DYNAMIC EXERCISE THERAPY IN RHEUMATOID-ARTHRITIS - A SYSTEMATIC REVIEW

The aim of this systematic review was to determine the effectiveness o f dynamic exercise therapy in improving joint mobility, muscle strengt h, aerobic capacity and daily functioning in patients with rheumatoid arthritis (RA). In addition, possible unwanted effects such as an incr ease in pain, disease activity and radiological progression were studi ed. A computer-aided search of the MEDLINE, Embase and SCISEARCH datab ases was performed to identify controlled trials on the effect of exer cise therapy. Randomized trials were selected on the effect of dynamic exercise therapy in RA patients with an exercise programme fulfilling the following criteria: (a) intensity level such that heart rates exc eeded 60% of maximal heart rate during at least 20 min; (b) exercise f requency greater than or equal to 2 a week; and (c) duration of interv ention greater than or equal to 6 weeks. Two blinded reviewers indepen dently selected eligible studies, rated the methodological quality and extracted data. Six out of 30 identified controlled trials met the in clusion criteria. Four of the six included studies fulfilled greater t han or equal to 7/10 methodological criteria. Because of heterogeneity in outcome measures, data could not be pooled. The results suggest th at dynamic exercise therapy is effective in increasing aerobic capacit y and muscle strength. No detrimental effects on disease activity and pain were observed. The effects of dynamic exercise therapy on functio nal ability and radiological progression are unclear. It is concluded that dynamic exercise therapy has a positive effect on physical capaci ty. Research on the long-term effect of dynamic exercise therapy on ra diological progression and functional ability is needed.