**Part 4**

**Exercise and Alternative Therapies** 

284 Rheumatoid Arthritis – Treatment

Saxne, T., Palladino, M.A.Jr., Heinegard, D., Talal, N. & Wollheim, F.A. (1998). Detection of

Shakibaei, M., Harikumar, K.B. & Aggarwal, B.B. (2009). Resveratrol addiction: to die or not

She, Q.B., Bode A.M., Ma, W.Y., Chen, N.Y. & Dong, Z. (2001). Resveratrol-induced

Wang, X. (2001). The expanding role of mitochondria in apoptosis. Genes & Development

Zhang, W., Wang, X. & Chen, T. (2011). Resveratrol induces mitochondria-mediated AIF

synovial fluid and serum. Arthritis & Rheumatism 31:1041-1044.

protein kinases and p38 kinase. Cancer Research 61:1604–1610.

to die. Molecular Nutrition & Food Research 53:115-128.

15:2922-2933.

10.1007/s11010-011-0802-9.

tumor necrosis factor- but not tumor necrosis factor- in rheumatoid arthritis

activation of p53 and apoptosis is mediated by extracellular-signal-regulated

and to a lesser extent caspase-9-dependent apoptosis in human lung adenocarcinoma ASTC-a-1 cells. Molecular and Cellular Biochemistry DOI:

**14** 

*U.K* 

Andrew B. Lemmey

**Resistance Training for Patients with** 

*School of Sport, Health and Exercise Sciences, Bangor University* 

**Rheumatoid Arthritis: Effects on Disability,** 

Rheumatoid arthritis (RA) is characterised by disability, cachexia, and obesity, and features exacerbated risk of both cardiovascular disease (CVD) and osteoporosis. To deal with RA generally and these associated conditions specifically, the World Health Organisation (WHO, 2008) and various national health authorities (e.g. American College of Rheumatology, ACR, 2002, 2006; European League Against Rheumatism, EULAR, Combe et al., 2007; American College of Sports Medicine, ACSM, 2010a, 2010b, 2010c, 2010d; American Heart Association, AHA, Williams et al., 2007) have advocated progressive resistance training (PRT; i.e. systematic weight training) as adjunct therapy. Additionally, two Cochrane Reviews (Hurkmans et al., 2009; van den Ende et al., 2000) have supported inclusion of this form of exercise in the routine management of RA patients. However, despite this weighty advocacy regular PRT is rarely prescribed for or undertaken by RA

In this chapter, the efficacy and safety of PRT as a treatment for RA will be discussed, with

Despite advances in the pharmaceutical treatment of RA, disability remains a feature of the disease. In a recent report from the British Society for Rheumatology Biologics Register (Lunt et al., 2010), the median (interquartile range) Health Assessment Questionnaire (HAQ) scores for large samples of patients receiving anti-tumor necrosis factor (anti-TNF) treatment (n=12,672) or standard disease modifying anti-rheumatic drugs (DMARD's; n=3,522) were 2.1 (1.8-2.5) and 1.6 (0.9-2.1), respectively; which are levels indicative of moderate to severe disability. Such widespread disability, as well as causing enormous suffering and reduction of Quality of Life (QoL) on a personal level, also has huge social and economic costs (Verstappen et al., 2004; Yelin, 1996). For example, within 10 years of RA diagnosis a prevalence of 35% for work disability is currently reported for both US and

**2. Disability, rheumatoid cachexia and osteoporosis in RA patients** 

training recommendations and considerations outlined.

European populations (Allaire et al., 2008; Eberhardt et al., 2007).

**1. Introduction** 

patients.

**2.1 Disability** 

**Rheumatoid Cachexia, and Osteoporosis;** 

 **and Recommendations for Prescription** 
