A DOSE RESPOSTA DE EXERCÍCIO FÍSICO E AR - REVISÃO

PHYSICAL EXERCISE AND RHEUMATOID ARTHRITIS – AN INTEGRATIVE REVIEW

Frederico Santos de Santana1, Camila de Santana Mota1, Raphaela Franco Miranda1, Fernando Rosa de Aguiar1, Sandor Balsamo1, Leonardo Costa Pereira1

1. University of Brasília – UnB;
2. UNIEURO Center University.

Correspondence to: Frederico Santos de Santana - QRSW 2 BL: B-12 - APTº 105 – Sudoeste – Brasília- DF – BRAZIL - E-mail: [e-mail]

We declare that we have no conflict of interest in this work.

PHYSICAL EXERCISE AND RHEUMATOID ARTHRITIS

RESUMO – é cada vez mais importante o conhecimento das doses-respostas de exercício físico para a indução dos efeitos benéficos, principalmente, no que diz respeito ao controle da atividade da AR e ao aumento da capacidade funcional dos pacientes. Sendo assim, o objetivo desta revisão sistemática é rastrear e identificar doses-resposta de exercício físico eficazes para a funcionalidade de pacientes com AR e para o controle da atividade da doença.

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INTRODUCTION

Rheumatoid arthritis (RA) is an autoimmune disease that is characterized mainly by chronic and symmetrical polyarthritis, of large and small joints, morning stiffness. In cases of inadequate control of disease activity, it can lead to severe musculoskeletal impairment, physical disability and functional impotence. Thus, the treatment of the disease is carried out through pharmacological interventions, especially by drugs that modify the course of the disease and the adoption of a healthier lifestyle, such as the practice of regular physical activity.

Physical activity is called any muscle contraction that generates a greater body energy expenditure than the baseline. However, the amount of physical activity practiced on a regular basis that causes positive physiological repercussions for the control of RA and its deleterious effects is still unknown. The main instruments for quantifying physical activity are a) questionnaires, which track the frequency, time and intensity of the activity (for example, the IPAQ - International Physical Activity Questionnaire); b) pedometers, which measure the number of steps taken by the individual and c) accelerometers, which calculate body displacement at a three-dimensional level. Regardless of the way in which the level of physical activity is quantified, it can be said that there is an indirectly proportional correlation between the amount of physical activity performed and the level of RA activity.

When physical activity is prescribed intentionally, in order to develop some physical capacity, the concept of physical exercise emerges. This is characterized by the determination of volume and intensity, which must be controlled by objective parameters that progress gradually and in order. The main effects of physical exercise and its adequate dosage are the increase in physical capacity or resistance. However, just as, in the practice of physical activity, the practice of physical exercise is also associated with better control of RA.

As, conceptually, physical exercise involves more structuring, that is, the realization of a good diagnosis of physical capacities, prescription and control - Continuum of Physical Training - the hypothesis developed that proposals for physical exercises generate greater control of the activity of the AIR. So, the aim of this study synthesize knowledge about the effects of physical exercise programs in controlling RA activity.

METHODS

        It is a systematic integrative literature review. Its writing process adopted, as a guide, some guidelines from the PRISMA group founded by the Canadian Institutes of Health Research, in order to create methodological standards for the construction of a systematic review, which is characterized by a concise and formulated question, using objective methods of identification, selection and criticism of the main studies in response to the main question (MOHER, 2009). Therefore, the present study started with the question: what is the dose of activity and physical exercise that demonstrate satisfactory effects to improve functional capacity and control the level of RA activity? This question was formulated from the evaluation of meta-analyzes that verified the effect of physical exercises for patients with rheumatologies and rheumatoid RA (Baillet, et al. 2012; Kelley, et al. 2011).

        From there, the following databases were selected to search for articles: PubMed (National Center for Biotechnology Information), Medline, Lilacs, Ibecs, SciELO (Scientific Electronic Library Online), Cochrane Library, Ebsco, PEDro and Highwire. The filtering criteria, the keywords, as well as the combinatorial arrangements used in the search for articles are shown in FIGURE 1.

data were rheumatoid arthritis combined with physical activity, exercise, strength, endurance, stretch, balance and hydrotherapy, such combinations always present in the title or in the summary of articles.

        The sample included articles that included: physical activity protocols longer than four weeks of intervention; individuals diagnosed with early RA, control group and investigation of effects on disease activity, inflammatory metabolism and physical performance. On the other hand, articles that did not clearly determine the parameters for controlling volume and intensity of physical exercise, that the sample tested was composed of animals, with no description of drug control throughout the protocol and duplicates were excluded.

RESULTADOS E DISCUSSÃO

Os principais achados deste estudo estão relacionados com o pioneirismo e a importância da temática, principalmente, para profissionais de saúde que prescrevem programas de intervenção de atividade física e propostas de tratamento não-farmacológica para AR. Há disponível na literatura uma considerável quantidade de estudos que envolvem atividades e exercícios físicos em pacientes com AM, porém são escassos os estudos que identificam em os parâmetros relacionados ao controle do volume e da intensidade do movimento humano, associados aos parâmetros clássicos de controle da AR. Em relação, especificamente, aos achados dos programas de treinamento de força muscular, a mediana e a variação das variáveis relacionadas à dose-resposta mostrou que um período de aproximadamente 6,5 (4-96) semanas já é suficiente para indução de respostas positivas nos parâmetros de controle da atividade da doença, assim como, uma frequência semanal de treinamento de 2,5 (2-4) vezes, o número de exercícios de força muscular de 2,5 (2-11) exercícios e 12 (12-22) séries por sessão, com a intensidade de 70% (50-100) da carga obtida em teste de 1 repetição máxima (RM).