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      Effects of Aerobic and Resistance Exercise in Older Adults With Rheumatoid Arthritis: A Randomized Controlled Trial

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          Abstract

          Objective

          To evaluate the effect of a moderate‐to‐high–intensity, aerobic and resistance exercise with person‐centered guidance in older adults with rheumatoid arthritis ( RA), through a randomized controlled multicenter trial.

          Methods

          Older adults (ages 65–75 years) with RA (n = 74) were randomized to either a 20‐week exercise intervention at a gym (n = 36) or to home‐based exercise of light intensity (n = 38). Assessments were performed at baseline, at 20 weeks, and at 12 months. The primary outcome was the difference in the Health Assessment Questionnaire disability index ( HAQ DI) score, and the secondary outcomes were the differences in physical fitness assessed by a cardiopulmonary exercise test, an endurance test, the timed up and go test, the sit to stand test, and an isometric elbow flexion force measurement.

          Results

          No significant differences between the groups were found for the primary outcome, HAQ DI score. Within the intervention group there was a significant improvement in the HAQ DI score when compared to baseline ( P = 0.022). Aerobic capacity ( P < 0.001) and 3 of 4 additional performance‐based tests of endurance and strength significantly improved ( P < 0.05) in the intervention group when compared to the control group. In the intervention group, 71% of patients rated their health as much or very much improved compared to 24% of patients in the control group ( P < 0.001). At the 12‐month follow‐up, there were no significant differences in change between the 2 groups on the HAQ DI score. A significant between‐group difference was found for change in an endurance test ( P = 0.022).

          Conclusion

          Aerobic and resistance exercise with person‐centered guidance improved physical fitness in terms of aerobic capacity, endurance, and strength in older adults with RA.

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          Most cited references41

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          The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.

          The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a "classification tree" schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91-94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.
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            Measurement of patient outcome in arthritis.

            A structure for representation of patient outcome is presented, together with a method for outcome measurement and validation of the technique in rheumatoid arthritis. The paradigm represents outcome by five separate dimensions: death, discomfort, disability, drug (therapeutic) toxicity, and dollar cost. Each dimension represents an outcome directly related to patient welfare. Quantitation of these outcome dimensions may be performed at interview or by patient questionnaire. With standardized, validated questions, similar scores are achieved by both methods. The questionnaire technique is preferred since it is inexpensive and does not require interobserver validation. These techniques appear extremely useful for evaluation of long term outcome of patients with rheumatic diseases.
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              The costs of fatal and non-fatal falls among older adults.

              To estimate the incidence and direct medical costs for fatal and non-fatal fall injuries among US adults aged >or=65 years in 2000, for three treatment settings stratified by age, sex, body region, and type of injury. Incidence data came from the 2000 National Vital Statistics System, 2001 National Electronic Injury Surveillance System-All Injury Program, 2000 Health Care Utilization Program National Inpatient Sample, and 1999 Medical Expenditure Panel Survey. Costs for fatal falls came from Incidence and economic burden of injuries in the United States; costs for non-fatal falls were based on claims from the 1998 and 1999 Medicare fee-for-service 5% Standard Analytical Files. A case crossover approach was used to compare the monthly costs before and after the fall. In 2000, there were almost 10 300 fatal and 2.6 million medically treated non-fatal fall related injuries. Direct medical costs totaled 0.2 billion dollars for fatal and 19 billion dollars for non-fatal injuries. Of the non-fatal injury costs, 63% (12 billion dollars ) were for hospitalizations, 21% (4 billion dollars) were for emergency department visits, and 16% (3 billion dollars) were for treatment in outpatient settings. Medical expenditures for women, who comprised 58% of the older adult population, were 2-3 times higher than for men for all medical treatment settings. Fractures accounted for just 35% of non-fatal injuries but 61% of costs. Fall related injuries among older adults, especially among older women, are associated with substantial economic costs. Implementing effective intervention strategies could appreciably decrease the incidence and healthcare costs of these injuries.
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                Author and article information

                Contributors
                elvira.m.lange@vgregion.se
                Journal
                Arthritis Care Res (Hoboken)
                Arthritis Care Res (Hoboken)
                10.1002/(ISSN)2151-4658
                ACR
                Arthritis Care & Research
                John Wiley and Sons Inc. (Hoboken )
                2151-464X
                2151-4658
                27 December 2018
                January 2019
                : 71
                : 1 ( doiID: 10.1002/acr.2019.71.issue-1 )
                : 61-70
                Affiliations
                [ 1 ] University of Gothenburg Gothenburg Sweden
                [ 2 ] Skaraborg Hospital Skövde Sweden
                Author notes
                [*] [* ]Address correspondence to Elvira Lange, MSc, PT, Department of Health and Rehabilitation at Institute of Neuroscience and Physiology, Box 455, 405 30 Göteborg, Sweden. E‐mail: elvira.m.lange@ 123456vgregion.se .
                Author information
                http://orcid.org/0000-0003-4190-8667
                Article
                ACR23589
                10.1002/acr.23589
                6590333
                29696812
                ba7666e5-35da-43fa-ba64-76fc29013a6d
                © 2018 The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 23 January 2018
                : 17 April 2018
                Page count
                Figures: 3, Tables: 2, Pages: 10, Words: 6760
                Funding
                Funded by: University of Gothenburg Centre for Person‐Centered Care
                Funded by: Health and Medical Care Committee of the Regional Executive Board
                Award ID: VGFOUREG‐66251
                Funded by: Region Västra Götaland
                Funded by: ALF/LUA at Sahlgrenska University Hospital
                Award ID: ALFGBG‐4636751
                Funded by: Swedish Rheumatism Association
                Award ID: R‐663361
                Categories
                Original Article
                Rheumatoid Arthritis
                Custom metadata
                2.0
                acr23589
                January 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:24.06.2019

                Rheumatology
                patient‐centred,person‐centred,person‐centered,exercise,rheumatoid arthritis,physiotherapy,physical therapy

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