La ralentización de la pérdida de hueso en pacientes con artritis reumatoidea por el ejercicio de alta intesidad y a largo plazo: Resultados de una randomización, ensayo controlado.
Zuzana de Jong 1 *, Marten Munneke 1, Willem F. Lems 2, Aeilko H. Zwinderman 1, Herman M. Kroon 1, Ernest K. J. Pauwels 1, Annemarie Jansen 3, Karel H. Ronday 4, Ben A. C. Dijkmans 5, Ferdinand C. Breedveld 1, Theodora P. M. Vliet Vlieland 1, Johanna M. W. Hazes 6 1Leiden University Medical Center, Leiden, The Netherlands 2Vrije Universiteit Medical Center, Amsterdam, The Netherlands 3Jan van Breemen Instituut, Amsterdam, The Netherlands 4Leyenburg Hospital, The Hague, The Netherlands 5Leiden University Medical Center, Leiden and Jan van Breemen Instituut, Amsterdam, The Netherlands 6Leiden University Medical Center, Leiden and Erasmus Medical Center, Rotterdam, The Netherlands
Patients with rheumatoid arthritis (RA) are more at risk for the development of osteoporosis and osteoporotic fractures than are their healthy peers. In this randomized, controlled, multicenter trial, the effectiveness of a 2-year high-intensity weight-bearing exercise program (the Rheumatoid-Arthritis-Patients-In-Training [RAPIT] program) on bone mineral density (BMD) was compared with usual care physical therapy, and the exercise modalities associated with changes in BMD were determined. Methods
Three hundred nine patients with RA were assigned to an intervention group, either the RAPIT program or usual care physical therapy. The primary end points were BMD of the hip and spine. The exercise modalities examined were aerobic fitness, muscle strength, and, as a surrogate for those effects not directly measured by the RAPIT program, attendance rate. Results
The data on the 136 RAPIT participants and 145 usual care participants who completed the study were analyzed. The mean rate of decrease in hip BMD, but not in lumbar spine BMD, was smaller in patients participating in the RAPIT program when compared with that in the usual care group, with a mean decrease of 1.6% (95% confidence interval [95% CI] 0.8-2.5) over the first year and 0.5% (95% CI 1.1-2.0) over the second year. The change in hip BMD was significantly and independently associated with changes in both muscle strength (multivariate odds ratio [OR] 1.75, 95% CI 1.07-2.86) and aerobic fitness (OR 1.79, 95% CI 1.10-2.90), but not with the attendance rate (OR 1.00, 95% CI 0.99-1.00). Conclusion
A long-term high-intensity weight-bearing exercise program for RA patients is effective in slowing down the loss of BMD at the hip. The exercise modalities associated with this effect are muscle strength and aerobic fitness.