RESUMEN
BACKGROUND: Patients with rheumatoid arthritis (RA) tend to be more overweight, take less physical exercise, exhibit decreased cardiorespiratory fitness and demonstrate reduced muscle strength compared with age- and sex-matched controls. Impaired cognitive function in RA is an important associated factor, although it has been less well-recognized. The aim of this study was to investigate the effects of a specifically designed exercise programme on body composition, aerobic capacity, muscle strength and cognition in RA. METHODS: Sixty-six patients with RA were randomized to a specifically designed, personalized exercise programme or standard care. Assessments included body composition, fitness, grip strength and cognitive testing, in addition to disease related measures. RESULTS: Significant improvements in C-reactive protein (p = 0.025), fatigue scores (p = 0.047) and truncal fat (p = 0.004) were observed in the exercise group compared with controls. Median waist circumference was significantly reduced (94.0 to 91.4 cm, p < 0.0001). Improvements were also seen in aerobic capacity (23.2 to 27.6 ml/kg/min, p = 0.002) and in median right (12.0 to 13.0 kg, p = 0.025) and left grip strength (8.0 to 10 kg, p = 0.005). Cognitive function improved in the exercise group, with median Montreal Cognitive Assessment score 25.5 at 0 months compared to 28.0 at 3 months (p = 0.001). CONCLUSION: This study demonstrates that exercise has a significant and positive impact on cognitive function in RA. Furthermore, physical activity is safe and effective in chronic inflammatory joint disease and is recommended as a vital component in the holistic management of these patients.Key Points⢠A dedicated physical exercise programme is feasible and safe in patients with rheumatoid arthritis (RA).⢠Physical exercise helps reduce fatigue scores and improves cardiovascular fitness in stable RA patients.⢠Physical exercise has a positive impact on cognition in patients with RA.⢠A structured exercise programme should be an integral part of chronic disease management protocols for patients with RA.
Asunto(s)
Artritis Reumatoide/terapia , Capacidad Cardiovascular , Terapia por Ejercicio/métodos , Fatiga/terapia , Adulto , Anciano , Artritis Reumatoide/sangre , Composición Corporal , Proteína C-Reactiva/análisis , Cognición , Tolerancia al Ejercicio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular , Calidad de VidaRESUMEN
PURPOSE: Four to fifty percent of patients will develop Failed Back Surgery Syndrome (FBSS) following lumbar spine surgery. Repeated surgeries lead to escalating costs and subsequent decreases in success rate. Much of the research to date has focused on the psychosocial factors associated with FBSS. All factors including physical and pathological aetiologies should be examined. These factors may be independent, co-exist with or predispose patients to the psychological factors associated with FBSS. Previous reviews on the topic have been limited by a lack of systematic overview. The aim of this review is to identify the physical, physiological and pathological aetiologies of FBSS. METHODS: This review was done in accordance with the PRISMA guidelines. A computer-aided search of the electronic databases from inception to December 2014 was performed. Outcome measures of interest included pain, functional and radiological assessments. Two reviewers independently selected studies for inclusion. Methodological quality was assessed using the Newcastle Ottawa Scale. RESULTS: Six studies met the inclusion criteria and included a total of 663 patients. A total of twenty two aetiologies were identified. Only three studies reviewed non-surgical aetiologies. Many of the studies relied on medical imaging to identify the aetiologies. A meta-analysis was not undertaken due to the heterogeneity of studies. CONCLUSIONS: The causes of FBSS can be attributed to patho-anatomical, peripheral pain generators, physical/ mechanical, neurophysiological, surgical and `other' aetiologies. Three of the studies only examined surgical causes of FBSS. Further research, that examines surgical and non-surgical aetiologies, is required to draw firm conclusions. With nineteen aetiologies identified, FBSS remains an unclear diagnosis for a complex heterogeneous group of patients.