratification."

By contrast, "patients with extensive structural damage should initially utilize the nondamaged joints; load on damaged joints should happen progressively with the intensity of exercise progressing from range of motion exercises to low-load exercise," the researchers write.

Translating research into practice

Michael F. Roizen MD, chief wellness officer of the Institute of Wellness at the Cleveland Clinic in Ohio, and author of several books including RealAge: Are You as Young as You Can Be?, said this is exactly the approach that he takes with RA patients at his institution.

"In our program, we have experts in RA who tailor [attainable exercises] to the pain level of the person," he told MSKreport.com. "You need someone to work with the patients to see how much they can tolerate."

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