Resistance training is far from futile
Published on 01 July 2010
New research has shown the effectiveness of weight-training in people with rheumatoid arthritis. Jane Tadman finds out more.
An unlikely form of “treatment” that has been shown to help people with rheumatoid arthritis (RA) might never match anti-TNF therapy. But for those patients prepared to pump regular iron in the gym, weight-lifting could make quite a difference to their quality of life – not to mention the quality of their muscles and overall strength.
Although RA is primarily a disease affecting the joints, it also severely reduces muscle mass and strength at a greater rate than in healthy people,leading to more disability. And now an Arthritis Research UK trial of RA patients in North Wales has shown that intensive resistance training improved their muscle mass and ability to perform everyday tasks. And while sweating over bench presses, leg extensions and abdominal crunches might not be every RA patient’s idea of therapy, for two willing volunteers, friends Chris Jones and Pat Hopkins, taking part in the twice-weekly training sessions for 24 weeks was a very positive experience.
Chris, aged 59, and Pat, who is 66, are both firm believers in the benefits of exercise, despite having severe RA. Pat is doing well on adalimumab, and Chris, who has been on a number of different drugs but suffered severe side-effects, is now managing without medication.Both thoroughly enjoyed the supervised resistance training sessions.
“I enjoy anything that’s a bit physical, that gets you going,” says Chris, a former canteen lady at a local school. “I felt that I was doing something about my condition. The fact that we were being supervised was very important. You don’t want someone watching you all the time but you need to know you’re doing it right – we were pushed and pushed and pushed and I couldn’t have done that on my own.”
The weights the volunteers were lifting were not for the faint-hearted, and study leader Dr Andrew Lemmey from the School of Sport, Health and Exercise Sciences at Bangor University says that the relative intensity at which they worked was the equivalent of what an athlete would do.
"The amount of weight they were lifting was substantially less than that of an athlete because of their muscle waste, but the effort they put into it was the same – 80 per cent of their absolute maximum,” he explains.
Chris Jones concurs: “I was pushed more than body builders were, and if I’d kept it up over a longer period of time I would have ended up with really chunky muscles.”
Unfortunately neither of the women kept up the same level of intensive weight-training after the trial ended although both still regularly exercise.
Says Pat: “The weight-lifting really worked for me, and I put on a lot of muscle and felt a lot better while I was doing it. Supervision is very important as you push yourself harder. We both hate the gym if we’re not with people who are helping and encouraging us. The normal municipal gyms are not very good for people who are older and have something wrong with them – and they’re always full of posers!”
Dr Lemmey picks up the point about the need for supervision. “All the exercise sessions were supervised by a trained physiotherapist and all our volunteers said this was fantastic. Motivation is the key. They knew what they had to do and there was an expectancy that they would do it, and people were happy to go to the sessions because they saw it was doing them some good, although it required a lot of time and effort. But to be effective it appears that the sessions have to be supervised.”
This reliance on a trained supervisor leading the sessions is now making it difficult to take the research forward, because employing experienced physiotherapists bumps up the cost.
Dr Lemmey, in conjunction with rheumatologists throughout the UK
(led by Professor Peter Maddison at Bangor University) is keen to set up a large multi-centre trial to look at the cost effectiveness of resistance training in RA patients, and wants to convince the NHS that it’s worth doing.
“We’ve shown that resistance training is very effective, but we can’t expect the NHS to afford supervised sessions twice a week for all patients with RA,” he says. “Making the sessions supervised makes it very expensive, but we are hopeful that there is a way round it. We might be able to combine supervised and unsupervised sessions, and we might need to involve a psychologist to help people get in the loop and maintain a routine, ie to invoke a behaviour change that allows them to incorporate exercise into their daily lifestyle.”
While the message to people with all kinds of arthritis to exercise is something that Arthritis Research UK has long promoted, Dr Lemmey makes it clear that general range of movement exercises are insufficient to build muscle, lose fat and improve physical function in RA patients. A high intensity exercise programme is needed.
It remains unlikely that this approach will be either suitable or appropriate for some people with RA. For women like Chris and Pat, who are motivated and describe themselves as “not sitterdowners”, however, it made a huge difference.
Adds Chris: “I would love to do the resistance training like I did before. It was very intense. Quite a few people have said to me: ‘Oh I could never do that because I have too much pain.’ I tell them that I have pain too! I think some people think they should have no pain, and they are not prepared to push themselves...... but I absolutely loved it.”
Researchers at Bangor University and Gwynedd Hospital recruited 28 patients with RA in order to study the effect of high-intensity progressive resistance training on their muscles. Volunteers were divided into two study groups, with 13 participants taking part in twice-weekly resistance training sessions for 24 weeks and the remaining 15 patients doing a series of home exercises. The group represented the average RA patient; two thirds were women, with an average age of 56, who had had RA for about eight years, and their disease was under control. The drop-out rate was very low, and the compliance rate was above 80 per cent.
Assessments were carried out at the beginning and end of the 24-week study period and the findings were published in the journal Arthritis Care & Research.
The researchers found that people who took part in resistance training sessions typically benefited from an increase in lean body mass – a person’s body weight minus their fat – and appendicular lean mass, which is the mass of the muscles in the arms and legs, and a decrease in total fat mass, which was apparent in a reduction of fat mass in their trunk (so reducing their risk of diabetes and cardio-vascular disease).
Participants’ strength in terms of training improved by 119 per cent, including a 30 per cent improvement in chair stands, a 25 per cent rise in knee extensor strength, a 23 per cent increase in arm curls and a 17 per cent improvement in walk time. In fact, function in these patients improved to the point where it was the equivalent to that of healthy individuals of the same age; in other words, RA-related disability had been removed.
Increases in muscle volume were also found to be associated with a rise in muscle levels of insulin-like growth factor 1 (IGF-1) and IGF binding protein 3, both of which promote the growth of muscles, bone and cartilage.
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