Functional Activity-based Exercise for Disability Management in Individuals with Rheumatoid Arthritis: A Case Series

Abstract

Aims: To evaluate the effect of a 10-week exercise protocol based on functional activities of daily living on the level of disability in individuals with rheumatoid arthritis (RA). Place and Duration of Study: Hospital das Clínicas of the Federal University of Pernambuco (rheumatology outpatient clinic) and Physiotherapy School Clinic of the Federal University of Pernambuco; between May and December 2022. Methods: A case series included individuals aged 18–65 years, diagnosed with RA, and stable on medication for at least three months. Participants underwent pre- and post-intervention assessments after a 10-week protocol of 20 supervised sessions (twice weekly). The exercise protocol was intended to simulate activities of daily living and included bridging, sit-to-stand from a chair, stair climbing, hand grip strength and obstacle-based walking training. Outcomes included: disability, assessed through Health Assessment Questionnaire (HAQ); upper limb function, evaluated using Disabilities of the arm, shoulder and hand (DASH); fatigue, through Fatigue Severity Scale (FSS); quality of life, using 36-Item Short-Form Health Survey (SF-36), lower limb strength, through 30-second sit-to-stand test (30s-STS); physical performance, using 6-minute walk test (6MWT). Statistical analyses included descriptive statistics and Wilcoxon signed-rank tests (p<0.05). Results: Ten participants (nine women), with a mean age of 53.1 ± 9.7 years and BMI of 31.2 ± 4.5 kg/m², completed the protocol. Significant improvements were observed in disability (HAQ: median pre=2.06, post=0.81; P=0.010), upper limb functional limitations (DASH: median pre=57.85, post=34.85; P=0.004), pain levels (P=0.003), and quality of life (SF-36 physical: +10.95, P=0.002; mental: +8.58, P=0.01). Conclusion: A functional activity-based exercise protocol is feasible, easy to implement, safe, and proved effective in reducing disability, pain and improving quality of life in individuals with RA. Further studies with more participants are needed to confirm our findings.