Exercise programs are often considered to be an important part of the treatment of rheumatoid arthritis. Researchers in Norway chose Tai Chi for a study of how much improvement patients can expect and what mechanisms may be responsible. Tai Chi is a traditional Chinese martial art that combines gentle movements with mental focus. It has been reported to provide benefits for the elderly in terms of improved agility and balance, posture control, lower extremity strength, physical function, increased flexibility, and reduced risk of falls.
The program consisted of 24 group exercise sessions, each 60 minutes long, conducted twice weekly for 12 weeks. The intensity level was reported to be equivalent to walking 6 km/hour (about 4 miles per hour). Fifteen patients participated. The results were measured with physical performance tests, focus group interviews, and Disease Activity Scores calculated from erythrocyte sedimentation rate, swollen and tender joint counts, and patient assessment of global health. Significant quantitative improvements were found in:
1. Number of swollen joints.
2. Timed-stand test for lower body strength. Subjects sat down in a chair and stood up 10 times as fast as possible.
3. Social function reports.
In addition, the focus group interviews showed positive health effects beyond those that are measured by standard techniques. Patients expressed a strong desire to continue the Tai Chi program.
The Disease Activity Score showed improvement at the end of the exercise program, but not at the follow-up assessment 12 weeks later. The balance and shoulder movement tests showed no change.
I'm curious about how other exercise programs would compare to the one studied here. Water fitness classes, yoga, and other routines provide similar benefits to many people. The authors of Reference 1 noted that a major limitation of their study is the lack of a control group. For the psychosocial factors such as reduced stress and increased confidence, it is not clear how much effect comes from the attention of the instructors and the interaction with other students in the class.
A British report (Reference 2) suggests that sustained remission for all rheumatoid arthritis patients is a reasonable goal in the foreseeable future. This paper emphasizes early diagnosis and treatment, mainly with drugs, to reduce joint damage from the inflammatory process. I expect that alternative therapies such as Tai Chi or similar exercise programs will be a part of this future success story.
Reference:
1. Uhlig T et al, “Exploring Tai Chi in rheumatoid arthritis: a quantitative and qualitative study”, BMC Musculoskeletal Disorders 2010; 11:43.
2. Isaacs JD, “The changing face of rheumatoid arthritis: sustained remission for all?” Nat Rev Immunol. 2010 Aug; 10(8): 605-11.
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.