Hôpital Sud, Grenoble Teaching Hospital, Echirolles Cedex, France.
Rheumatology (Oxford). 2012 Mar;51(3):519-27. doi: 10.1093/rheumatology/ker330. Epub 2011 Nov 24.
To evaluate the efficacy of resistance exercises in RA patients.
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.
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.
Resistance exercise in RA is safe, and the improvement in most outcomes was statistically significant and possibly clinically relevant for RA disability.
评估抗阻运动治疗类风湿关节炎（RA）的疗效。
检索 Pubmed、Embase 和 Cochrane 数据库自建库至 2009 年 11 月及近 3 年的风湿病学术会议摘要，纳入比较抗阻运动疗法与不包括抗阻运动疗法的干预措施治疗 RA 患者的随机对照试验（RCT）。研究的结局指标包括干预后 HAQ 残疾指数、步行速度评估的功能能力、视觉模拟量表（VAS）疼痛评分、关节计数、等长和等速肌力及握力。采用加权均数差（WMD）评估疗效，采用相对危险度（RR）评估耐受性。采用方差倒数模型进行数据合并，并进行异质性检验。
纳入 10 项 RCT，共 547 例患者。Jadad 评分的均数（标准差）为 2.3（0.6）。抗阻运动显著改善了等速肌力（WMD=23.7%，P＜0.001）、等长肌力（WMD=35.8%，P＜0.001）、握力（WMD=26.4%，P＜0.001）和 HAQ（WMD=-0.22，P＜0.001）。运动还对 50 英尺步行测试（WMD=-1.90s，P＜0.001）和红细胞沉降率（WMD=-5.17，P=0.005）有积极影响。两组的退出率[RR=0.95，95%置信区间（CI）0.61，1.48]和不良事件（RR=1.08，95%CI 0.72，1.63）差异无统计学意义。患者和运动特征未影响结果。亚组分析显示，高强度方案与更高的疗效相关。
RA 患者进行抗阻运动是安全的，且大多数结局指标的改善具有统计学意义，对 RA 残疾可能具有临床相关性。
