Orlova E V, Karateev D E, Kochetkov A V, Mozhar T E
Vopr Kurortol Fizioter Lech Fiz Kult. 2013 Mar-Apr(2):14-9.
The objective of the present work was to compare the effectiveness of two therapeutic exercise programs for the patients presenting with early rheumatoid arthritis (RA). The study included 51 patients. Fifteen of them (group 1) were given conventional medicamental therapy in combination with high-intensity dynamic physical exercises with the use of the Enraf-Nonius training devices (45-60 min). Eighteen patients of group 2 were offered 10 sessions of remedial gymnastics for the joints (45 min each) under the guidance of an instructor that were continued under the domestic conditions (45 min each session thrice weekly for 3 months). Eighteen patients of group 3 were given medicamental therapy alone (control). The parameters estimated in the study included the mean strength of knee joint extension and ankle joint flexion measured with the use of En-TreeM devices, articular pain (100 mm BAHI), DAS28, HAQ, and RAPID3 indices. It was shown that both programs of therapeutic exercises reduced the severity of the disease, improved the functional and motor activity of the patients and their quality of life. The majority of these characteristics were significantly different from those documented in the control group (p<0.05). The clinical effectiveness of high-intensity training with the use of exercise machines was higher than without them (articular pain was reduced by 57.9% (p<0.01), DAS28 by 24.7% (p<0.05), HAQ by 60.7% (p<0.01). RAPID3 by 47.5% (p<0.01), mean strength of extension of the weak and strong knee joints increased by 87.9% (p<0.01) and 70.5% (p<0.01) respectively, the strength of flexion of the severely and less severely affected ankle joints increased by 84.6 (p<0.01) and 68.8% (p<0.01) respectively. Compliance with regular performance of therapeutic joint exercises during 3 months was higher (83.3%) than with high-intensity dynamic training with the use of exercise machines (60%). It is concluded that the latter modality should be recommended to the younger patients with RA (below 40 years), a short history of the disease, and its low activity.
本研究的目的是比较两种治疗性锻炼方案对早期类风湿关节炎（RA）患者的有效性。该研究纳入了51名患者。其中15名（第1组）接受了传统药物治疗，并结合使用恩拉夫-诺尼乌斯训练设备进行高强度动态体育锻炼（45 - 60分钟）。第2组的18名患者在教练指导下进行了10节关节康复体操课程（每节45分钟），之后在家庭环境中继续进行（每周三次，每次45分钟，共3个月）。第3组的18名患者仅接受药物治疗（对照组）。研究中评估的参数包括使用En-TreeM设备测量的膝关节伸展和踝关节屈曲的平均力量、关节疼痛（100毫米BAHI）、DAS28、HAQ和RAPID3指数。结果表明，两种治疗性锻炼方案均降低了疾病的严重程度，改善了患者的功能和运动活动以及生活质量。这些特征中的大多数与对照组记录的特征有显著差异（p<0.05）。使用运动器械进行高强度训练的临床效果高于不使用运动器械的情况（关节疼痛减轻了57.9%（p<0.01），DAS28降低了24.7%（p<0.05），HAQ降低了60.7%（p<0.01），RAPID3降低了47.5%（p<0.01），弱侧和强侧膝关节伸展的平均力量分别增加了87.9%（p<0.01）和70.5%（p<0.01），严重和不太严重受影响的踝关节屈曲力量分别增加了84.6%（p<0.01）和68.8%（p<0.01）。在3个月内，坚持定期进行关节治疗性锻炼的依从性（83.3%）高于使用运动器械进行高强度动态训练的依从性（60%）。得出的结论是，对于年龄较轻（40岁以下）、病程短且疾病活动度低的类风湿关节炎患者，应推荐后一种方式。
