Overall Clinical Bottom Line: Based on current available research, a program of dynamic exercise appears to statistically significantly increase lower extremity muscle strength, as measured by a dynamometer, as compared to a program of no exercise or a more conservative and traditional program of range of motion, stretching and/or isometric exercise in patients with rheumatoid arthritis. The impact of a dynamic exercise program on function is less clear. Based on the small amount of research currently available, there is conflicting evidence to support a statistically significant increase in functional ability for patients who are not experiencing an active disease state. For patients who are experiencing an active disease state, there is evidence to indicate that the dynamic exercise program does not result in statistically significant changes in functional ability. In neither subpopulation was dynamic exercise found to increase pain or disease activity. Further research is necessary to understand the effects of frequency, intensity, and duration of exercise sessions in addition to specific types of exercise performed. Furthermore, inclusion and exclusion criteria should address subjects’ disease activity state and functional level so that differences in response to exercise among subpopulations within patients with rheumatoid arthritis can be distinguished.
Clinical Scenario: Physical therapists are often called upon to treat patients who have rheumatoid arthritis. In many cases, increasing muscular strength is one of the components of these patients’ rehabilitation programs. Physical therapists need to be able to devise therapeutic exercise programs that optimally improve muscular strength without exacerbating disease activity in this patient population. Consequently, an understanding of what form of exercise (range of motion, isometric, dynamic with resistance) will benefit the patient with rheumatoid arthritis the most is essential. As always, the ultimate goal of physical therapy is to increase the functional ability of the patient while doing no harm.
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