A randomized controlled trial of center-based and home-based exercise programs among patients with rheumatoid arthritis

Background: Rheumatoid arthritis (RA) patients benefit from aerobic and strengthening exercises. Objective: To compare the effectiveness of a home exercise program against center-based aerobic and strengthening exercises on the grip strength, endurance, function, and fatigue among patients with RA. Methodology: In this assessor-blind, randomized trial, 50 RA patients were assigned to either center-based physical therapy (CPT) or home exercise program (HEP) that included aerobic and strengthening exercises performed for four weeks. The grip strength, 6-minute walk test (6MWT), health assessment questionnaire- disability index (HAQ-DI), and the multidimensional assessment of fatigue (MAF) index were determined at weeks 0 (baseline), 2 and 4 weeks. Results: Thirty-seven patients completed the study. All patients were females with a mean (±SD) age of 53 ± 11 years. The baseline characteristics were similar except for a higher pain intensity score in the CPT group (p=0.02). The grip strength of patients in both groups was low and did not change after four weeks. The 6MWT mean difference ±standard error (SE) was 21.39 ± 4.13 meters in CPT (p<0.01) and 9.46 ± 5.87 meters in HEP (p=0.33). Functional disability was mild with a mean difference ± SE of 0.38 ± 0.1 for CPT (p<0.01) and 0.15 ± 0.08 for HEP (p=0.16). The level of fatigue was moderate with a significant mean difference ± SE of 7.98 ± 1.71 for CPT (p<0.01) and 4.46 ± 1.14 for HEP (p<0.01). There was no significant between-group difference in the change in grip strength, 6MWT, HAQ-DI, and MAF index after four weeks of intervention. Conclusion: Home-based and center-based physical therapy programs are comparable in improving endurance, function, and fatigue in patients with RA.