AB1259 THE IMPACT OF DIFFERENT EXERCISE MODES AND INTENSITIES ON PAIN AND ENJOYMENT IN PEOPLE WITH EARLY RHEUMATOID ARTHRITIS

Abstract

Background
The benefits of exercise for people with rheumatoid arthritis (RA) are now widely recognised [1]. However, exercise participation among people with RA remains low. A key reason for that could be the commonly held belief that exercise, may exacerbate disease activity while acutely increasing levels of joint pain. The association of acute exercise with pain has not been established in RA and especially in people with a recent diagnosis.

Objectives
This study investigated the impact of acute aerobic-and resistance-type exercise on perceptions of pain in people with early RA.

Methods
Following local NHS ethical approval, ten people with RA volunteered for the study (Age=46±13years; BMI=29.4±8.6kg/m ² , RA diagnosis= 13±9months, mean±SD). Inclusion criteria were RA diagnosis (2010 EULAR criteria) within the last two years and not engaging in regular physical activity (i.e. no participation in structured exercise >2 times per week). They were assessed for maximal aerobic capacity and maximal strength at chest press, leg press and wide-grip lateral pulldown to determine intensities for exercise conditions. Thereafter they completed one no-exercise control trial (CON) and four exercise trials: 30 minutes of sub-maximal cycling at a workload equivalent to 65% VO 2 max (CYCLE); high intensity interval exercise consisting of 10x1 minutes cycling intervals at a workload equivalent to 95% VO 2 max (HIIE); resistance exercise consisting of three sets of 12-15 repetitions at 70%1RM (RES-70); resistance exercise consisting of three sets of repetitions to failure at 30%1RM (RES-30). All trials were randomised and separated by a washout period of 3-7 days. Participants completed a a visual analogue scale (VAS) for pain at baseline then 2-and 24-hours post exercise; they also completed a questionnaire related to exercise enjoyment 2-and 24-hours post exercise.

Results
Currently four RA participants have completed the study and all participants completed the prescribed exercises in full. Perceived pain was low at 2 hours (0.7±0.4) and 24 hours post-exercise (1.2±0.8) for all exercise conditions (see table 1). Importantly, a difference in heart rate between the aerobic conditions (heart rate during HIIE was 16% higher than during CYCLE), and a difference in workload between the resistance conditions (RES-30 was 117% higher than RES-70) did not result in a difference in pain perception. One participant reported increased pain at 24 hours (7cm vs 1cm at 2 hours) post RES-30, but claimed that this was purely muscular and not joint pain. Interestingly, all participants enjoyed the exercises with comparable high results across the exercise conditions (see table 1).
Table 1 Pain and Enjoyment Descriptives
Trial Baseline VAS pain (cm) 2-hour VAS pain (cm) 24-hour VAS pain (cm) 2-hour exercise enjoyment (1-119) 24-hour exercise enjoyment (1-119)

CON
0.1±0.3
0.1±0.3
0.3±0.3
63.8±13.0
63.8±13.0

CYCLE
0.1±0.3
0.5±0.4
0.9±1.2
86.8±11.0
88.0±8.8

HIIE
0.1±0.3
1.3±1.9
1.1±1.7
85.0±27.8
88.3±19.1

RES-70
0.1±0.3
0.4±0.4
0.5±0.4
91.3±13.0
88.3±6.6

RES-30
0.1±0.3
0.4±0.5
2.4±3.1
88.5±17.1
85.0±13.1

(mean±SD)

Conclusion
This study identified minimal exercise effect on perceived pain at 2 hours-and 24 hours-post exercise among participants with early RA. This suggests that exercise did not exacerbate pain and importantly, high intensities and high loads did not cause additional pain. Nevertheless, further larger studies are required to examine the role of acute exercise on disease activity, e.g. inflammation, and the association with perceived pain in people with early RA.

References
[1]Combe B, et al. 2016 update of the EULAR recommendations for the management of early arthritis. Annals of the Rheumatic Diseases 2016; 76: 948-959.

Disclosure of Interests
None declared

Full text

Scientific Abstracts 1921
subclinical synovitis and tenosynovitis (the latter is recently identied as a strong
predictor for RA-development).
Methods: 315 patients with recent-onset (<1 year) arthralgia of small joints
and a clinical suspicion for progression to RA were consecutively included in
our CSA-cohort. At baseline the squeeze test (compression across the knuck-
les of MCP- and MTP-joints with the force of a rm handshake) and unilateral
contrast-enhanced 1.5T MRI of MCP(2-5)- and MTP(1-5)-joints was performed
and scored according to RAMRIS. MRI-scores were dichotomized with data
from age-matched symptom-free controls as reference. Follow-up ended when
patients developed clinically apparent inammatory arthritis (IA), or else after 2
years. Associations of the squeeze test and MRI-data were studied with general-
ized estimating equations, associations with IA-development with cox regression.
Results: 51% of CSA-patients had a positive squeeze test in MCP- or MTP-
joints. In univariable analyses a positive test was associated with MRI-detected
subclinical synovitis (OR 2.10 (95%CI 1.30-3.40)) and tenosynovitis (OR 1.68
(1.05-2.68)). In multivariable analyses including both inammatory features only
synovitis remained signicant (OR 1.90 (1.16-3.13)). Thus, a positive squeeze
test is a measure of subclinical synovitis, with a sensitivity of 44% (95%CI 33-55)
and specicity of 72% (68-76).
A positive squeeze test in CSA was not associated with IA-development in cox
regression adjusted for age, gender, CRP and ACPA-status (HR 1.57 (0.77-3.19).
This was consistent with the nding that subclinical synovitis was not associated
with IA-development in multivariable analysis adjusted for age, gender, CRP,
ACPA-status and tenosynovitis (HR 1.40 (0.59-3.31), whilst tenosynovitis was
associated (HR 4.94 (2.03-12.06).
Conclusion: The squeeze test is a simple test that, when positive in CSA, dou-
bles the probability of presence of subclinical synovitis.
Disclosure of Interests: None declared
DOI: 10.1136/annrheumdis-2020-eular.1730
Rehabilitation
AB1259 THE IMPACT OF DIFFERENT EXERCISE MODES AND
INTENSITIES ON PAIN AND ENJOYMENT IN PEOPLE
WITH EARLY RHEUMATOID ARTHRITIS
C.Balchin1, A. L.Tan2,3, L. A.Bissell2,3, C.Reilly1, J.Mckenna1, O.Wilson1,
A.Stavropoulos-Kalinoglou1. 1Leeds Beckett University, Leeds, United
Kingdom; 2Leeds Institute of Rheumatic and Musculoskeletal Medicine,
University of Leeds, Leeds, United Kingdom; 3NIHR Leeds Biomedical
Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
Background: The benets of exercise for people with rheumatoid arthritis (RA)
are now widely recognised [1]. However, exercise participation among people
with RA remains low. A key reason for that could be the commonly held belief that
exercise, may exacerbate disease activity while acutely increasing levels of joint
pain. The association of acute exercise with pain has not been established in RA
and especially in people with a recent diagnosis.
Objectives: This study investigated the impact of acute aerobic-and resist-
ance-type exercise on perceptions of pain in people with early RA.
Methods: Following local NHS ethical approval, ten people with RA volun-
teered for the study (Age=46±13years; BMI=29.4±8.6kg/m2, RA diagnosis=
13±9months, mean±SD). Inclusion criteria were RA diagnosis (2010 EULAR cri-
teria) within the last two years and not engaging in regular physical activity (i.e.
no participation in structured exercise >2 times per week). They were assessed
for maximal aerobic capacity and maximal strength at chest press, leg press and
wide-grip lateral pulldown to determine intensities for exercise conditions. There-
after they completed one no-exercise control trial (CON) and four exercise trials:
30 minutes of sub-maximal cycling at a workload equivalent to 65% VO2max
(CYCLE); high intensity interval exercise consisting of 10x1 minutes cycling
intervals at a workload equivalent to 95% VO2max (HIIE); resistance exercise
consisting of three sets of 12-15 repetitions at 70%1RM (RES-70); resistance
exercise consisting of three sets of repetitions to failure at 30%1RM (RES-30). All
trials were randomised and separated by a washout period of 3-7 days. Partici-
pants completed a a visual analogue scale (VAS) for pain at baseline then 2-and
24-hours post exercise; they also completed a questionnaire related to exercise
enjoyment 2-and 24-hours post exercise.
Results: Currently four RA participants have completed the study and all par-
ticipants completed the prescribed exercises in full. Perceived pain was low at 2
hours (0.7±0.4) and 24 hours post-exercise (1.2±0.8) for all exercise conditions
(see table1). Importantly, a difference in heart rate between the aerobic condi-
tions (heart rate during HIIE was 16% higher than during CYCLE), and a differ-
ence in workload between the resistance conditions (RES-30 was 117% higher
than RES-70) did not result in a difference in pain perception. One participant
reported increased pain at 24 hours (7cm vs 1cm at 2 hours) post RES-30, but
claimed that this was purely muscular and not joint pain. Interestingly, all partic-
ipants enjoyed the exercises with comparable high results across the exercise
conditions (see table1).
Table 1 Pain and Enjoyment Descriptives
Trial Baseline VAS
pain (cm)
2-hour VAS
pain (cm)
24-hour VAS
pain (cm)
2-hour exercise
enjoyment (1-119)
24-hour exer-
cise enjoyment
(1-119)
CON 0.1±0.3 0.1±0.3 0.3±0.3 63.8±13.0 63.8±13.0
CYCLE 0.1±0.3 0.5±0.4 0.9±1.2 86.8±11.0 88.0±8.8
HIIE 0.1±0.3 1.3±1.9 1.1±1.7 85.0±27.8 88.3±19.1
RES-70 0.1±0.3 0.4±0.4 0.5±0.4 91.3±13.0 88.3±6.6
RES-30 0.1±0.3 0.4±0.5 2.4±3.1 88.5±17.1 85.0±13.1
(mean±SD)
Conclusion: This study identied minimal exercise effect on perceived pain at
2 hours-and 24 hours-post exercise among participants with early RA. This sug-
gests that exercise did not exacerbate pain and importantly, high intensities and
high loads did not cause additional pain. Nevertheless, further larger studies are
required to examine the role of acute exercise on disease activity, e.g. inamma-
tion, and the association with perceived pain in people with early RA.
References:
[1] Combe B, et al. 2016 update of the EULAR recommendations for the man-
agement of early arthritis. Annals of the Rheumatic Diseases 2016; 76:
948-959.
Disclosure of Interests: None declared
DOI: 10.1136/annrheumdis-2020-eular.3519
AB1260 ARE THERMAL CURE AND REHABILITATION
EFFECTIVE FOR RELIEVING LOW BACK PAIN?
RESULTS OF A RANDOMIZED CONTROLLED TRIAL
A.Fazaa1, N.Belguith2, A.Abdennebi3, J.Mbarek4, S.Miladi1, M.Sellami1,
K.Ouenniche1, S.Kassab1, S.Chekili1, L.Souabni1, A.Ben Hamida5,
L.Zakraoui1, K.Ben Abdelghani1, A.Laatar1. 1Hôpital Mongi Slim, Rhumatology,
La Marsa, Tunisia; 2institut kassab d’orthopédie, médecine physique
rééducation et réadaptation fonctionnelle, Mannouba, Tunisia; 3station thermale
Djbal ElOuest, Zaghouan, Tunisia; 4centre de rééducation Jbal El Ouest,
Zaghouan, Tunisia; 5faculté de medecine de Tunis, épidemilogie, Tunis, Tunisia
Background: Low back pain (LBP) is a major health problem around the world.
It affects almost 80% of the population. Patient with LBP suffer from a heavy pain
which is associated to long time incapacity. Different methods of treatment are
applied in the objective of reducing pain and thus improving functional capacities
of patients.
Objectives: Our study aimed to compare the benets, with regard to LBP symp-
toms, of a thermal cure and a rehabilitation treatment.
Methods: It is a randomized therapeutic trial including patients with LBP, ran-
domly divided into two groups: thermal cure and physical rehabilitation. Both of
them were conducted in the same spa center of Djbal El Ouest. Outcome meas-
ures were visual analogic scale of pain (VAS), Oswestry Disability Index (ODI),
Short Form-36 (SF36) questionnaire and schober test. Evaluation was carried
out at day 18, 3 months, 6 months and 12 months following treatment.
Results: Seventy-four patients were included, divided into 2 groups: thermal
group (n=37) and dry rehabilitation group (n=37). Seventy patients performed
the full treatment.
In the group of patients treated with thermal cure treatment (n=37), a signicant
improvement of VAS of pain, ODI and SF 36 was noted in day 18, 3 months,6
months and 12 months (Table1).
Table 1. Tendencies of the clinical indexes after treatment by thermal
cure
D0
(n=37)
D18
(n=37)
3months
(n=35)
6months
(n=32)
12months
(n=36)
VAS ± SD 68,2 ± 16,235,8 ± 26,5 55 ± 19 60,2 ± 18,1 56,1 ± 19
P 0,000 0,00 0 0,008 0,0 02
ODI ± SD 38,3 ± 14,1 29 ± 17,5 32 ± 14,1 30,2 ± 14,1 28,5 ± 13,6
P 0,03 0,03 0,07 0,000
SF 36 physical mean score ± SD34,4 ± 14,3 64,2 ± 18 45,9 ± 19 50 ± 21,8 47,9 ± 18,5
P 0,000 0,00 0 0,000 0,001
SF36 mental mean score ± SD 38,9 ± 16,3 71 ± 21,6 55,1 ± 20,4 56,4 ± 19,952,2 ± 20,8
P 0,000 0,000 0,000 0,000
Scober test ± SD 3,1 ± 1,3 3,5 ± 1,3 2,8 ± 1 3 ± 1,1 3,2 ± 1,5
P 0,037 0,322 0,812 0,657
VAS: visual analog scale; ODI: Oswestry Disability Index; SF36: short form 36
on May 13, 2021 by guest. Protected by copyright.http://ard.bmj.com/Ann Rheum Dis: first published as 10.1136/annrheumdis-2020-eular.3519 on 2 June 2020. Downloaded from