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IRD IA – Improve Muscle Strength

Evidence summary (Updated 2022)

Muscle wasting and reduced strength (up to 70%) are common in patients with rheumatoid arthritis (1). They are also at risk of rheumatoid cachexia. RCTs evaluating the effect of exercise interventions for those with rheumatoid arthritis have identified improvements in knee extensor isometric strength and grip strength, assessed using a dynamometer (2). A combination of aerobic and muscle strengthening exercises are recommended routinely for those with rheumatoid arthritis (3). Further, a more recent systematic review found that low intensity resistance training combined with blood flow restriction appears to be better than low intensity resistance training in gaining knee extension muscle strength in women with rheumatoid arthritis. (4)

Quality of evidence:

Grade A (RA) – Robust data over long period

Strength of recommendation
Grade 1 (RA) – Strong recommendation

Muscle strength is reduced in those with inflammatory rheumatic disease. There is a strong evidence base that physical activity and exercise interventions can help improve muscle strength in patients with Rheumatoid Arthritis.


  1. Walsmith J, Roubenoff R. Cachexia in rheumatoid arthritis. Int J Cardiol. 2002;85(1):89-99.
  2. Baillet A, Vaillant M, Guinot M, Juvin R, Gaudin P. Efficacy of resistance exercises in rheumatoid arthritis: meta-analysis of randomized controlled trials. Rheumatology (Oxford). 2012;51(3):519-527.
  3. Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, Van den Ende EC. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev. 2009(4):CD006853.
  4. Dos Santos LP, Santo RC, Ramis TR, Portes JK, Chakr RM, Xavier RM. The effects of resistance training with blood flow restriction on muscle strength, muscle hypertrophy and functionality in patients with osteoarthritis and rheumatoid arthritis: A systematic review with meta-analysis. PloS one. 2021 Nov 10;16(11):e0259574