Ytterberg S R, Mahowald M L, Krug H E
University of Minneapolis Medical School, Minneapolis 55417.
Baillieres Clin Rheumatol. 1994 Feb;8(1):161-89. doi: 10.1016/s0950-3579(05)80230-4.
The data available indicate that ROM, strengthening and aerobic conditioning exercises are safe for patients with OA, RA or AS, despite earlier concerns that exercise might exacerbate joint symptoms or accelerate disease. Less clear are the therapeutic benefits of exercise. In patients with OA, stretching, strengthening, and aerobic conditioning programmes can improve the deficits observed in these patients. The improvements observed generally have been small, and the evidence that these individual improvements result in improved overall function is minimal. None the less, it is likely that exercise will reduce pain, improve endurance for physical activities and improve cardiovascular fitness. Study of the long-term effects of exercise in the geriatric population, for sustaining independent living and functioning, is critically important for future health care and social expenditures. In RA, strengthening and aerobic conditioning exercise programmes can increase muscle strength and cardiovascular fitness and probably improve physical function as well. Improvements demonstrated in patients with RA seem more convincing than those in patients with OA and AS; this probably represents their poorer physical status prior to exercising. For patients with AS, intensive physiotherapy brings statistically significant short-term improvements in spinal and hip ROM which are only modestly clinically significant. It is possible that spinal mobility exercises decelerate loss of mobility over the long term, but controlled studies are needed to confirm this. Improvement in respiratory function with exercise appears to be related to cardiopulmonary fitness and perhaps to improvements in diaphragmatic respiration rather than to changes in thoracic cage mobility. Given the overall safety and likely benefits of the described forms of exercise, exercise should be included in the overall treatment of patients with OA, RA or AS. Careful patient evaluation and education about exercise should be a part of the exercise programme.
现有数据表明，尽管此前有人担心运动会加剧关节症状或加速疾病进展，但对于骨关节炎（OA）、类风湿关节炎（RA）或强直性脊柱炎（AS）患者而言，关节活动度（ROM）、强化训练和有氧运动是安全的。运动的治疗益处尚不明确。对于OA患者，伸展、强化训练和有氧运动计划可改善这些患者所观察到的功能缺陷。通常观察到的改善较小，且这些个体改善能带来整体功能改善的证据微乎其微。尽管如此，运动仍可能减轻疼痛、提高身体活动耐力并改善心血管健康状况。研究运动对老年人群维持独立生活和功能的长期影响，对于未来的医疗保健和社会支出至关重要。在RA中，强化训练和有氧运动计划可增加肌肉力量和心血管健康状况，可能还会改善身体功能。RA患者所显示的改善似乎比OA和AS患者更具说服力；这可能是因为他们在运动前身体状况较差。对于AS患者，强化物理治疗在短期内可使脊柱和髋关节ROM取得具有统计学意义的改善，但在临床上仅具有适度的意义。从长期来看，脊柱活动度锻炼有可能减缓活动能力的丧失，但需要对照研究来证实这一点。运动带来的呼吸功能改善似乎与心肺健康状况有关，或许还与膈肌呼吸的改善有关，而非胸廓活动度的变化。鉴于上述运动形式总体上具有安全性且可能有益，应将运动纳入OA、RA或AS患者的整体治疗中。对患者进行仔细评估并就运动进行教育应成为运动计划的一部分。
