title: Efficacy of resistance exercises in rheumatoid arthritis: meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To evaluate the efficacy of resistance exercises in RA patients.
  
  
  METHODS
  A systematic literature search was done using Pubmed, Embase and Cochrane databases through November 2009 and in abstracts presented at rheumatology scientific meetings over the past 3 years. Randomized controlled trials (RCTs) comparing resistance exercise based therapy with interventions without resistance exercise for the treatment of RA patients were included. Outcomes studied were post-intervention disability on the HAQ, functional capacity assessed by walking speed, pain on the visual analogue scale (VAS), joint count, isometric, isokinetic and grip strength. Efficacy was assessed by weighted mean differences (WMDs) and tolerance was assessed by relative risk (RR). Data were pooled using the inverse of variance model, and heterogeneity was tested.
  
  
  RESULTS
  Ten RCTs, including 547 patients, met the study inclusion criteria. The mean (S.D.) Jadad score was 2.3 (0.6). Resistance exercises significantly improved isokinetic strength (WMD = 23.7%, P < 0.001), isometric strength (WMD = 35.8%, P < 0.001), grip strength (WMD = 26.4%, P < 0.001) and HAQ (WMD = -0.22, P < 0.001). Exercise also had a positive impact on the 50-foot walking test (WMD = -1.90 s, P < 0.001) and ESR (WMD = -5.17, P = 0.005). Withdrawals [RR = 0.95, 95% confidence interval (CI) 0.61, 1.48] and adverse events (RR = 1.08, 95% CI 0.72, 1.63) were well balanced in both groups. Patient and exercise characteristics did not influence the results. Subgroup analysis revealed a trend towards higher efficacy associated with high-intensity programmes.
  
  
  CONCLUSIONS
  Resistance exercise in RA is safe, and the improvement in most outcomes was statistically significant and possibly clinically relevant for RA disability.
authors: Hôpital Sud, Grenoble Teaching Hospital, Echirolles Cedex, France. abaillet@chu-grenoble.fr
authors: Athan
authors: A
authors: Baillet
authors: Mathieu
authors: M
authors: Vaillant
authors: Michel
authors: M
authors: Guinot
authors: Robert
authors: R
authors: Juvin
authors: Philippe
authors: P
authors: Gaudin
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000628:therapy*; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic; D055070:Resistance Training / Q000009:adverse effects / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome