The Significance and Efficacy of Resistance Exercise in Patients With Rheumatoid Arthritis (Ra) – A Clinical and Molecular Perspective

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by progressive joint destruction and immunometabolic complications, notably rheumatoid cachexia. This review article investigates the significance and efficacy of resistance exercise in mitigating myopenia, sarcopenic obesity, and systemic inflammation in RA patients. The objective is to elucidate the underlying molecular mechanotransduction pathways, the role of myokines, and the clinical outcomes of progressive resistance training (PRT). A comprehensive review of the current literature, including recent randomized controlled trials and meta-analyses, was conducted to evaluate clinical and physiological effects. The findings indicate that PRT effectively counteracts muscle atrophy by activating the mTORC1 pathway and exerts potent anti-inflammatory effects via the release of muscle-derived interleukin-6 (IL-6). Furthermore, PRT demonstrates synergistic potential with modern biological and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs). Clinically, properly dosed PRT improves functional capacity, reduces cardiovascular risk, and alleviates patient-reported outcomes such as fatigue and sleep disruption, without exacerbating synovial inflammation or radiographic progression in stable RA. We conclude that structured resistance training is a crucial, evidence-based non-pharmacological therapy for RA — warranting equal consideration alongside standard aerobic exercises — and provide structured dosing guidelines based on the FITT-VP framework.