Effects of a Group-Based Exercise and Educational Program on Physical Performance and Disease Self-Management in Rheumatoid Arthritis: A Randomized Controlled Study

Background. Evidence supports the use of educational and physical training programs for people with rheumatoid arthritis (RA). Objective. The purpose of this study was to evaluate the effects of a group-based exercise and educational program on the physical performance and disease self-management of people with RA. Design. This was a randomized controlled trial. Setting. The study was conducted at a rehabilitation center in the Netherlands. Participants. Thirty-four people diagnosed with RA participated in the study. Participants were randomly assigned to either an intervention group (n = 19) or a waiting list control group (n = 15). Intervention. The intervention in this study was an 8-week, multidisciplinary, group therapy program for people with RA, consisting of physical exercise designed to increase aerobic capacity and muscle strength (force-generating capacity) together with an educational program to improve health status and self-efficacy for disease-self-management. Measurements. The main outcome measures were maximum oxygen uptake ((V) over dotO(2)max), muscle strength of the elbow and knee flexors and extensors, health status, and perceived self-efficacy. All data were recorded before intervention in week 1, after intervention in week 9, and at follow-up in week 22. Results. The intervention group showed significant improvement (12.1%) in (V) over dotO(2)max at week 9 compared with the control group (-1.7%). Although significant within-group changes were found over time for muscle strength of the upper and lower extremities and health status that favored the intervention group, no between-group changes were found regarding these outcomes. Limitations. An important limitation was the small number of participants included in our study, which may have resulted in a lack of power. Conclusions. The present group-based exercise and educational program for people with RA had a beneficial effect on aerobic capacity but not on muscle strength, health status, or self-efficacy.