Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial.
OBJECTIVE
To confirm, in a randomized controlled trial (RCT), the efficacy of high-intensity progressive resistance training (PRT) in restoring muscle mass and function in patients with rheumatoid arthritis (RA). Additionally, to investigate the role of the insulin-like growth factor (IGF) system in exercise-induced muscle hypertrophy in the context of RA.


METHODS
Twenty-eight patients with established, controlled RA were randomized to either 24 weeks of twice-weekly PRT (n = 13) or a range of movement home exercise control group (n = 15). Dual x-ray absorptiometry-assessed body composition (including lean body mass [LBM], appendicular lean mass [ALM], and fat mass); objective physical function; disease activity; and muscle IGFs were assessed at weeks 0 and 24.


RESULTS
Analyses of variance revealed that PRT increased LBM and ALM (P < 0.01); reduced trunk fat mass by 2.5 kg (not significant); and improved training-specific strength by 119%, chair stands by 30%, knee extensor strength by 25%, arm curls by 23%, and walk time by 17% (for objective function tests, P values ranged from 0.027 to 0.001 versus controls). In contrast, body composition and physical function remained unchanged in control patients. Changes in LBM and regional lean mass were associated with changes in objective function (P values ranged from 0.126 to <0.0001). Coinciding with muscle hypertrophy, previously diminished muscle levels of IGF-1 and IGF binding protein 3 both increased following PRT (P < 0.05).


CONCLUSIONS
In an RCT, 24 weeks of PRT proved safe and effective in restoring lean mass and function in patients with RA. Muscle hypertrophy coincided with significant elevations of attenuated muscle IGF levels, revealing a possible contributory mechanism for rheumatoid cachexia. PRT should feature in disease management.
Lemmey
Andrew B
AB
Bangor University, Bangor, UK. a.b.lemmey@bangor.ac.uk
Marcora
Samuele M
SM
Chester
Kathryn
K
Wilson
Sally
S
Casanova
Francesco
F
Maddison
Peter J
PJ
D001172:Arthritis, Rheumatoid / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D001823:Body Composition; D002100:Cachexia / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D005081:Exercise Therapy; D005260:Female; D006304:Health Status; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000378:metabolism; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000254:growth & development / Q000378:metabolism; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018972:Insulin-Like Growth Factor Binding Protein 3; D007334:Insulin-Like Growth Factor I