title: Assessment of a sixteen-week training program on strength, pain, and function in rheumatoid arthritis patients.
abstract: OBJECTIVE
  To assess the effects of a 16-week progressive, individualized, high-intensity strength training program on muscle strength, pain, and function in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  Twenty-four RA patients (men, n = 5; women, n = 19) receiving infliximab participated in a randomized controlled trial. The strength training (ST) group (n = 16) participated in a supervised program 3 times per week, and the control (C) group (n = 8) continued with standard of care as overseen by their rheumatologist. Assessments were completed at baseline and at weeks 8 and 16. Strength was measured by 3 repetition maximum (3RM), isometric hand dynamometer, and isokinetic dynamometer. A 100-mm visual analogue scale was used to assess pain. Functional performance was derived from a timed 50-foot walk and the Health Assessment Questionnaire Disability Index.
  
  
  RESULTS
  The mean percent increase in strength (3RM) for the ST group from baseline to week 16 was 46.1% +/- 31.6% (P < 0.01) (mean of all three 3RM exercises: hammer curl, leg press, and incline dumbbell press), with mean gains in strength up to 4 times that of baseline values reported in all strength training exercises (upper and lower body) performed during exercise sessions. On average, right-hand grip strength increased by 2.9 +/- 4.0 kg in the ST group, in comparison with a loss of 1.2 +/- 3.0 kg in the C group over 16 weeks. The ST group had a 53% reduction in pain, in comparison with almost no change in the C group. The ST group had a significant improvement in 50-foot walk time, with a mean reduction of -1.2 +/- 1.6 seconds, in comparison with the C group (mean increase of 0.8 +/- 1.0 seconds; P = 0.01) over the 16 weeks. There was a clinically important difference (predefined as mean change +/-0.25) in the Health Assessment Questionnaire Disability Index in the ST group (-0.4 +/- 0.4) but not in the C group (-0.1 +/- 0.4).
  
  
  CONCLUSIONS
  High-intensity strength training in RA patients with varying levels of disease activity and joint damage had a large, significant effect on strength, and led to improvements in pain and function, with additive patient benefits beyond the effect of their infliximab use.
authors.affiliation: Department of Kinesiology, Boise State University, Boise, Idaho, USA. hilaryflint-wagner@boisestate.edu
authors.forename: Hilary G
authors.initials: HG
authors.lastname: Flint-Wagner
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lisse
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Lohman
authors.forename: Scott B
authors.initials: SB
authors.lastname: Going
authors.forename: Terri
authors.initials: T
authors.lastname: Guido
authors.forename: Ellen
authors.initials: E
authors.lastname: Cussler
authors.forename: Donald
authors.initials: D
authors.lastname: Gates
authors.forename: David E
authors.initials: DE
authors.lastname: Yocum
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D018771:Arthralgia / Q000503:physiopathology*; D001172:Arthritis, Rheumatoid / Q000503:physiopathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D015444:Exercise / Q000502:physiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D000069285:Infliximab; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D010865:Pilot Projects; D055070:Resistance Training / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab