Journal Article Review July 2017

July, 2017:  Does resistance training affect muscle strength, joint pain, and hand function in individuals with hand osteoarthritis?

Magni N et al: The effects of resistance training on muscle strength, joint pain, and hand function in individuals with hand osteoarthritis: a systematic review and meta-analysis. Arthritis Research and Therapy, 2017; 19:131.   Abstract and full text

For individuals with hip or knee osteoarthritis (OA), resistance training reduces symptoms, impairment, and dysfunction. Several studies have noted reduced muscle strength in the hands of individuals with OA, and many work and daily living activities require considerable strength for completion. The present investigation queried whether resistance training would benefit the hands in individuals with OA as it seems to do for hips and knees.

These investigators from New Zealand conducted a systematic review and meta-analysis of the literature in English, Spanish, and Italian and found five randomized controlled studies (350 participants) that met their rigorous inclusion criteria. Eighty-seven percent of participants were women. Ages ranged from 61 to 81 years.

The included studies varied regarding the duration (4-12 weeks) and supervision (group vs individual, clinic vs home after instruction) of the exercise program. The exercises themselves varied in frequency and intensity from three times weekly to daily. The intensity of exercise varied from using rubber bands and Play-Doh with unknown fraction of maximum voluntary contraction (MVC) to quantitated MVC ranging from 16% to 100%. All studies progressed the number of exercise repetitions up to a maximum of 20. One study progressed exercise from 40% to 60% of MVC.

Results: Two of the five studies showed improved grip strength after resistance training in the study group compared to the control group. The pooled results, however, indicated with moderate-quality evidence that resistance exercises did not improve grip strength.

Most studies showed a trend towards reduced pain in the resistance training group, but only two studies reported statistically significant changes in pain compared to the control group. The pooled results showed low-quality evidence that resistance exercise reduced pain.

One study noted a significant change in self-reported hand function after resistance training compared to the control group. The pooled results, however, provided low quality evidence that the strengthening exercises did not improve hand function.

Overall, resistance exercises did not have much effect on strength, comfort, or function.

Discussion: The authors were surprised that grip strength did not improve. They speculated that the reason was that the muscles were trained at lengths shorter or longer than used for the testing position.

The authors noted that the frequency, intensity, sets, repetitions, and progression of exercises in the reported studies were not sufficient to induce improved strength in older individuals.

They conclude that their lack-luster results may stem from the scarcity of studies (5) and their low-quality study designs. “Further studies should consider focusing exercise programs specifically on identified muscle deficits as well as optimising exercise training parameters to achieve clinically significant strength improvements in people with hand OA.”

COMMENT: I agree with their conclusions. Devise and execute a better study. There are millions of Baby Boomers who will have worsening hand OA over the next several decades. They have been youthful and energetic up to now. They will want to continue. How can we help?