This research aims to demonstrate the utility of the vector impedance analysis for assessing change in hydration in body cell mass in patients with rheumatoid arthritis, and to investigate the benefits of physical exercise for this population. Recent research has shown that patients classified with low body cell mass using bioelectrical impedance vector analysis, having increased risk of infections and serve as predictors for cardiovascular diseases. These findings indicate that patients with lower cellular mass as determined by vectorial bioelectrical impedance analysis have a high risk of infections.
Additionally, we have observed that physical exercise improves strength and quality of life, and reduces inflammation in patients with rheumatoid arthritis. Assessing body composition to vectorial analysis of bioelectrical impedance will enable informed decision in pharmacological treatment. Additionally, integrating physical exercise as part of the treatment aims to prevent or improve a specific alteration associated with changes in body composition.
It is crucial to evaluate the long-term effects of body composition alterations in patients with rheumatoid arthritis and demonstrate the effectiveness of physical exercise in increasing cellular mass, which is the most metabolically active human body compartment, which provides a greater functional reserve associated with better prognosis. To begin, ask the patient to remove both shoes, the right sock, and any metal objects that are in contact with their skin. Position the patient supine for five minutes with extended arms and legs.
Clean the back of the hand and the right foot with 70%alcohol. To classify cachexia by BIVA, download the BIVA tolerance RXE graph software, and open it. Go to the second worksheet titled reference populations and choose a row that corresponds to the reference population.
Then copy and paste it into the second row highlighted in yellow. Next, go to the fifth worksheet titled subjects, and in column A, enter the patient's ID, and in column B, enter the number one. In column E, using M for men and F for women, enter the patient's sex.
In columns F and G, input the previously noted resistance and reactance values at 50 kilohertz. Then enter height in centimeters and weight in kilograms in the next two columns. In column J, enter the number corresponding to the reference population chosen in the second worksheet.
Following this, in column K, input a number between one and 10 for the point graph sheet. Enter the patient's age in the next column from the options bar at the top of the software, click on the compliments, then select the calculate option and click it. Next, navigate to sheet three, point graph, to observe a BIVA graph according to the chosen reference population.
Upon seeing a dialogue box, select the group code entered in column K, then click okay. A BIVA graph is displayed with the patient's vector drawn as a geometric figure. Next, observe the tolerance ellipses of 50, 75 and 95%and the quadrants one, two, three and four in the BIVA graph.
Before beginning the exercise session, ask the patients to describe any pain or discomfort felt in their joints. Next, for the upper extremity warmup, instruct the patient to reach a range of motion with no discomfort for each joint movement. For the lower extremity, guide the patient to perform warmup exercises in a standing position with both feet grounded on a stable surface.
Then instruct the patient to reach a non-painful movement speed through the range of motion for each joint while sitting on the chair in the setup phase, instruct the patient to perform functional movement patterns with more than two joints per segment. Initiate the work phase by setting a comfortable walking speed for the patient on the treadmill. After five minutes, adjust the speed while concurrently measuring the heart rate with a pulse oximeter.
Increase the speed until reaching a heart rate zone between 55 and 75%of the maximum heart rate. After 10 minutes, assess the patient using a perceived effort rating scale. For the final five minutes, lower the treadmill speed to a comfortable pace for the patient.
Next, perform upper extremity mobility resistance exercises while handling a wooden stick with both hands. After teaching the patient combined exercises encompassing the range of motion for more than two joints, instruct the patient to place one end of the resistance band on the floor and step on it with their foot. Then perform elbow flexion against the band's resistance.
For lower extremity exercises, have the patient in a stable chair with 90 degree hip and knee flexion. Then perform hip flexions for each leg up to 20 to 30 degrees above the starting position. Then ask the patient to perform a slight hip flexion above 10 degrees from the base position, followed by a hip abduction.
Lastly, lead the patient to return at a slow tempo to the base position. Next, make a soccer goal by placing two chairs approximately 1.3 meters apart. Direct the patient to kick a 30 centimeter plastic at a three meter spot in front of the soccer goal.
Finally, gently perform a global stretch for cooling without putting stress on the joints. Participants who did not undertake the exercise program had a similar disease activity, but a slightly higher average age and BMI. No changes were made to any patient's pharmacological treatment during the intervention period.
Before the exercise, all patients were classified as cachexic and had an average resistance of 630 and a reactance of 46. After exercise, the patients were reclassified as normal with an average resistance of 577 and reactants of 57. The patients who did not participate in the exercise program showed a shift in BIVA classification toward cachexia over six months.
Implementing the dynamic exercise program resulted in a decrease in resistance per height and an increase in reactance per height. No statistically significant changes were observed in the group that did not undergo the exercise program.
