How can hand exercises help manage rheumatoid arthritis symptoms. What are the most effective exercises for improving hand flexibility and strength in RA patients. Which precautions should be taken when performing hand exercises with rheumatoid arthritis.

Understanding the Importance of Hand Exercises for Rheumatoid Arthritis

Rheumatoid arthritis (RA) often affects the hands, causing pain, stiffness, and reduced functionality. Hand exercises play a crucial role in managing these symptoms and maintaining joint health. They help keep tendons flexible, improve circulation through joints, and enhance overall hand strength and dexterity.

Alice Pena, a certified hand therapist and physical therapist, emphasizes the benefits of hand exercises: “It’s a nice way to get a little strengthening going and lets patients sense what their level of activity might be.” This insight underscores the dual purpose of these exercises – not only do they provide physical benefits, but they also help individuals gauge their capabilities and limitations.

Essential Guidelines for Performing Hand Exercises with RA

Before diving into specific exercises, it’s important to understand some key principles for safely and effectively performing hand exercises with rheumatoid arthritis:

• Stop if you experience pain during any exercise
• Aim for 5 repetitions per session, once or twice daily (consult your healthcare provider for personalized recommendations)
• Apply moist heat before exercising to ease motion and prevent discomfort
• Consider soaking hands in warm water, using a paraffin wax bath, or wrapping hands in a warm, damp towel before exercising
• Some exercises, like making a fist, can be done while taking a warm shower

Flat-Hand Finger Lifts: Boosting Flexibility and Control

The flat-hand finger lift exercise is an excellent starting point for improving finger flexibility and control. Here’s how to perform it:

1. Place your hands flat on a table or against a wall, palm down
2. Starting with your thumb, slowly raise each finger individually
3. Hold each finger up for 1-2 seconds
4. Gently lower the finger back down
5. Repeat with each finger

This exercise helps isolate and strengthen individual finger muscles, promoting better dexterity and reducing stiffness.

Making a Fist: Enhancing Range of Motion

The fist-making exercise is simple yet effective for improving hand range of motion. Follow these steps:

1. Start with your fingers straight
2. Slowly draw your fingers together into the center of your palm, forming a loose fist
3. Keep your thumb across your fingers, not tucked underneath
4. Hold this position for up to one minute
5. Slowly open your hand
6. Repeat a few times with each hand

This exercise helps maintain and improve the flexibility of finger joints, which is crucial for performing daily tasks.

Towel Grip Exercise: Strengthening Your Grip

The towel grip exercise is an excellent way to improve hand strength and assess grip functionality. Here’s how to do it:

1. Place a hand towel or kitchen towel flat on a table
2. Cup your hand lightly, supported by your fingertips and thumb
3. “Walk” your fingertips towards you, pulling the towel into your palm
4. Gather as much towel as possible into your fist
5. Gently squeeze
6. Repeat a few times, then switch hands

This exercise not only strengthens your grip but also helps you monitor how RA might be affecting your hand strength over time.

Finger Pinches: Improving Dexterity for Daily Tasks

Finger pinches are particularly beneficial for enhancing dexterity, making everyday tasks like buttoning clothes or tying shoelaces easier. Here’s the process:

1. Touch your thumb to the tip of each finger, one at a time
2. Press firmly, as if pinching
3. Hold for 1-2 seconds
4. Release and move to the next finger
5. Repeat with all fingers on both hands

By practicing this exercise regularly, you can maintain and improve fine motor skills crucial for daily activities.

Thumb Stretch: Maintaining Thumb Mobility and Function

The thumb plays a vital role in hand function, making this stretch especially important. Follow these steps:

1. Start with your thumb pointing outward, away from your palm
2. Move your thumb across your palm
3. Try to touch the base of your little finger
4. Hold for a few seconds, then release
5. Repeat several times

This exercise helps maintain the thumb’s range of motion, which is crucial for gripping objects and performing various hand movements.

Finger Spreading: Reducing Stiffness and Strengthening Muscles

The finger spreading exercise is a simple yet effective way to combat stiffness and strengthen the muscles around your hand joints. Here’s how to do it:

1. Start with your hand in a relaxed position
2. Slowly and gently spread your fingers and thumb as wide apart as possible
3. Hold this position for several seconds
4. Slowly bring your fingers back together
5. Repeat several times with each hand

Regular practice of this exercise can significantly improve hand flexibility and reduce the stiffness often associated with rheumatoid arthritis.

The Role of Heat Therapy in Hand Exercises

Incorporating heat therapy before performing hand exercises can greatly enhance their effectiveness and comfort. Heat helps to:

• Increase blood flow to the hands
• Relax muscles and tendons
• Reduce joint stiffness
• Decrease pain sensations

Consider using one of these heat therapy methods before your exercise routine:

1. Soak your hands in warm water for 5-10 minutes
2. Use a paraffin wax bath
3. Wrap your hands in a towel soaked in hot water
4. Perform some exercises, like making a fist, while taking a warm shower

Recognizing When to Rest: Listening to Your Body

While regular hand exercises are beneficial for managing rheumatoid arthritis symptoms, it’s equally important to recognize when rest is necessary. During flares or periods of increased symptoms, it may be advisable to temporarily pause your exercise routine. Instead, consider wearing a supportive brace or splint to protect your joints from further damage.

Signs that indicate you should take a break from hand exercises include:

• Increased pain during or after exercises
• Swelling in the hands or fingers
• Unusual stiffness or difficulty moving your fingers
• Warmth or redness in the joints

Always consult with your healthcare provider or a physical therapist if you’re unsure about continuing your exercise routine during a flare-up.

Customizing Your Hand Exercise Routine

While the exercises described above are generally beneficial for individuals with rheumatoid arthritis, it’s important to remember that each person’s condition is unique. Factors such as the severity of your RA, any joint deformities, and your overall health can influence which exercises are most appropriate for you.

Consider the following steps to customize your hand exercise routine:

1. Consult with your rheumatologist or a hand specialist to discuss your specific needs and limitations
2. Work with a physical therapist or occupational therapist to develop a personalized exercise plan
3. Start with gentle exercises and gradually increase intensity and duration as tolerated
4. Keep a journal to track your progress and any changes in symptoms
5. Be patient and consistent – improvements may take time to become noticeable

Integrating Hand Exercises into Your Daily Routine

Consistency is key when it comes to reaping the benefits of hand exercises for rheumatoid arthritis. To make these exercises a regular part of your day, consider the following strategies:

• Set a specific time each day for your hand exercises, such as right after waking up or before bed
• Use visual reminders, like sticky notes or phone alerts, to prompt you to do your exercises
• Combine hand exercises with other daily activities, such as watching TV or during work breaks
• Involve a friend or family member in your routine for accountability and support
• Reward yourself for sticking to your exercise plan to maintain motivation

Complementary Therapies for Hand Health in RA

While hand exercises are a crucial component of managing rheumatoid arthritis symptoms, they can be even more effective when combined with other therapeutic approaches. Consider incorporating these complementary therapies into your RA management plan:

1. Massage therapy: Gentle massage can help reduce pain and stiffness in the hands
2. Acupuncture: Some individuals find relief from RA symptoms through acupuncture treatments
3. Mindfulness and relaxation techniques: Stress reduction can help manage pain and improve overall well-being
4. Nutrition: A balanced diet rich in anti-inflammatory foods may help reduce RA symptoms
5. Assistive devices: Using tools designed for individuals with arthritis can reduce strain on your hands during daily activities

Always consult with your healthcare provider before starting any new therapy to ensure it’s safe and appropriate for your specific condition.

Monitoring Progress and Adjusting Your Routine

As you continue with your hand exercise routine, it’s important to regularly assess your progress and make adjustments as needed. Here are some ways to monitor your hand health and exercise effectiveness:

• Keep a symptom diary to track changes in pain, stiffness, and function
• Regularly measure your grip strength using a hand dynamometer (available at many physical therapy clinics)
• Assess your ability to perform daily tasks that require hand dexterity
• Take photos of your hands periodically to visually track any changes in swelling or deformity
• Schedule regular check-ups with your rheumatologist to discuss your progress and any necessary adjustments to your treatment plan

Remember that progress may be gradual, and there may be setbacks along the way. Stay patient and consistent with your efforts, and don’t hesitate to reach out to your healthcare team if you have concerns or questions about your hand exercise routine.

The Future of Hand Therapy for Rheumatoid Arthritis

As research in rheumatoid arthritis treatment continues to advance, new approaches to hand therapy are emerging. Some promising developments include:

• Virtual reality-based hand exercises that make therapy more engaging and trackable
• Wearable technology that provides real-time feedback on hand movements and exercise quality
• Personalized exercise programs based on genetic markers and individual disease patterns
• Integration of hand exercises with overall RA management through smartphone apps and telemedicine

While these innovations are exciting, it’s important to remember that the fundamental principles of hand exercises for RA remain crucial. Consistency, proper technique, and listening to your body will always be key components of effective hand therapy.

By incorporating regular hand exercises into your rheumatoid arthritis management plan, you can work towards maintaining and improving your hand function, reducing pain and stiffness, and enhancing your overall quality of life. Remember to consult with your healthcare provider to ensure that your exercise routine is tailored to your specific needs and limitations. With patience, persistence, and the right approach, you can take important steps towards managing your RA symptoms and keeping your hands as healthy and functional as possible.

Hand Exercises for Rheumatoid Arthritis (RA) Relief

A few quick and simple exercises can ease RA pain and stiffness in your hands and make everyday tasks far easier.

By Madeline R. Vann, MPHMedically Reviewed by Alexa Meara, MD

Reviewed: February 14, 2023

Medically Reviewed

Hand exercises help keep your fingers moving by keeping tendons flexible and improving circulation through your joints.iStock

Losing hand strength and flexibility in your fingers is a common complaint for people with rheumatoid arthritis (RA). Fortunately, practicing a few easy hand exercises — no special equipment or much time needed — can be hugely beneficial both for stopping pain and stiffness and for improving joint function.

“It’s a nice way to get a little strengthening going and lets patients sense what their level of activity might be,” explains certified hand therapist Alice Pena, a physical therapist who is a former spokesperson for the American Physical Therapy Association.

Some Rules of ‘Thumb’ for Hand Exercises With RA

While hand exercises are typically good for rheumatoid arthritis, if anything hurts, stop. In general, you can repeat the following exercises up to five times per session, once or twice a day. Talk to your doctor or physical therapist about the best number of reps for you to avoid strains.

Moist heat can make the motion of hand exercises for rheumatoid arthritis easier and help prevent discomfort. One option is to soak your hands in warm water for 5 to 10 minutes before you begin. Treating your hands with a warm paraffin wax bath or wrapping them in a towel soaked first in hot water are other options. You can also practice some of these exercises, such as making a fist, while taking a warm shower.

1. Increase Flexibility With Flat-Hand Finger Lifts

Start by placing your hands flat, palm down, on a table or against a wall. Then, starting with your thumb, slowly raise each finger individually off the table or surface. Hold each finger up for one or two seconds, and then gently lower it.

2. Increase Your Range of Motion by Making a Fist

Start with your fingers straight out, then draw them together down into the center of your palm to make a loose fist. (Keep your thumb across your fingers and not tucked beneath them.) Hold this position for up to one minute, then open your hand slowly and repeat a few times on each hand.

3. Improve Your Grip by Walking Your Fingers

Place a hand towel or kitchen towel flat on a table. With one hand lightly cupped and supported by your fingertips and thumb, “walk” your fingertips toward you to pull the towel up into the palm of your hand. “Get as much towel into your fist as you can and gently squeeze,” says Pena. This keeps you aware of how RA might be affecting your grip and how strong your grip is, she explains. Repeat a few times then switch to your other hand.

RELATED: Don’t Lose Your Grip: Rheumatoid Arthritis and Grip Strength

4.

Increase Your Dexterity With Finger Pinches

Pinching your thumb to the tip of each of your fingers one at a time can help make everyday tasks — such as tying shoelaces or doing up buttons — easier if you have RA. Take your thumb and touch it to a finger and press it firmly like a pinch. Hold for a second or two and release. Do this with each finger individually.

5. Keep Your Thumb Nimble With a Simple Stretch

Focusing on your thumb is necessary because it is so important to so many different hand motions. A key exercise for maintaining the thumb’s function begins with your thumb pointing outward, away from your palm. Then move your thumb across your palm to try to touch the base of your little finger. This kind of motion can help you grip circular objects, such as the handle of a hairbrush.

6. Maintain Hand Flexibility by Spreading Your Fingers

Simply spread your fingers and thumb as wide apart as possible, slowly and gently. Hold for several seconds. This is a great way to reduce stiffness and strengthen the muscles around the joints in your hand.

Know When It’s Best to Take a Break

Succeeding with RA treatment means knowing when to temporarily lay off exercising, Pena says. For example, during flares or a worsening of your symptoms, it might be best to wear a supportive brace or a splint and forgo exercising to avoid additional damage to your joints. Listen to your body.

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Hand Exercises for Rheumatoid Arthritis

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The joints in the fingers, thumbs, and wrists can become stiff and swollen from certain types of autoimmune arthritis, especially rheumatoid arthritis. Everyday tasks, such as opening car doors and brushing teeth, can become challenging and painful. Hand exercises can help stretch and strengthen muscles and tendons, help relieve symptoms, and improve hand function.

Read more about Hand Pain and Rheumatoid Arthritis

The best hand exercise program is one that has been customized for a person’s unique anatomy and circumstances. A qualified health care practitioner, such as an occupational therapist or physical therapist who specializes in the hand, can tailor a program to an individual’s needs.

While a personalized hand exercise program is ideal, the 4 hand exercises described below are okay for most people who have rheumatoid arthritis. The goal of these exercises is to:

• Strengthen muscles and tendons in the hand and forearms
• Improving range of motion in the fingers and thumbs
• Improve hand function, including the ability to grip, pinch, and hold objects

If hand pain is present, it is a good idea to clear these exercises with a qualified health care practitioner. During each exercise, keep the wrist in a relaxed, neutral (straight) position. Stop any exercise if it triggers sharp or severe pain.

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Thumb Crosses

Rheumatoid arthritis can make the joint at the base of the thumb (the carpometacarpal joint) feel stiff, achy, and weak. Since the thumbs are used during many daily activities, it is important to maintain these joints’ range of motion and muscle strength.

Doing this exercise regularly may help alleviate stiffness and improve strength:

• Extend your fingers and thumb straight up, like you are about to give a high-5
• Bring your thumb across the palm of your, hand toward the base of your pinky

Hold for a few seconds and then relax. Repeat 8 to 12 times, then switch hands. Do 1 to 3 sets a day.

Knuckle Bends

These exercises are designed to ease stiffness in the knuckles and strengthen the forearm muscles that control the fingers.

• Start with fingers extended in the high-5 position
• Make a claw by bending your 4 fingers at their top two knuckles (called the proximal interphalangeal joints and the distal interphalangeal joints)
• Try to bend the knuckles so much that the tips of the fingers curl around and touch the palm. Due to stiffness or deformity, it might not be possible to reach all the way to the palm, in which case simply proceed as far as is possible and comfortable for you.
• Keep the thumb extended throughout this exercise

When doing this exercise, try to resist the urge to bend the large knuckles (called the metacarpophalangeal joints) where the fingers meet the palm. Repeat the exercise 8 to 12 times, then switch hands. Do 1 to 3 sets a day.

In This Article:

• Therapy for Rheumatoid Arthritis in the Hand

• Hand Exercises for Rheumatoid Arthritis

Fist Stretches

Stiff, swollen hand joints can make it difficult to make a fist. Making a fist requires a lot of the same muscles and tendons that are used for gripping. Regularly performing this fist stretch may help improve grip strength.

• Make a fist
• Extend your fingers and thumb, so they are straight and fanned out

It may be challenging to make a tight fist or fully straightening the fingers and thumb. Do your best. Repeat 8 to 12 times, then switch hands. Do 1 to 3 sets a day.

Thumb to Fingertip Touches

This exercise can increase dexterity and strength in the thumb and finger joints. Regularly performing this exercise may help improve the ability to pinch small objects, such as credit cards, papers, and eating utensils.

• Start with the thumb and fingers extended in the high 5 position.
• Touch the tip of your thumb with the tip of your index finger, similar to an “okay” sign.
• Return the index finger to the starting position, and repeat with the other 3 fingers, touching the tip of the thumb to the tips of the middle, ring, and pinky fingers.

When touching a thumb to fingertip, try to keep the other 3 fingers straight up. Repeat this series 8 to 12 times, then switch hands.

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When done regularly, these hand exercises will probably get easier over time. Once hand strength improves, regular exercises may still be necessary to maintain functional gains.

Read more about Treatments for Rheumatoid Arthritis in Hands

A licensed health care practitioner with specialized knowledge about rheumatoid arthritis in the hands can suggest additional exercises as well as other treatments to help alleviate rheumatoid arthritis symptoms in the hands.

Cheryl Crow is a licensed occupational therapist. A rheumatoid arthritis patient herself, Ms. Crow combines her personal experiences and professional expertise to help others navigate the everyday challenges associated with chronic joint pain.

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Exercise for rheumatoid arthritis | Hello

In rheumatoid arthritis, the disease affects small joints, gradually spreading its harmful effect to larger ones. In the process, the inner surface of the articular bag and cartilage tissue are destroyed. Most often, the disease affects women and teenagers, as well as people who are regularly exposed to physical activity. By resorting to exercise therapy for rheumatoid arthritis (exercise therapy), you can ease the symptoms and improve well-being. Treatment of the spine and joints is prescribed by exercise therapy doctors, orthopedists or rheumatologists. The program is compiled taking into account the patient’s condition, his physical capabilities and existing contraindications.

What does exercise therapy do

Due to therapeutic exercises, rheumatoid arthritis maintains joint mobility. With a decrease in activity, muscle tissue atrophies, blood circulation slows down, and edema develops. At the same time, body weight increases. This is important because being overweight interferes with movement and puts more stress on your joints.

Thanks to the exercises, muscle and connective tissues, tendons are strengthened. As a result, the risk of injury is reduced. Simultaneously, during exercise, muscle relaxation occurs, and in rheumatoid arthritis, this helps prevent pain and accelerates regeneration processes.

Classes have a positive effect on the processes of metabolism and oxygen absorption, weight is reduced. But exercise therapy for rheumatism is contraindicated if the disease is in an advanced stage, and also when:

• inflammation in the internal organs and the cardiovascular system is detected;
• the acute stage of a chronic disease has begun;
• infection has occurred;
• there is intoxication of the body;
• infection develops;
• have heart or lung failure;
• suffering from fever;
• the temperature has risen;
• a hernia appeared;
• diagnosed with cancer.

Physical activity in rheumatoid arthritis should be regular and feasible. It is necessary to perform the exercises three times a day: in the morning, in the afternoon and before bedtime. At the same time, you should try to evenly distribute the load, equally working with both right and left limbs. Breathing should be measured, deep, and the load should be increased gradually, taking into account well-being.

Caring for the hands

Hand exercises for rheumatoid arthritis include exercises for fingers, wrists, shoulders and elbows. Classes begin with the development of the wrists, gradually rising up:

1. Stretch your arms forward. Turn open palms in different directions.
2. Close fists and repeat turns.
3. Sit down at the table. Place open palms on it. Now you need to raise your fingers up so that everything that is below the interdigital spaces lies motionless on the table.
4. Press palms together (as if in prayer) and raise to the level of the face. Put your elbows on the table. Then you need to slowly spread them, while the fingers should still touch each other.
5. Squeeze an expander, a special ball or an anti-stress toy in the palm of your hand.

To develop the elbow joints, it is necessary to bend and then raise the arms so that the hands are down and the elbows are at shoulder level. Now you need to reduce and breed the shoulder blades. Then you need to go to the wall, lean on it with your elbows and start push-ups.

Physical exercises for rheumatoid arthritis to develop the shoulder girdle include classic movements. First you just need to take turns raising and lowering your shoulders. After that, you need to make circular movements back and forth with them. To stretch from behind, behind the back at waist level, you need to interlock your fingers into the lock and lift them up, bringing the shoulder blades together.

Footwork

Orthopedists have developed a standard set of exercise therapy exercises for the lower extremities in rheumatoid arthritis. There are also proprietary methods. The classic exercises are as follows:

1. Tighten your toes and relax them.
2. Stand up straight and roll from heel to toe and back.
3. Rise on your toes and try to stay in this position for 1-2 minutes.
4. Place small objects on the floor and then try to pick them up. The exercise can be done both sitting and standing.
5. Rotate the foot, raise and lower it. You can also sit down.
6. Lie on the floor and do a “bike” with your hips up and your feet imitating the motion of the pedals.
7. Still lying on the floor, stretch out your arms and legs. Then you need to slowly bring the left heel to the buttocks, and then raise the leg so that the knee touches the chest. Repeat the movement on the right side.
8. Lying on your back, bend your knees and spread them to the maximum distance.
9. The exercise is similar to the previous one, but is performed with outstretched legs.

It is very useful to walk barefoot on the ground or grass as often as possible. Periodically, it is desirable to make swing movements: just stand up straight and stretch your legs, and then make wide swings with one limb, then the other.

Emphasis on the knees

Very effective exercises for rheumatoid arthritis of the knee joint, developed by Dr. S.M. Bubnovsky. The main goals of the complex he proposes are to activate the blood supply in the knee area, stimulate the production of synovial fluid, and strengthen the ligaments and muscles. Also in the process, the spinal column is strengthened, due to which the pressure of body weight on the knees is reduced. The complex proposed by the doctor consists of only three exercises:

1. Lie down on the floor and roll over onto your back. Then, in turn, raise one leg, then the other, bending it at the knee. Fix the limb at the top point for 1 minute. Legs should always be lowered slowly. While one limb is up, the other should lie on the floor. Repeat the movement 10 times. Hands can be extended along the body or placed on the stomach.
2. Same starting position. It is necessary to raise the pelvis with support on the feet and outstretched arms. You should get a “bridge” with the legs as bent as possible. Next, you need to stand like this for at least 1 minute and gently lower yourself. Exercise is done 15 times.
3. Lie on your back with your arms and legs extended. Then slowly bring one knee to the nose, then the other. You can help yourself with your hands, pull yourself up with your head. Do 10 sets for each leg.

To practice Bubnovsky on the floor, you need to prepare a soft surface. You can work on an orthopedic mattress. The complex cannot be called easy to perform, but the result of the classes appears quite quickly.

Summary

Exercise therapy does not cure rheumatoid arthritis. In severe situations, the pain will not go away, and you still have to go for surgery. But the body prepared by exercises recovers faster and easier. In the initial stage of the disease, classes will help to maintain joint mobility for longer and lead a full-fledged lifestyle.

Exercises for rheumatoid arthritis of the hand

What is rheumatoid arthritis and what is exercise?

Rheumatoid arthritis is a joint disease that often affects the hands and wrists. Hand exercises include mobility, strengthening (with equipment such as putty), or functional training.

Study profile

We found seven studies comparing hand exercise with no exercise therapy in 841 adults with rheumatoid arthritis.

Main results

In a short-term follow-up (less than 3 months), people who did hand exercises rated their function 1.1 points higher on an 80-point hand function test (0 to 80 points, higher score means better function) . People who didn’t exercise rated their functions 75 points.

At medium-term follow-up (3 to 11 months), people who did hand exercises rated their function 5 points higher on a 100-point scale (0 to 100 points, higher score means better function), and 4 points higher with long-term follow-up (more than 12 months). People who did not exercise rated their functions at 52.1 points.

In a short-term follow-up, people who exercised rated their pain 28 mm lower on the 100 mm pain scale (0 to 100 mm, lower value means less pain). People who didn’t exercise rated their pain at 68mm. At the mid-term follow-up, people who exercised rated their pain 3 points lower on a 100-point pain scale (from 0 to 100, lower means less pain), and 4 points lower at long-term follow-up. People who didn’t exercise rated their pain at 51.4.

In short-term follow-up, exercisers had 3% and 4% improvement in their left and right hands in grip strength. For individuals who did not exercise, strength indicators were 14. 3 kg and 15.6 kg, respectively. In both medium and long-term follow-up, exercisers had a 1% improvement in both hands in average grip strength. In individuals who did not exercise, strength indicators were 13.2 kg.

In short-term follow-up, exercisers had 4% and 6% improvement in left and right hands in pinch strength. For individuals who did not exercise, strength indicators were 1.2 kg and 1.2 kg, respectively. At medium and long-term follow-up, exercisers had 2% and 3% improvement in both hands in average pinch grip strength. In individuals who did not exercise, strength indicators were 4 kg.

It should be noted that while there were apparently better measures of hand function, pain, grip strength, and pinch grip with hand exercises, these improvements may not equate to clinical benefit.

No study evaluated the American College of Rheumatology Criteria 50 (a measure that indicates greater than or equal to 50% improvement in a patient’s symptoms when receiving treatment).

Compared with participants who received regular care, those who also received hand exercises with strategies to stick to this program were 19% and 5% are more likely to stick to their program for a year or more.

One study reported no adverse effects associated with exercise. The remaining studies did not measure this outcome.

Quality of evidence

The quality of the evidence was very low to high quality across outcomes. We downgraded the quality of the evidence due to problems with participants not being blinded to their prescribed treatments and measurements, problems with how participants were assigned to study groups, and small study sizes.

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Translation notes:

Translation: Ziganshina Lilia Evgenievna. Editing: Yudina Ekaterina Viktorovna.