A pilot study
by Dr. Susan Allen,
an M.U. researcher,
has found
preliminary evidence
that might leave
rheumatoid arthritis
sufferers ...

Reaching for
Healthy Bones

Written and Photographed by Sid Perkins of the Missourian Staff

This story appeared in the "Frontiers" section (page 5A)
of the Columbia Missourian on November 5, 1996.

A recently completed study of mid-Missouri women could help dispel the conventional wisdom that patients with rheumatoid arthritis shouldn't exercise.

The study, conducted by Dr. Susan Allen at the University of Missouri-Columbia, sought to extend and confirm the results of a pilot study that showed a regular program of exercise resulted in increased bone density among rheumatoid arthritis patients who also suffered from osteoporosis.

Osteoporosis, commonly known as "brittle bone disease," causes a loss of bone tissue, which leaves the bones porous, brittle, and subject to easy breakage. Although many individual factors might help cause osteoporosis, women who also have rheumatoid arthritis suffer from the combination of several risk factors.

"There are probably three reasons why women with rheumatoid arthritis have osteoporosis," Allen said. "One is disease-related issues, related to the inflammation. The second is that they're very inactive. And the third reason is medications, the biggest ones being corticoids or steroids."

Although all three of these factors can cause the loss of bone density and lead to osteoporosis, the effect of exercise on bone density is what Allen's recent study was designed to evaluate.

"Being weight-bearing is really important for the integrity of bone," she said.

Allen said people who have gone into space for extended periods of time have lost bone density because of the lack of gravity. Even on Earth in the presence of gravity, people who are inactive or who don't put place weight on their bones through regular exercise can be victims of this phenomenon.

"What I normally do with all my patients is have them learn how to do back extension exercises, because it helps them counterbalance the normal tendency to slouch," she said.

"When they increase the muscle tone of their back muscles, it actually provides a weight-bearing effect on the vertebrae, and studies have shown that women who have good strong extensors in the back have higher bone density with fewer fractures.

"Putting stress on bone is a good thing," Allen said.

A pilot study, in which two patients were monitored for a period of 12 months, concluded that rheumatoid arthritis patients who had lost significant bone density might benefit from conditioning exercise. After seven months of exercise, the bone density in the vertebrae of the lower back for both patients was markedly increased.

Then, due to other problems, both women stopped their exercise program in mid-study. Subsequent measurements showed that the women suffered adverse effects on bone density.

"They were actually supposed to go for 12 months, but they both, for different reasons, stopped," Allen said. "And when they quit exercising, they began to lose the bone."

Allen's most recent study extended over an 18-month period and included about 150 mid-Missouri women between the ages of 30 and 75 who suffer from osteoporosis. About half of the participants in the study had rheumatoid arthritis, while the others did not. At the beginning of the study, there was a measurable difference between the two groups.

The baseline data showed the group who also had rheumatoid arthritis had severe osteoporosis - a lot more than the women their age who did not have the rheumatoid arthritis, Allen said.

Although the data obtained in the later portions of the study haven't been analyzed completely, the results of the earlier pilot study provide an idea of what the results might show.

"We would anticipate that those who didn't exercise were going to lose bone or keep about the same, and that those who exercise will gain some," Allen said.

Allen also said patients who didn't exercise regularly before the study would be expected to gain bone density as a result of the exercise program, while those who had exercised regularly before the study would likely maintain their bone density.

Allen's study is an extension of the work of Dr. Marian Minor and Dr. Donald Kay, her colleagues at University Hospital and Clinics. One of their studies in the late 1980s challenged the idea that patients with rheumatoid arthritis should not exercise. They showed that conditioning exercise is effective for the patients and does not exacerbate the symptoms of the arthritis.

"What we were taught in medical school was that people who had rheumatoid arthritis should not exercise," Allen said.

She said that Minor and Kay showed in their earlier work that the disease-related measures of the illness actually got better with exercise.

"With this study we thought we would look at another outcome measure," Allen said. "We wanted to look at what happens when these patients exercise, because they are at risk for fracture if they keep losing bone."

If the results of Allen's study confirm what was found in the pilot study, it could significantly change the way both doctors and arthritis patients view exercise.

"It would show another reason why patients should exercise," she said. "The cost of a fracture to a patient is that they become incapacitated. You want to prevent fracture and the complications associated with that."

Allen is now analyzing the data obtained from her study, and she hopes to publish the results sometime next year.



"Social" exercise brings results

"Your grandma lifts weights" might seem to be a schoolyard slur that ranks right up there with "Your mother wears Army boots."

But it shouldn't be. The use of hand weights, along with stretching exercises and other low-impact aerobics, is becoming a key component of exercise programs for beginners or for people who can't engage in strenuous exercise due to health problems.

Mary Davies, 77, of Hallsville, began an exercise program two years ago on the advice of her doctor, who suggested she needed to do something about her "dowager's hump," a slouching condition that is common among women with osteoporosis.

"The exercise program has helped me, definitely," Davies said. "It helps by making me more conscious of my posture. It sure helped my back, I know that."

Davies has benefited from her exercise program in other ways, as well.

"I like the weight lifting, I really do," she said. "I had a fractured wrist, and the weights helped me strengthen my wrist during recovery."

Donna Rothermich, 45, of Boonville, suffers from rheumatoid arthritis and osteoporosis. She was a participant in both of Dr. Susan Allen's studies evaluating the effect of exercise on bone density in patients with osteoporosis.

"I knew exercise worked, because my bone density increased during the pilot study," she said.

Although her increased bone density is not outwardly apparent, Rothermich also was able to cite other health benefits from exercise that are more obvious to her.

"I have more energy, and I don't get as tired as I used to," she said. "I used to be exhausted from my shopping trips, but now I have energy left over to work in my garden.

"It's all, I believe, because of the exercise."



There is a big demand in the community for exercise programs such as the one in which Davies and Rothermich participate, said Ann Halterman, exercise instructor at The Health Connection, a community health center in the lower level of Parkade Center.

"There's no pressure," Halterman said. "People can exercise at their own pace, and they like that. It's also a big social event."

Exercise programs result in noticeable improvements in health in a variety of ways, Halterman said.

"They're pretty much lost in the beginning," she said. "But after a while, their coordination improves. We start with their legs and feet, and then we add the arms. Their balance improves, and their cardiovascular fitness improves as well.

"Some come to lose weight, and some come to have a good time," Halterman said. "But the majority of them come to maintain a healthy lifestyle."

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Copyright 1996 by Missourian Publishing Association Inc.
All rights reserved.
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