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Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis

  • Review
  • Intervention

Authors


Abstract

Background

An up-to-date overview of the effectiveness and safety of dynamic exercise therapy (exercise therapy with a sufficient intensity, duration, and frequency to establish improvement in aerobic capacity and/or muscle strength) is lacking.

Objectives

To assess the effectiveness and safety of short-term (< three months) and long-term (> three months) dynamic exercise therapy programs (aerobic capacity and/or muscle strength training), either land or water-based, for people with RA. To do this we updated a previous Cochrane review (van den Ende 1998) and made categories for the different forms of dynamic exercise programs.

Search methods

A literature search (to December 2008) within various databases was performed in order to identify randomised controlled trials (RCTs).

Selection criteria

RCTs that included an exercise program fulfilling the following criteria were selected: a) frequency at least twice weekly for > 20 minutes; b) duration > 6 weeks; c) aerobic exercise intensity > 55% of the maximum heart rate and/or muscle strengthening exercises starting at 30% to 50% of one repetition maximum; and d) performed under supervision. Moreover, the RCT included one or more of the following outcome measures: functional ability, aerobic capacity, muscle strength, pain, disease activity or radiological damage.

Data collection and analysis

Two review authors independently selected eligible studies, rated the methodological quality, and extracted data. A qualitative analysis (best-evidence synthesis) was performed and, where appropriate, a quantitative data analysis (pooled effect sizes).

Main results

In total, eight studies were included in this updated review (two additional studies). Four of the eight studies fulfilled at least 8/10 methodological criteria. In this updated review four different dynamic exercise programs were found: (1) short-term, land-based aerobic capacity training, which results show moderate evidence for a positive effect on aerobic capacity (pooled effect size 0.99 (95% CI 0.29 to 1.68). (2) short-term, land-based aerobic capacity and muscle strength training, which results show moderate evidence for a positive effect on aerobic capacity and muscle strength (pooled effect size 0.47 (95% CI 0.01 to 0.93). (3) short-term, water-based aerobic capacity training, which results show limited evidence for a positive effect on functional ability and aerobic capacity. (4) long-term, land-based aerobic capacity and muscle strength training, which results show moderate evidence for a positive effect on aerobic capacity and muscle strength. With respect to safety, no deleterious effects were found in any of the included studies.

Authors' conclusions

Based on the evidence, aerobic capacity training combined with muscle strength training is recommended as routine practice in patients with RA.

摘要

背景

動態運動計畫 (有氧量/肌肉強度訓練) 於類風溼性關節炎的病人

目前對於動態運動治療 (具有充分強度,長度和頻度,可以造成有氧量與肌肉強度更進步的運動治療)的效用與安全性上的最新觀點是缺乏的。

目標

為了評估有類風濕性關節炎的人,於陸地或水上,其短期(小於三個月)與長期 (大於三個月) 動態運動治療計畫(有氧量與肌肉強度訓練)的效用和安全性。為此,我們更新過去考科藍文獻回顧(van den Ende 1998) 。並且為不同形式的動態運動計畫作了索引表。

搜尋策略

一篇為找出隨機控制試驗 (RCTs) 而涵蓋各種資料庫的文獻搜尋 (到2008年12月

選擇標準

隨機控制試驗包含一個需要履行下列挑選條件的運動計畫: a. 每星期至少運動兩次,並且超過20分鐘 b. 為期六周 c. 有氧運動強度大於55% 之最大心率,肌肉強度運動開始於30 – 50% 之最大重複 d. 在監督下履行並且,這個隨機控制試驗包含下列一到多個結果的測量:功能能力有氧量肌肉強度疼痛疾病活動度放射線迫害

資料收集與分析

兩位回顧者各自挑選合格的文獻,評分其方法論的品質與擷取的資料。使用定性分析(最佳證據綜合法) ,於恰當處作量化資料分析(匯整效益值)

主要結論

這個最新的回顧包含了8個研究 (2個額外的研究) 。8個研究中的4個符合起碼8/10的方法學條件。在這個回顧裡,有四種不同的動態運動計畫: (1) 短期的、陸上的有氧訓練,有中度的證據顯示對於有氧量有正面助益。 (95% CI 0.29 to 1.68) (2) 短期的,陸上的有氧訓練及肌力訓練,有中度的證據顯示對於有氧量及肌力有正面助益 (95% CI 0.01 to 0.93). (3) 短期的、水上有氧訓練,只有有限的證據顯示對於功能及有氧量正面助益。 (4) 長期的、陸上的有氧訓練以及肌力訓練,有中度的證據顯示對於有氧量及肌力有正面助益。至於安全性方面,在任何納入的研究中沒有發現有害的影響。

作者結論

證據顯示,有氧訓練合併肌肉強度訓練在類風濕性關節炎患者身上是建議常規使用的。

翻譯人

本摘要由臺灣大學附設醫院黃全敬翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

動態運動計畫 (有氧量/肌肉強度訓練) 於類風溼性關節炎的病人。這個回顧Cochrane資料庫的總結包含了目前我們所知運動對於類風濕性關節炎的影響。在類風濕性關節炎患者身上:陸上的有氧運動和肌力訓練可能可以短暫輕微改善疼痛和功能。在這個回顧裡,沒有發現運動造成的有害副作用 (疼痛增加或關節傷害等) 。這樣的結論適用於陸上或水上運動,雖然絕大部分研究的時間都不夠長,無法判斷運動是否會造成關節傷害。何謂動態運動又何謂類風濕性關節炎?動態運動治療計畫是指有足夠強度、持續時間、以及頻率的活動,可以增強耐力或肌力。運動是指任何可以增強體適能的活動。可以讓你更有活力、耐力或體力的運動稱為有氧運動。人們去運動的原因有很多,包括減重、增強肌力、增強體能。當罹患類風濕性關節炎時,正常來說是對抗感染的免疫系統會攻擊關節周圍的組織。這會使你的關節腫脹、僵硬和疼痛。手上和腳上的小關節通常最先被影響。目前類風濕性關節炎無法治癒,所以像是運動的治療目的是減緩疼痛和僵硬,並且改善活動的能力。對於參與短期陸上動態運動計畫的患者最好的評估項目是疼痛 (比較高分代表較差或較痛) 參與運動計畫的患者於12週後在0到10分的評分表上對於疼痛給予大約一半的分數 (6% 有絕對的改善) 。沒有參與運動計畫的患者在0到10分的評分表上對於疼痛給予1分。身體機能 (較高的分數代表較差的身體機能) 參與運動計畫的患者於12週後在0到3分的評分表上對於身體機能給予大約一半的分數 (6% 有絕對的改善) 。參與運動計畫的患者在0到3分的評分表上對於身體機能給予大約1.5分。沒有參與運動計畫的患者在0到3分的評分表上對於身體機能給予大約1分。

Plain language summary

Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis

This summary of a Cochrane review presents what we know from research about the effect of exercise on Rheumatoid Arthritis (RA). 

The review shows that in people with rheumatoid arthritis:

- Aerobic exercise and muscle strength training on land probably improve pain and physical function slightly in the short term. 

- There were no harmful side effects (such as increased pain or damage to your joints) of exercise found in this review.  This was true for exercising on land or in the water, although most of the studies were not long enough to tell if exercise might cause joint damage.

What is dynamic exercise and what is rheumatoid arthritis?

Dynamic exercise therapy programs means activities with enough intensity, duration, and frequency to improve stamina or muscle strength.   Exercise can be any activity that enhances physical fitness. Exercise which gives you more energy, endurance or stamina is often called aerobic exercise.  People exercise for many different reasons including weight loss, strengthening muscles and for general fitness.

When you have rheumatoid arthritis, your immune system, which normally fights infection, attacks the lining of your joints. This makes your joints swollen, stiff and painful. The small joints of your hands and feet are usually affected first. There is no cure for RA at present, so treatments such as exercise aim to relieve pain and stiffness and improve your ability to move. 

Best estimate of what happens to people with rheumatoid arthritis who take part in a short term land-based dynamic exercise program:

Pain (higher scores mean worse or more severe pain)

- People who took part rated their pain to be about half a point lower on a scale of 0 to 10 after 12 weeks (6% absolute improvement).
- People who took part in a dynamic exercise program rated their pain to be about half a point on a scale of 0 to 10.
- People who did not exercise rated their pain to be 1 on a scale of 0 to 10. 

Physical Function (higher score means worse physical function)

- People who took part rated their physical function to be about half a point lower on a scale of 0 to 3 after 12 weeks (6% absolute improvement).
- People who took part in a dynamic exercise program rated their physical function to be about 1.5 on a scale of 0 to 3.
- People who did not exercise rated their physical function to be 1 on a scale of 0 to 3. 

Laički sažetak

Dinamička tjelovježba za ublažavanje reumatoidnog artritisa

Ovaj sažetak Cochrane sutavnog pregleda predstavlja sažetak svih kliničkih pokusa o djelotvornosti tjelovježbe za reumatoidni artritis (RA). 

Ovaj pregled pokazuje da u osoba s reumatoidnim artritisom:

- Aerobna tjelovježba i vježbe za povećanje snage mišića na tvrdoj podlozi vjerojatno mogu malo ublažiti bol i tjelesnu funkciju u kratkom roku. 

- Nije bilo štetnih neželjenih učinaka (kao što je pojačanje boli ili oštećenje zglobova) tjelovježbe.  To je utvrđeno i za vježbe na tvrdoj podlozi i za vježbe u vodi, iako većina studija nije trajala dovoljno dugo da bi se moglo procijeniti je li tjelovježba dovela do oštećenja zglobova.

Što je dinamička tjelovježba i što je reumatoidni artritis?

Dinamička tjelovježba podrazumijeva aktivnosti koje imaju dovoljan intenzitet, trajanje i učestalost da bi poboljšali izdržljivost ili snagu mišića.   Tjelovježba može biti bilo kakva aktivnost koja poboljšava tjelesnu kondiciju. Tjelovježba koja daje više energije, izdržljivosti i snage često se naziva i aerobni trening.  Ljudi vježbaju zbog raznih razloga, uključujući mršavljenje, jačanje mišića i za opću kondiciju.

Kod reumatoidnog artritisa, imunološki sustav koji obično suzbija infekcije, napada ovojnice zglobova. Zbog toga su zglobovi otečeni, ukočeni i bolni. Obično su prvo pogođeni mali zglobovi u rukama i nogama. Trenutno nema lijeka za RA, tako da se koriste terapije koje ublažavaju simptome, a između ostalog i tjelovježba čiji je cilj ublažiti bol i ukočenost mišića te poboljšati pokretljivost pacijenata. 

Najbolja procjena o tome što se dogodi kad oboljeli od reumatoidnog artritisa vježbaju kratko vrijeme u programu dinamičke tjelovježbe na tvrdoj podlozi

Bol (više vrijednosti znače goru ili ozbiljniju bol)

-Osobe koje su vježbale ocijenile su svoju bol kao pola boda manju na ljestvici od 0 do 10 nakon 12 tjedana (6% apsolutno poboljšanje).
-Osobe koje su vježbale u dinamičkim programima tjelovježbe ocijenile su svoju bol kao 0,5 na ljestvici od 0 to 10.
-Osobe koje nisu vježbale ocijenile su svoju bol kao 1, na ljestvici od 0 do 10. 


Tjelesna funkcija (viši rezultat znači lošiju tjelesnu funkciju)

-Osobe koje su vježbale ocijenile su svoju tjelesnu funkciju kao pola boda manju na ljestvici od 0 do 13 nakon 12 tjedana (6% apsolutno poboljšanje).
-Osobe koje su vježbale u dinamičkim programima tjelovježbe ocijenile su svoju tjelesnu funkciju kao 1,5 na ljestvici od 0 to 3.
-Osobe koje nisu vježbale ocijenile su svoju tjelesnu funkciju kao 1, na ljestvici od 0 do 3. 

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Livia Puljak
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

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