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Aktuelle Rheumatologie 2012; 37(03): 161-167
DOI: 10.1055/s-0031-1301345
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© Georg Thieme Verlag KG Stuttgart · New York

Körperliche Aktivität und Sport bei Rheumatoider Arthritis

Physical Activity, Sports and Rheumatoid Arthritis
O. Schultz
1   Universitätsklinik Köln, Medizinische Klinik II, Köln
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Publication History

Publication Date:
08 March 2012 (online)

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Zusammenfassung

Die rheumatoide Arthritis ist gekennzeichnet durch chronisch entzündliche und destruktive Gelenkveränderungen, die in Kombination mit den metabolischen und kardiovaskulären Folgen der systemischen Entzündungserkrankung zu einem Verlust von Muskelmasse, Kraft und Ausdauer führen. Die resultierende körperliche Inaktivität bei etwa 80% der Patienten mit rheumatoider Arthritis führt wiederum zu einer Verschlechterung der Grunderkrankung und zu metabolischen Folgeerkrankungen wie Diabetes, Adipositas und Osteoporose sowie einer kardiovaskulären Risikokonstellation mit signifikant erhöhter Mortalität. Auch die neuen Therapiestrategien der Biologika-Ära können trotz ihrer Erfolge bezüglich einer optimierten Krankheitskontrolle diese Problematik nicht adäquat lösen. Allerdings bieten sie erstmals realistische Optionen, auch die Patienten mit chronisch-rheumatischen Erkrankungen frühzeitig und dauerhaft an einer körperlichen Trainingstherapie teilnehmen zu lassen. Die Bedeutung der körperlichen Aktivität bezüglich der Prävention und Behandlung der häufigsten Erkrankungen ist zwar unbestritten, aber im klinischen Kontext deutlich unterbewertet. Auch bei der rheumatoiden Arthritis ist das Potenzial eines sportlichen Trainings weitgehend ungenutzt. Die aktuelle Studienlage dokumentiert eine Verbesserung der Muskelkraft, Ausdauer und Beweglichkeit ohne nachteilige Effekte auf die Krankheitsaktivität oder eine direkte strukturelle Schädigung der Gelenke. Obwohl die Langzeitdaten bezüglich der Beeinflussung metabolischer und kardiovaskulärer Folgeerkrankungen noch unzureichend sind, ist unter den Bedingungen der modernen Rheumatherapie eine strukturierte, frühzeitig beginnende und dauerhafte Trainingstherapie als sicher und effektiv zu bewerten. Ein kombiniertes, dynamisches Training von Kraft, Ausdauer und Flexibilität, individuell angepasst an die Krankheitsaktivität und den Fitnesszustand ist als integrative Maßnahme des Therapiekonzeptes zu empfehlen.

Abstract

Rheumatoid arthritis as anarcheotype of chronic inflammatory disease with significant metabolic and cardiovascular impacts proceeds the progressive loss of muscle mass, strength and endurance. The physical inactivity, affecting most patients with rheumatoid arthritis, results in an impaired course of the disease itself, metabolic comorbidities such as diabetes, obesity and osteoporosis as well as a serious cardiovascular risk with increased mortality. In spite of their impressive clinical achievements, the innovative treatment strategies of the biological era are not sufficient to solve these problems. Nevertheless, they offer unique opportunities for patients with chronic rheumatic diseases to participate early and for the long-term in physical exercise. The preventive and curative potential of physical activity for most diseases is beyond dispute, however, it is considerably underestimated in the clinical context. The feasibility of an intensive physical exercise for patients with rheumatoid arthritis is almost ignored so far, although all studies reveal an enhancement of strength and fitness without negative impacts on joint structure or disease activity. Significant data concerning the long-term metabolic and cardiovascular effects are still lacking, however an early and continuous physical training in the context of a modern therapeutic strategy can be considered advantageous and safe for almost all patients with rheumatoid arthritis. An ideal concept would be the integration of a dynamic and combined training of strength, aerobic fitness and flexibility tailored for the particular disease activity and fitness status into the therapeutic scheme and lifestyle of the patient.

Schlüsselwörter

Rheumatoide Arthritis - Sport - Trainingstherapie - Fitness

Key words

rheumatoid arthritis - sport - exercise therapy - fitness
 

  • Literatur

  • 1 Klareskog L, Catrina AI, Paget S. Rheumatoid arthritis. The Lancet 2009; 373 (9664) 659-672
    CrossrefPubMedGoogle Scholar
  • 2 Smolen JS, Aletaha D, Bijlsma JW et al. T2T Expert Committee . Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 2010; 69: 631-637
    CrossrefPubMedGoogle Scholar
  • 3 Sokka T, Kautiainen H, Pincus T et al. QUEST-RA . Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA study. Arthritis Res Ther 2010; 12 (02) R42
    CrossrefPubMedGoogle Scholar
  • 4 Pincus T, Sokka T, Wolfe F. Premature mortality in patients with rheumatoid arthritis: evolving concepts. Arthritis Rheum 2001; 44: 1234-1236
    CrossrefPubMedGoogle Scholar
  • 5 Douglas KM, Pace AV, Treharne GJ, Saratzis A, Nightingale P, Erb N, Banks MJ, Kitas GD. Excess recurrent cardiac events in rheumatoid arthritis patients with acute coronary syndrome. Ann Rheum Dis 2006; 65: 348-353
    CrossrefPubMedGoogle Scholar
  • 6 Naranjo A, Sokka T, Descdzo MA, Collo-Alen J, Pinens T et al. Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study. Arthritis Res Ther 2008; 10: R30
    CrossrefPubMedGoogle Scholar
  • 7 Sokka T, Hakkinen A, Kautiainen H et al. Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Rheum 2008; 59: 42-50
    CrossrefPubMedGoogle Scholar
  • 8 Sattar N, McInnes IB. Vascular comorbidity in rheumatoid arthritis: potential mechanisms and solutions. Curr Opin Rheumatol 2005; 17: 286-292
    CrossrefPubMedGoogle Scholar
  • 9 Stavropoulos-Kalinoglou A, Metsios GS, Panoulas VF, Douglas KM, Nevill AM, Kitas GD et al. Associations of obesity with modifiable risk factors for the development of cardiovascular disease in patients with rheumatoid arthritis. Ann Rheum Dis 2009; 68: 242-245
    CrossrefPubMedGoogle Scholar
  • 10 Brown H, Roberts J. Exercising choice: The economic determinants of physical activity behaviour of an employed population. Soc Sci Med 2011; 73 (03) 383-390
    CrossrefPubMedGoogle Scholar
  • 11 Wang G, Helmick CG, Macera C et al. Inactivity-associated medical costs among US adults with arthritis. Arthritis Care Res 2001; 45: 439-445
    CrossrefPubMedGoogle Scholar
  • 12 Norheim KB, Jonsson G, Omdal R. Biological mechanisms of chronic fatigue. Rheumatology 2011; 50 (06) 1009-1018
    CrossrefPubMedGoogle Scholar
  • 13 Plasqui G. The role of physical activity in rheumatoid arthritis. Physiol Behav 2008; 94: 270-275
    CrossrefPubMedGoogle Scholar
  • 14 Rall LC, Roubenoff R. Rheumatoid cachexia: metabolic abnormalities, mechanisms and interventions. Rheumatol 2004; 43: 1219-1223
    CrossrefPubMedGoogle Scholar
  • 15 Paget SJ. Nervous mimicry of organic diseases. Lancet 1873; ii: 727-729
    PubMedGoogle Scholar
  • 16 Summers GD, Metsios GS, Stavropoulos-Kalinoglou A, Kitas GD. Rheumatoid cachexia and cardiovascular disease. Nat Rev Rheumatol 2010; 6: 445-451
    CrossrefPubMedGoogle Scholar
  • 17 Karimi M, Mazloomzadeh S, Kafan S et al. The frequency of metabolic syndrome in women with rheumatoid arthritis and in controls. Int J Rheum Dis 2011; 14 (03) 248-254
    CrossrefPubMedGoogle Scholar
  • 18 Giles JT, Bartlett SJ, Andersen R et al. Association of body fat with C-reactive protein in rheumatoid arthritis. Arthritis Rheum 2008; 58 (09) 2632-2641
    CrossrefPubMedGoogle Scholar
  • 19 Stavropoulos-Kalinoglou A, Metsios GS, Koutedakis Y et al. Obesity in rheumatoid arthritis. Rheumatology 2011; 50 (03) 450-462
    CrossrefPubMedGoogle Scholar
  • 20 Cairns AP, McVeigh JG. A systematic review of the effects of dynamic exercise in rheumatoid arthritis. Rheumatol Int 2009; 30: 147-158
    CrossrefPubMedGoogle Scholar
  • 21 Glass D, Roubenoff R. Recent advances in the biology and therapy of muscle wasting. Annals of the New York Academy of Sciences 2010; 1211 (01) 25-36
    CrossrefPubMedGoogle Scholar
  • 22 Tsuchida K. Targeting myostatin for therapies against muscle-wasting disorders. Curr Opin Drug Discov Devel 2008; 11: 487-494
    PubMedGoogle Scholar
  • 23 Zhao J, Brault JJ, Schild A et al. FOX03 coordinately activates protein degradation by the autophagic lysosmal and proteasomal pathways in atrophying muscle cells. Cell Metab 2007; 6: 472-483
    CrossrefPubMedGoogle Scholar
  • 24 Zoico E, Roubenoff R. The role of cytokines in regulating protein metabolism and muscle function. Nutr Rev 2002; 60: 39-51
    CrossrefPubMedGoogle Scholar
  • 25 Metsios GS, Stavropoulos-Kalinoglou A, Douglas KM, Kouledakis Y, Nevill AM, Panoulas VF, Kita M. Blockade of tumour necrosis factor-alpha in rheumatoid arthritis: effects on components of rheumatoid cachexia. Rheumatology 2007; 46: 1824-1827
    CrossrefPubMedGoogle Scholar
  • 26 Drey M. Sarcopenia – pathophysiology and clinical relevance. Wien Med Wochenschr published online July 29, 2011
    PubMedGoogle Scholar
  • 27 Hurkmans EJ, Van Der Giesen FJ, Bloo H et al. Physiotherapy in rheumatoid arthritis: development of a practice guideline. Acta Reumatol Port 2011; 36 (02) 146-158
    PubMedGoogle Scholar
  • 28 Strasser B, Leeb Strehblow C. et al. The effects of strength and endurance training in patients with rheumatoid arthritis. Clin Rheumatol 2010; vol. 30 (05) pp. 623-632
    PubMedGoogle Scholar
  • 29 Gecht MR, Connell KJ, Sinacore JM et al. A survey of exercise beliefs and exercise habits among people with arthritis. Arthritis Care Res 1996; 9: 82-88
    CrossrefPubMedGoogle Scholar
  • 30 Munneke M, de Jong Z, Zwinderman AH et al. High intensity exercise or conventional exercise for patients with rheumatoid arthritis? Outcome expectations of patients, rheumatologists, and physiotherapists. Ann Rheum Dis 2004; 63: 804-808
    CrossrefPubMedGoogle Scholar
  • 31 Küther G. Trainingstherapie bei Rheumatoider Arthritis: Eine systematische Übersicht. Akt Rheumatol 2010; 35 (06) 364-374
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Hurkmans E, van der Giesen FJ, Vliet Vlieland TP et al. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev 2009; 4 CD006853
    PubMedGoogle Scholar
  • 33 De Jong Z, Munneke M, Kroon HM et al. Long-term follow-up of a highintensity exercise program in patients with rheumatoid arthritis. Clin Rheumatol 2009; 28: 663-671
    CrossrefPubMedGoogle Scholar
  • 34 Cooney JK, Law R-J, Matschke V et al. Benefits of Exercise in Rheumatoid Arthritis. Journal of Aging Research 2011; 2011: 1-14
    PubMedGoogle Scholar
  • 35 Lundberg IE, Nader GA. Molecular effects of exercise in patients with inflammatory rheumatic disease. Nat Clin Pract Rheumatol 2008; 4: 597-604
    CrossrefPubMedGoogle Scholar
  • 36 Gleeson M. Immune function in sport and exercise. J Appl Physiol 2007; 103: 693-699
    CrossrefPubMedGoogle Scholar
  • 37 Petersen AM, Pedersen BK. The role of IL-6 in mediating the anti-inflammatory effects of exercise. J Physiol Pharmacol 2006; 57 (Suppl. 10) 43-51
    PubMedGoogle Scholar
  • 38 Fischer CP, Berntsen A, Perstrup LB, Eskildsen P, Pedersen BK. Plasma levels of interleukin-6 and C-reactive protein are associated with physical inactivity independent of obesity. Scand J Med Sci Sports 2007; 17: 580-587
    PubMedGoogle Scholar
  • 39 Dossumbekova A, Anghelina M, Madhavan S, He L, Quan N, Knbloch T, Agarwal S. Biomechanical signals inhibit IKK activity to attenuate NF-kappaB transcription activity in inflamed chondrocytes. Arthritis Rheum 2007; 56: 3284-3296
    CrossrefPubMedGoogle Scholar
  • 40 Madhavan S, Anghelina M, Roth-Deschner B, Wypasek E, John A, Deschnen J, Piesco N. Biomechanical signals exert sustained attenuation of proinflammatory gene induction in articular chondrocytes. Osteoarthritis Cartilage 2006; 14: 1023-1032
    CrossrefPubMedGoogle Scholar
  • 41 Neuberger GB, Aaronson LS, Gajewski B et al. Predictors of exercise and effects of exercise on symptoms, function, aerobic fitness, and disease outcomes of rheumatoid arthritis. Arthritis Care Res 2007; 57: 943-952
    CrossrefPubMedGoogle Scholar
  • 42 Haglund EK, Bremander AB. Aerobic capacity in patients with rheumatoid arthritis: a comparison of two submaximal test methods. Musculoskeletal Care 2009; 7 (04) 288-299
    CrossrefPubMedGoogle Scholar
  • 43 Lemmey AB, Marcora SM, Chester K et al. Effects of resistance training in cachectic rheumatoid arthritis patients – a randomised controlled trial. Arthritis Rheum 2009; 61: 1726-1734
    CrossrefPubMedGoogle Scholar
  • 44 Hsieh LF, Chen SC, Chuang CC et al. Supervised aerobic exercise is more effective than home aerobic exercise in female Chinese patients with rheumatoid arthritis. J Rehabil Med 2009; 41: 332-337
    CrossrefPubMedGoogle Scholar
  • 45 Lemmey AB, Williams SL, Marcora SM et al. Are the benefits of a high-intenstiy progressive resistance training program sustained in rheumatoid arthritis patients?: A 3 year follow-up study. Arthritis Care Res 2011; Jun 13
    PubMedGoogle Scholar
  • 46 Metsios GS, Stavropoulos-Kalinoglou A, Treharne GJ et al. Disease activity and low physical activity associate with number of hospital admissions and length of hospitalisation in patients with rheumatoid arthritis. Arthritis Res Ther 2011; 13 (03) R108
    CrossrefPubMedGoogle Scholar
  • 47 de Jong Z, Munneke M, Zwinderman AH et al. Long term high intensity exercise and damage of small joints in rheumatoid arthritis. Ann Rheum Dis 2004; 63: 1399-1405
    CrossrefPubMedGoogle Scholar
  • 48 de Jong Z, Vliet Vlieland TPM. Safety of exercise in patients with rheumatoid arthritis. Curr Opin Rheumatol 2005; 17: 177-182
    CrossrefPubMedGoogle Scholar
  • 49 Matschke V, Murphy P, Lemmey AB et al. Muscle quality, architecture, and activation in cachectic patients with rheumatoid arthritis. J Rheumatol Feb. 2010; 37 (02) 282-284
    CrossrefPubMedGoogle Scholar
  • 50 Lemmey AB, Marcora SM, Chester K et al. Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. Arthritis Rheum 2009; 61: 1726-1734
    CrossrefPubMedGoogle Scholar
  • 51 de Boer IG, Peeters AJ, Ronday HK et al. The usage of functional wrist orthoses in patients with rheumatoid arthritis. Disabil Rehabil 2008; 30 (04) 286-295
    CrossrefPubMedGoogle Scholar
  • 52 Marcora SM, Lemmey AB, Maddison PJ. Can progressive resistance training reverse cachexia in patients with rheumatoid arthritis? Results of a pilot study. J Rheumatol 2005; 32: 1031-1039
    PubMedGoogle Scholar
  • 53 Baillet A, Zeboulon N, Gossec L et al. Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: meta-analysis of randomized controlled trials. Arthritis Care Res 2010; 62: 984-992
    CrossrefPubMedGoogle Scholar
  • 54 Noreau L, Moffet H, Drolet M et al. Dance-based exercise program in rheumatoid arthritis. Feasibility in individuals with American College of Rheumatology functional class III disease. Am J Phys Med Rehabil 1997; 76 (02) 109-113
    CrossrefPubMedGoogle Scholar
  • 55 Wang C. Tai Chi and Rheumatic Diseases. Rheumatic Disease Clinics of NA 2011; 37 (01) 19-32
    PubMedGoogle Scholar
  • 56 Haaz S, Bartlett SJ. Yoga for arthritis: a scoping review. Rheum Dis Clin North Am 2011; 37 (01) 33-46
    CrossrefPubMedGoogle Scholar