06-4 Comparative efficacy of gym high-intensity dynamic exercises and therapeutic exercises in patients with early rheumatoid arthritis: 6-month randomized controlled trial

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Objectives: Тo compare the efficacy of two 6-month exercise programs in patients with early rheumatoid arthritis (RA).
Patients and Methods: 51 patients with early RA were randomized into 3 groups. At hospital stage 15 patients underwent 10 high-intensity dynamic exercises using gym apparatus Enraf-Nonius for 45-60 min, including aerobic part (En-Cardio) and 18-20 muscle-strengthening exercises (En-Dynamic Track), 18 patients - 10 therapeutic exercises for joints for 45 min under the supervision of a trainer. At outpatient stage the exercises lasted for 6 months 3 times a week. 18 patients received only drug therapy (control). Tender and swollen joint count, pain on 100-mm visual analogue scale (VAS), erythrocyte sedimentation rate (ESR), Disease Activity Score (DAS28), Stanford Health Assessment Questionnaire (HAQ), Rheumatology Assessment Patient Index Data (RAPID3), the average powers of knee extension and ankle flexion by EN-TreeM movement analysis were evaluated at baseline and at 6 months.
Results: After 6 months in the both exercise groups there were statistically significant differences from the control group in most parameters (p<0.05) (table). Efficacy of the intensive gym exercises was higher than the therapeutic exercises by tender joint count, HAQ, RAPID3 (p<0.05). After 6 months in the gym group tender joint count decreased by 62.0%, swollen joint count - by 56.3%, ESR - by 54.8%, pain - by 60.7%, DAS28 - by 0.99±0.14, HAQ - by 0.91±0.33, RAPID3 - by 5.22±1.25, the extension power of a weaker knee joint increased by 74.7%, the flexion power of a more affected ankle joint - by 71.8% (р<0.01). Adherence to the regular therapeutic exercises for 6 months was better (77.8%) then to the gym exercises (60.0%). Predictors of the regular high-intensity gym exercises were the young age (under 40 years) and the very early stage of RA. Most patients, who regularly did exercises, had low disease activity (66.7% in the gym group and 57.1% in the therapeutic exercises group vs 36.7% in the control group, р<0.05).
Conclusion: The both exercise programs increase functional status, quality of life and power of motion without detrimental effect on disease activity. Gym exercises should be recommended to young RA patients with the short duration of the disease.