Häkkinen A, Sokka T, Kotaniemi A, Hannonen P
Central Finland Health Care District, Jyväskylä, Finland.
Arthritis Rheum. 2001 Mar;44(3):515-22. doi: 10.1002/1529-0131(200103)44:3<515::AID-ANR98>3.0.CO;2-5.
To evaluate the impact of a 2-year program of strength training on muscle strength, bone mineral density (BMD), physical function, joint damage, and disease activity in patients with recent-onset (<2 years) rheumatoid arthritis (RA).
In this prospective trial, 70 RA patients were randomly assigned to perform either strength training (all major muscle groups of the lower and upper extremities and trunk, with loads of 50-70% of repetition maximum) or range of motion exercises (without resistance) twice a week; all were encouraged to engage in recreational activities 2-3 times a week. All patients completed training diaries (evaluated bi-monthly) and were examined at 6-month intervals. All were treated with medications to achieve disease remission. Maximum strength of the knee extensors, trunk flexors and extensors, and grip strength was measured with dynamometers. BMD was measured at the femoral neck and lumbar spine by dual x-ray densitometry. Disease activity was determined by the Disease Activity Score, the extent of joint damage by the Larsen score, and functional capacity by the Health Assessment Questionnaire (HAQ); walking speed was also measured.
Sixty-two patients (31 per group) completed the study. Strength training compliance averaged 1.4-1.5 times/week. The maximum strength of all muscle groups examined increased significantly (19-59%) in the strength-training group, with statistically significant improvements in clinical disease activity parameters, HAQ scores, and walking speed. While muscle strength, disease activity parameters, and physical function also improved significantly in the control group, the changes were not as great as those in the strength-training group. BMD in the femoral neck and spine increased by a mean +/- SD of 0.51 +/- 1.64% and by 1.17 +/- 5.34%, respectively, in the strength-training group, but decreased by 0.70 +/- 2.25% and 0.91 +/- 4.07% in the controls. Femoral neck BMD in the 17 patients with high initial disease activity (and subsequent use of oral glucocorticoids) remained constantly at a statistically significantly lower level than that in the other 45 patients.
Regular dynamic strength training combined with endurance-type physical activities improves muscle strength and physical function, but not BMD, in patients with early RA, without detrimental effects on disease activity.
评估一项为期2年的力量训练计划对近期发病（<2年）类风湿关节炎（RA）患者的肌肉力量、骨密度（BMD）、身体功能、关节损伤和疾病活动的影响。
在这项前瞻性试验中，70例RA患者被随机分为两组，一组进行力量训练（下肢、上肢和躯干的所有主要肌肉群，负荷为最大重复次数的50 - 70%），另一组进行每周两次的无阻力关节活动度练习；鼓励所有患者每周进行2 - 3次娱乐活动。所有患者完成训练日记（每两个月评估一次），并每隔6个月接受检查。所有患者均接受药物治疗以实现疾病缓解。使用测力计测量膝伸肌、躯干屈肌和伸肌的最大力量以及握力。通过双能X线骨密度仪测量股骨颈和腰椎的骨密度。通过疾病活动评分确定疾病活动度，通过 Larsen 评分确定关节损伤程度，通过健康评估问卷（HAQ）确定功能能力；同时测量步行速度。
62例患者（每组31例）完成了研究。力量训练的依从性平均为每周1.4 - 1.5次。力量训练组中所有检测的肌肉群的最大力量均显著增加（19 - 59%），临床疾病活动参数、HAQ评分和步行速度也有统计学意义的显著改善。虽然对照组的肌肉力量、疾病活动参数和身体功能也有显著改善，但变化不如力量训练组大。力量训练组中股骨颈和脊柱的骨密度分别平均增加了0.51±1.64%和1.17±5.34%，而对照组分别下降了0.70±2.25%和0.91±4.07%。17例初始疾病活动度高（随后使用口服糖皮质激素）患者的股骨颈骨密度始终显著低于其他45例患者。
对于早期RA患者，定期进行动态力量训练并结合耐力型体育活动可改善肌肉力量和身体功能，但不能提高骨密度，且对疾病活动无不利影响。
