There are two major types of arthritis, osteoarthritis and rheumatoid arthritis, as well as an associated condition known as fibromyalgia. It is predicted that by 2020 approximately 60 million Americans will be diagnosed with arthritis, which will be a 40% increase in this malady over just the past 20 years.3
Osteoarthritis, which accounts for almost 95% of arthritic cases, is caused by degeneration of articular cartilage and subchondral bone and is characterized by pain, weakness, and dysfunction in the affected joints.14 Rheumatoid arthritis, which makes up about 5% of arthritic cases, is an inflammatory, autoimmune disorder that is characterized by pain, weakness, and dysfunction in the affected joints, as well as by muscle loss and fat gain known as rheumatoid cachexia.20 Fibromyalgia, which is experienced by up to 3% of the population (mostly women) is a less understood condition that is characterized by widespread pain, weakness, fatigue, and sleep interference.7,8,16
Muscle loss and fat gain are associated with osteoarthritis, rheumatoid arthritis, and fibromyalgia, and exacerbate each of these disorders.14,16,19,20 It is therefore logical to assume that resistance exercise may be an effective means for counteracting some of the debilitating aspects of these diseases. Indeed, numerous studies have shown positive results in osteoarthritis, rheumatoid arthritis, and fibromyalgia patients who participated in supervised strength training programs.
With respect to knee osteoarthritis, two major research reviews have reported beneficial outcomes subsequent to participation in strength training programs.10,15 A study by Jan and Liau13 found that resistance training reduced arthritic discomfort, and a study by King and colleagues14 determined that resistance training increased knee extensor and flexor strength without increased knee joint pain. Ettinger and associates9 found that both resistance exercise and aerobic training resulted in more strength, less disability, and less pain for older adults with knee osteoarthritis. One study4 revealed strength increases in older women with knee osteoarthritis and total knee arthroplasty after 13 weeks of twice-weekly resistance training sessions. A follow-up study5 using the same strength training program produced significant improvements in functional performance and unilateral balance in older women with both knee osteoarthritis and total knee arthroplasty.
With respect to rheumatoid arthritis, resistance training has resulted in increased muscle strength, muscle mass, muscle fiber cross-sectional area, and muscle nuclei, thereby counteracting the effects of rheumatoid cachexia.20 A two-year strength training study by Hakkinen and colleagues12 showed significant improvements in muscle strength and systemic inflammation in patients with rheumatoid arthritis. Other studies have demonstrated beneficial effects of resistance training for people with rheumatoid arthritis, including increased muscle, decreased fat, and improved physical function.17, 18 A comprehensive review of research on this topic concluded that individuals who have rheumatoid arthritis should include resistance exercise as part of their routine care.6
As with arthritis, several studies have demonstrated that resistance exercise may have positive effects in people with fibromyalgia.1,2,11 Research programs incorporating two weekly strength training sessions have shown a variety of reinforcing results in women with fibromyalgia. A study by Ernberg and colleagues8 revealed reduced pain intensity after a 15-week strength training period. Ericsson and associates7 reported improvements in physical fatigue following 15 weeks of progressive resistance exercise. Larsson16 examined changes in muscle strength, health status, and pain intensity in 130 women with fibromyalgia. The strength training group experienced significantly greater improvements than the control group in all of these assessment areas.
Research clearly supports sensible resistance training as both an effective exercise intervention and a regular lifestyle component for people who have osteoarthritis, rheumatoid arthritis, or fibromyalgia. Based on the research reviewed, it seems that the American College of Sports Medicine’s standard strength training guidelines are appropriate for each of these patient populations. Most of these studies incorporated strength training programs that featured basic resistance exercises (e.g., leg extensions, leg curls, leg presses, chest presses, seated rows, shoulder presses, biceps curls, trunk flexions, trunk extensions), two or three weekly workouts, two or three training sets, 8 to 12 exercise repetitions per set, controlled movement speeds and pain free movement ranges. It is therefore recommended that, contingent upon physician approval, osteoarthritis, rheumatoid arthritis, and fibromyalgia patients engage in a basic program of resistance training under the careful supervision of certified exercise professionals/personal trainers.
Wayne L. Westcott, Ph.D., is professor of Exercise Science at Quincy College in Quincy, MA and author of 28 books on strength training. He is an active member of the New England Chapter of the American College of Sports Medicine.
- Bircan C, Karasel SA, Akgun B, et al. Effects of muscle strengthening versus aerobic exercise program in fibromyalgia. Rheumatol Int.2008; 28:527-32.
- Brosseau I, Wells GA, Tugwell P, et al. Ottawa panel evidence-based clinical practical guidelines for strengthening exercises in the management of fibromyalgia: part 2. Physical Therapy. 2008; 88:873-86.
- Centers for Disease Control and Prevention. National Arthritis Action Plan: A Public Health Strategy,1999. [cited 2017 July 26]. Available from: https://stacks.cdc.gov/view/cdc/6378 /.
- Ciolac EG, Greve JM. Muscle strength and exercise intensity adaptation to resistance training in older women with knee osteoarthritis and total knee arthroplasty. Clinics. 2011; 66(12):2079-84.
- Ciolac EM, Rodrigues da Silva JM, D’Andrea Greve JM. Effects of resistance training in older women with knee osteoarthritis and total knee arthroplasty. Clinics. 2015; 70(1):7-13.
- Cooney JK, Law RJ, Matschke V, et al. Benefits of exercise in rheumatoid arthritis. J Aging Res. 2011; Article ID 681640. doi:10.4061/2011/681640.
- Ericsson A, Palstam A, Larsson A, et al. Resistance exercise improves physical fatigue in women with fibromyalgia: a randomized controlled trial. Arthritis Res Ther. 2016; 18:176. doi:10.1186/s13075-016-1073-3.
- Ernberg M, Christidis N, Ghafouri B, et al. Effects of 15 weeks of resistance exercise on pro- inflammatory cytokine levels in the vastus lateralis muscle of patients with fibromyalgia. Arthritis Res Ther. 2016; 18:138. doi:10.1186/s13075-016-1041-y.
- Ettinger WH, Burns R, Messier S, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis: the fitness arthritis and seniors trial (FAST). JAMA.1997; 277(1):25-31.
- Focht BC. Effectiveness of exercise interventions in reducing pain symptoms among older adults with knee osteoarthritis: a review. J Aging Phys Act.. 2006; 14:212-35.
- Hakkinen A, Hakkinen K, Hannonen P, Alen M. Strength training induced adaptations in neuromuscular function of premenopausal women and fibromayalgia: comparison with healthy women. Ann Rheum Res. 2001; 60: 21-6.
- Hakkinen A, Sokka T, Kotaniemi A, Hannonen P. A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis. Arthritis Rheum.2001; 44(3):515-22.
- Jan M, Lin J, Liau J, et al. Investigation of clinical effects of high- and low-resistance training for patients with knee osteoarthritis: a randomized controlled trial. Physical Therapy. 2008; 88:427-36.
- King LK, Birmingham TB, Kean CO, et al. Resistance training for medial compartment knee osteoarthritis and malalignment. Med Sci Sports Exerc. 2008; 40(8):1376-84.
- Lange A, Vanwanseele B, Fiatarone SM. Strength training for treatment of osteoarthritis of the knee: a systematic review. Arthritis Rheum. 2008; 59:1488-94.
- Larsson A, Palstam A, Lofgren M, et al. Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia – a randomized controlled trial. Arthritis Res Ther. 2015; 17:161. doi:10.1186/s13075-015-0679-1.
- Lemmey AB, Marcora SM, Chester K, et al. Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. Arthritis Care Res. 2009; 61(12):1726-34.
- Macora SM, Lemmey AB, Maddison PJ. Can progressive resistance training reverse cachexia in patients with rheumatoid arthritis? Results of a pilot study. J Rheumatol.2005; 32(6):1031-39.
- Messier SP, Mihalko SL, Beavers DP, et al. Strength training for arthritis trial (START): design and rationale. BMC Musculoskelet Disord. 2013; 14:208. doi: 1471-2474/14/208.
- Sharif S, Thomas JM, Donley DA, et al. Resistance exercise reduces skeletal muscle cachexia and improves muscle function in rheumatoid arthritis. Case Rep Med. 2011; Article ID 205691. doi:10.115/2011/205691.
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