Exercise therapy in patients with rheumatoid arthritis and osteoarthritis: A review

Exercise therapy in patients with rheumatoid arthritis (RA) or osteoarthritis (OA) is controversial, because both improvement and deterioration of the patients' condition can be expected to occur. The literature was searched for studies on the outcome of exercise therapy in RA- and OA-patients. Twenty-four studies were identified, comprising nine controlled studies. In the present review, these studies are critically summarized. It was found that controlled studies have only reported improvements or non-significant results; deterioration of the patients' condition has not been reported. With regard to specific modalities of exercise therapy, it was found that aerobic exercise in RA-patients has been most thoroughly studied: improvements for specific categories of outcome (e.g., walking time and other sorts of observed disability) have been repeatedly reported, while for other categories of outcome (e.g., pain) non-significant results have been consistently reported. Several methodological deficiencies (concerning randomization, blinded evaluation and power) and assets (concerning compliance) in controlled studies are noted and evaluated. It is concluded that, despite several qualifications, the available evidence is in favor of exercise therapy in RA- and OA-patients. Neglected areas of research, including comparisons between subgroups of patients, are identified and suggestions for future research are given.