Abstract
Background
Inflammatory arthritis [IA] has adverse effects on strength, function, fatigue and well-being. Guidelines recommend people with IA should exercise to improve strength and cardiovascular fitness. In 2015, our Rheumatology Physiotherapy Team introduced an evidence-based Progressive Resistance Training Programme [PRTP] for people with IA. This research aimed to evaluate its effectiveness within a United Kingdom National Health Service [NHS] setting.
Methods
A pre- to post-treatment evaluation was conducted. People with IA attending Rheumatology Physiotherapy were offered the supervised PRTP (1-hour x 10 weeks), performing 7 resistance exercises each session (70-80% 1RM, 3 x 8-12 reps). Pre- and post-treatment outcomes included Health Assessment Questionnaire [HAQ], EQ5D-5L, Self-Efficacy (SARAH Trial), 30 second Sit-to-Stand [STS], FACIT-F (fatigue scale) and Grip Strength. Changes in outcomes were analysed using Paired Samples t-tests and standardised mean difference (SMD) were calculated.
Results
201 patients commenced the programme between May 2015 and April 2019, with 121 participants completing it. Diagnoses included Rheumatoid Arthritis (n = 149), Psoriatic Arthritis (n = 42), Juvenile Idiopathic Arthritis (n = 5), Enteropathic IA (n = 2), Oligoarthritis (n = 1), Reactive Arthritis (n = 1) and Undifferentiated IA (n = 1). Age = mean 56.8 ± SD 14.8 years; number of sessions attended = 7.7 ± 3.4. There were no differences between participants not completing (n = 54; 72% women; age 55.0 ± 14.6 years; HAQ 0.99 ± 0.70) versus those completing the PRTP (n = 147; 78% women; age 57.5 ± 14.8 years; HAQ 0.86 ± 0.65). A pragmatic decision was made to analyse all available data for each outcome.
Conclusion
All outcome measures demonstrated statistically significant improvements. Notably, minimal clinically important differences were achieved in STS and FACIT-F. STS correlates to lower limb power, balance and endurance, and is a predictor of falls. Fatigue significantly impacts function in people with IA, often limiting confidence and willingness to participate in exercise activities. Effective evidence based PRTPs for people with IAs can be delivered in an NHS service. Improvements in function, wellbeing, self-efficacy, strength and fatigue are achievable, however, exploration of the clinical relevance of these observed changes is recommended. Further research exploring patients’ perspectives of the PRTP and adherence to long-term exercise is needed.
Disclosures
J. Skeates: None. J. Pearson: None. S. Derham: None. S. Palmer: None.
The effects of progressive resistance training on daily physical activity in young people with cerebral palsy: a randomised controlled trial
