title: Slowing of bone loss in patients with rheumatoid arthritis by long-term high-intensity exercise: results of a randomized, controlled trial.
abstract: OBJECTIVE
  Patients with rheumatoid arthritis (RA) are more at risk for the development of osteoporosis and osteoporotic fractures than are their healthy peers. In this randomized, controlled, multicenter trial, the effectiveness of a 2-year high-intensity weight-bearing exercise program (the Rheumatoid-Arthritis-Patients-In-Training [RAPIT] program) on bone mineral density (BMD) was compared with usual care physical therapy, and the exercise modalities associated with changes in BMD were determined.
  
  
  METHODS
  Three hundred nine patients with RA were assigned to an intervention group, either the RAPIT program or usual care physical therapy. The primary end points were BMD of the hip and spine. The exercise modalities examined were aerobic fitness, muscle strength, and, as a surrogate for those effects not directly measured by the RAPIT program, attendance rate.
  
  
  RESULTS
  The data on the 136 RAPIT participants and 145 usual care participants who completed the study were analyzed. The mean rate of decrease in hip BMD, but not in lumbar spine BMD, was smaller in patients participating in the RAPIT program when compared with that in the usual care group, with a mean decrease of 1.6% (95% confidence interval [95% CI] 0.8-2.5) over the first year and 0.5% (95% CI 1.1-2.0) over the second year. The change in hip BMD was significantly and independently associated with changes in both muscle strength (multivariate odds ratio [OR] 1.75, 95% CI 1.07-2.86) and aerobic fitness (OR 1.79, 95% CI 1.10-2.90), but not with the attendance rate (OR 1.00, 95% CI 0.99-1.00).
  
  
  CONCLUSIONS
  A long-term high-intensity weight-bearing exercise program for RA patients is effective in slowing down the loss of BMD at the hip. The exercise modalities associated with this effect are muscle strength and aerobic fitness.
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: de Jong
authors.forename: Marten
authors.initials: M
authors.lastname: Munneke
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.forename: Herman M
authors.initials: HM
authors.lastname: Kroon
authors.forename: Ernest K J
authors.initials: EK
authors.lastname: Pauwels
authors.forename: Annemarie
authors.initials: A
authors.lastname: Jansen
authors.forename: Karel H
authors.initials: KH
authors.lastname: Ronday
authors.forename: Ben A C
authors.initials: BA
authors.lastname: Dijkmans
authors.forename: Ferdinand C
authors.initials: FC
authors.lastname: Breedveld
authors.forename: Theodora P M
authors.initials: TP
authors.lastname: Vliet Vlieland
authors.forename: Johanna M W
authors.initials: JM
authors.lastname: Hazes
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D015519:Bone Density; D004164:Diphosphonates / Q000627:therapeutic use; D015444:Exercise; D005081:Exercise Therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006621:Hip Joint; D006801:Humans; D008297:Male; D008875:Middle Aged; D009129:Muscle Tonus; D010024:Osteoporosis / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D010809:Physical Fitness; D016474:Weight-Bearing
chemical_list: D004164:Diphosphonates; D005938:Glucocorticoids