Effects of isotonic and isometric hand exercises on pain, hand functions, dexterity and quality of life in women with rheumatoid arthritis

The primary objective of our study was to evaluate the effect of 6-week-long isotonic and isometric hand exercises on pain, hand functions, dexterity and quality of life in women diagnosed as rheumatoid arthritis (RA). Our secondary objective was to assess the changes in handgrip strength and disease activity. This randomized, parallel, single-blinded 6-week intervention study enrolled 52 female patients between 40 and 70 years of age, who were diagnosed with RA according to American College of Rheumatology criteria, had disease duration of at least 1 year and had a stage 1-3 disease according to Steinbrocker's functional evaluation scale. Patients were randomized into isotonics and isometrics groups. Exercises were performed on sixth week. All patients were applied wax therapy in the first 2 weeks. Their pain was assessed with visual analog scale (VAS), their hand functions with Duruoz Hand Index (DHI), dexterity with nine hole peg test (NHPT) and quality of life with Rheumatoid Arthritis Quality of Life questionnaire (RAQoL). Dominant and non-dominant handgrip strengths (HS) were measured. Disease activity was determined by disease activity score (DAS 28). We evaluated the difference in the above parameters between baseline and 6 weeks by Wilcoxon paired t test. The study was completed with 47 patients (isotonics n = 23; isometrics n = 24). VAS, DHI, NHPT, and RAQoL scores significantly improved in both groups by the end of 6th week compared to the baseline scores of the study (for isotonics p = 0.036, p = 0.002; p = 0.0001, p = 0.003; for isometrics p = 0.021, p = 0.002, p = 0.005, p = 0.01, respectively). DAS 28 scores decreased in both exercise groups (p = 0.002; p = 0.0001, respectively), while isometrics showed a significant increase in dominant HS (p = 0.029), and isotonics showed a significant increase in non-dominant HS (p = 0.013). This study showed that isometric and isotonic hand exercises decrease pain and disease activity and improve hand functions, dexterity and quality of life as well as mildly increasing muscle strength in patients diagnosed as RA.