CONCLUSION OF THE REVIEW OF ARTICLES

Search strategy; The Cochrane library, PubMed, Google Scholar, and Web of Science were searched for
all the randomized controlled trial on the efficacy of resistance training in patients with RA to improve
muscle strength and physical function.
The PICO chosen for the search strategy was as follows;
Population – rheumatoid arthritis
Intervention – resistance training
Comparator – control
Outcome measure – physical function

Methodological quality;
Based on PEDro scoring,
1. Lourenzi et al., 2017; (article 1) – 8/10
2. Haglo et al., 2021; (article 2) – 6/10
3. Rodrigues et al., 2020; (article 3) – 7/10
4. Lange et al., 2019; (article 4) – 8/10
5. Seneca et al., 2015; (article 5) – 6/10
Methodological quality of all the articles was good according to PEDro scoring. Therefore, the
information derived from these articles can be effectively used as evidence based practice in future
rehabilitation.
All the 5 articles were in support of resistance exercise program for RA patients to improve
physical function and muscle strength. Physical function was assessed by either HAQ or SF-36 or both.
Despite, all the articles utilized resistance training as an intervention protocol, there was heterogeneity in
the training protocols and 4 out of 5 training protocols were effective in improving physical function.
Only the study by Lange et al., 2019 (article 4) in which aerobic training was utilized in combination with
resistance training did not show any improvement in HAQ-DI.
The supporting and contrasting evidence to the effect of resistance training on disability
and functional capacity by HAQ and SF-36 have shown in literature. These contradictions are
likely due to sample size variations and the fact that most of the studies on resistance exercises
addressed changes in muscle strength. The limitation of HAQ in evaluating more complex
activities and the floor effect, partially explained this observation.
 Concluding from the article reviews; supervised high intensity interval resistance training
is a safe training protocol and can be effectively utilized as evidence based practice to improve
physical function in individuals with RA. Apart from this, there are some issues with the
intervention protocol that maybe needed to be addressed in future studies. An appropriate
duration for achieving maximum gains in muscle strength should be established. There may be a
need to establish an intervention protocol utilizing supervised high intensity interval training,
involving UL and LL strengthening exercises in individuals with RA for future studies. Direct
comparison between different strength training programmes may need to be established for
future studies.

COCHRANE RISK OF BIAS GRAPH AND SUMMARY

The specificity and sensitivity of all the 5 article reviews based on Cochrane risk of bias
tool is mentioned below in the form of risk of bias graph. The summary table on the
methodological quality of all the 5 articles is also provided below;

Figure 1. risk of bias graph

Figure 2. risk of bias summary
 REFERENCES OF THE ARTICLES REVIEWED

Haglo, H., Berg, O. K., Hoff, J., Helgerud, J., & Wang, E. (2022). Maximal strength training in
patients with inflammatory rheumatic disease: implications for physical function and
quality of life. European journal of applied physiology, 122(7), 1671–1681.
https://doi.org/10.1007/s00421-022-04948-w

Lange, E., Kucharski, D., Svedlund, S., Svensson, K., Bertholds, G., Gjertsson, I., &
Mannerkorpi, K. (2019). Effects of Aerobic and Resistance Exercise in Older Adults
With Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis care &
research, 71(1), 61–70. https://doi.org/10.1002/acr.23589

Lourenzi, F. M., Jones, A., Pereira, D. F., Santos, J. H. C. A. D., Furtado, R. N. V., & Natour, J.
(2017). Effectiveness of an overall progressive resistance strength program for improving
the functional capacity of patients with rheumatoid arthritis: a randomized controlled
trial. Clinical rehabilitation, 31(11), 1482–1491.
https://doi.org/10.1177/0269215517698732

Rodrigues, R., Ferraz, R. B., Kurimori, C. O., Guedes, L. K., Lima, F. R., de Sá-Pinto, A. L.,
Gualano, B., & Roschel, H. (2020). Low-Load Resistance Training With Blood-Flow
Restriction in Relation to Muscle Function, Mass, and Functionality in Women With
Rheumatoid Arthritis. Arthritis care & research, 72(6), 787–797.
https://doi.org/10.1002/acr.23911

Seneca, T., Hauge, E. M., & Maribo, T. (2015). Comparable effect of partly supervised and self-
administered exercise programme in early rheumatoid arthritis--a randomised, controlled
trial. Danish medical journal, 62(8), A5127.