Dynamic strength training in patients with early rheumatoid arthritis increases muscle strength but not bone mineral density

Objective. To assess the effects of 12 months' dynamic strength training on muscle strength and bone mineral density (BMD) at the lumbar spine and fem oral neck in patients with early rheumatoid arthritis (RA). Methods. Thirty-two subjects in the training group (EG) and 33 in the contr ol group (CG) completed the study. EG carried out strength training 2 times a week with moderate loads of 50-70% of repetition maximum. They were also encouraged to do recreational physical activities. CG performed recreation al physical activities and range of motion exercises. Maximal strength of t he knee extensors, trunk extensors and flexors, and grip strength were reco rded with dynamometers. BMD was measured using dual x-ray absorptiometry. M odified Disease Activity Score, erythrocyte sedimentation rate, and pain we re used for the estimation of disease activity, and Stanford Health Assessm ent Questionnaire to measure functional disability Results, The 12 month resistance training in EG led to statistically signif icant mean increases of 22-35% in all muscle groups examined. CG patients w ere also able to increase their strength to some degree (3-24%), but at the end of the study strengths in CG were significantly lower than in EG. By t he end of the study lumbar spine BMD had changed by +0.19% (4.24) in EG and by -1.14% (4.36) in CG, The corresponding changes of femoral BMD were +1.1 0% (3.71) and -0.03% (3.58). The changes in BMD were minor and statisticall y not significant in both groups. However, femoral BMD was found to be decr eased among those patients treated periodically with oral glucocorticoids ( n = 15, 3 subjects from EG and 12 from CG) compared with changes in BMD amo ng those not treated with systemic glucocorticoids (n = 50). Conclusion, Minimally supervised strength training resulted in significant improvements in muscle strength without detrimental effects on disease acti vity. The detected annual changes in central BMD were minor and statistical ly insignificant in both groups. Special attention should be focused on tho se patients with RA with high disease activity and concomitant glucocortico id treatment.