Weight training to treat arthritis

Rheumatoid arthritis is an inflammatory, chronic, autoimmune, systemic and progressive disease that affects a small proportion of the world's population, but is more prevalent in women, and especially in adults; its most common symptoms include pain and inflammation, but they also lead to psychological problems such as depression or anxiety. The inflammatory reaction in rheumatoid arthritis is triggered by the presentation of an antigen to a synovial lymphocyte, as well as the production of inflammatory mediators such as interleukins and cytokines, which, together with other inflammatory agents and cofactors, are capable of invading and destroying cartilage and bone tissue, as well as being responsible for the extensive destruction observed in rheumatoid arthritis.

The destructive properties are related to various agents and factors that are not covered in this article, but which together produce functional impairment, reducing quality of life across all aspects of human life, including physical dimensions. In this case, therapy involving weight training to treat arthritis is essential for preserving movement, restoring lost movement, increasing strength and static endurance, increasing dynamic endurance, improving the sense of well-being and promoting cardiovascular endurance.

In our case, muscle hypertrophy is an important factor in protecting the inflamed joint, because it corrects and thus prevents the loss and/or limitation of movement, muscle atrophy and weakness, as well as joint instability. When a person has rheumatoid arthritis, they experience atrophy of type I and II muscle fibres, which suggests that the muscles involved in normal activities exert brief dynamic or static pressure essential for basic functions, such as lifting a cup, sitting down, writing or moving objects.

These functions are essentially “weightlifting” associated with type II muscle activities (glycolytic, anaerobic), which represent short-duration resistance contractions. These fibres are strengthened preferentially by isometric contractions in muscle contraction programmes that can be dynamic or static, or a combination of both; these contractions lead to muscle fibre hypertrophy and improved strength in people with rheumatoid arthritis.

Isometric exercises help prevent muscle atrophy and also produce less inflammation and less change in intra-articular pressure than other forms of strength exercise; these should be prescribed in the initial and/or inflammatory stage, while a stage of decreasing symptoms should involve a transition to contraction exercises at different angles. Studies have shown that resistance training with weights, unlike conventional therapy, increases muscle mass, muscle strength and maximum neural stimulation in people with rheumatoid arthritis.

Several studies compared neuromuscular activation in conventional therapeutic exercises with exercises using weights, concluding that conventional exercises produce the 40- 60% neuromuscular activation necessary to stimulate increases in muscle strength, while resistance training with weights is capable of modulating the expression of the disease's pro-inflammatory agents, soluble adhesion molecules and chemoattractant factors.

Studies on weight training and the reduction of inflammation

A study conducted by Americans showed that including a weight training programme for people with arthritis, maintaining 70% of VO2max for six months, attenuates the local expression of pro-inflammatory cytokines (TNF-alpha, IL-1, IL-6) in skeletal muscles. Meanwhile, some studies have demonstrated changes in the plasma concentration of IL-10 and IL-ra (IL-1 receptor antagonist) after high-intensity resistance exercises with weights, a condition that may contribute to the anti-inflammatory environment, forming an important mediator of the anti-inflammatory effects of physical training.

• IL-10 can act on different cell types and induces the suppression of inflammatory responses in various cell types,
• It is responsible for the “orchestration” of inflammatory reactions, particularly the inhibition of changes mediated by TNF-alpha, thereby reducing localised inflammation.

Other research studies compared the clinical effects of high-resistance exercise (60% of 1RM) and low-resistance exercise (10% of 1 RM) in people with knee osteoarthritis, with loads modified every two weeks. The authors of the studies found no statistically different results when comparing gains in strength and functionality of the knee muscles, but when comparing training at (90% of 1RM) with (70% of 1RM) and with another at (50% of 1RM), it was observed that strength gains occurred with high-intensity training.

In other studies, volunteers with rheumatoid arthritis were instructed to perform exercises on machines for the upper and lower limbs, with three sets of eight repetitions, twice a week for 12 weeks, at a load of 80-85% of 1 RM, which was modified every two weeks. After the analyses, the authors concluded that this type of training is feasible and safe provided that rheumatoid arthritis is controlled, showing gains in strength and reductions in pain and fatigue, without exacerbating disease activity.

In view of these considerations, we can conclude that weight training to treat arthritis is ideal as a non-pharmacological treatment to improve physical function and quality of life; it should also be applied progressively, supervised by an experienced trainer and a monitoring doctor, tailoring each situation so that results are optimised and protocols can be used or replicated according to each situation.

Sources

1. Icade Chile Reviews by Fernando Mella: How to treat arthritis with resistance training with weights
2. KDAHL, C: Dynamic versus static training in patients with rheumatoid arthritis.
3. FEIGENBAUM. M: Prescription of resistance training for health and disease.
4. GERBER, L.H: Exercise and arthritis