Effect of Pilates exercises with celery seed on antinuclear antibody levels in middle-aged women

DOI: https://doi.org/10.21203/rs.3.rs-1691604/v1

Abstract

The aim of this study was to investigate the effect of Pilates training with celery seed supplementation on middle-aged women with rheumatoid arthritis to determine its effecting on the Antinuclear Antibodies levels (ANA) rheumatoid arthritis patients. Forty women with rheumatoid arthritis with mean age (53.80 ± 3.71) were randomly divided into four groups: control group, supplement group, exercise group and exercise group with celery seed consumption and each group with 10 replicates (N = 10). The exercise and exercise groups performed celery seed training for 8 weeks and 3 sessions per week for (30-60) minutes at an intensity of (35-65%) of maximum heart rate؛ and supplementation group supplemented with celery seed supplement 3 times daily after meal; and after eight weeks of exercise Blood samples were taken 24 hours before the study and 48 hours after the last training session. Data were analyzed using SPSS software. Celery seed supplementation and Pilates training had no significant decrease on rheumatoid arthritis. The results of the present study showed that eight weeks of Pilates training with celery seed supplement led to decline (ANA) in middle-aged women with rheumatoid arthritis. 

1. Introduction

Rheumatoid arthritis is one of the most common diseases that cause various damage and variant side effects. The severity and variety of disorders depends on the location and extent of the lesion. Rheumatoid arthritis or rheumatoid arthritis is one of the most common chronic inflammatory, systemic, and autoimmune diseases that is associated with decreased joint health including joint pain and inflammation, fatigue, and loss of muscle mass; and these factors lead to functional limitations, disability, along with reduced quality of life and disruption of normal daily activities and depression [1]. Rheumatoid arthritis can occur at any age, but the prevalence of the disease is usually middle-aged. Children and young people can also get the condition, which is called "juvenile rheumatoid arthritis" or "juvenile chronic arthritis"; And the characteristics of the disease in children are different from adults [2]. The prevalence of rheumatoid arthritis accounts for approximately 1% of the world's population; but this figure varies from country to country, with 3% of the population reported in some countries. Two population-based studies have been performed in Iran that show the prevalence of rheumatoid arthritis in rural (Fasham) and urban (Tehran) about 0.3% [3]. Rheumatoid arthritis was first described by Alfred Grod in 1889 and isolated from other rheumatic diseases such as gout [4].

Rheumatoid arthritis is three times more common in women than men [5, 6]. The peak age of the disease is reported to be between 30 and 60 years. Disability is common and significant. In rheumatoid arthritis, for unknown reasons, the body's immune system, which normally fights external factors such as germs and viruses, attacks its own cells in the joint membrane and causes inflammation in the joint membrane [7].

The disease has a slow or sudden onset and is associated with symptoms of pain, swelling, warmth, limited mobility, and morning joint dryness. Inflammation eventually causes joint cartilage destruction and bone wear, followed by joint deformity [8]. This disease, like many chronic joint diseases, has significant complications such as movement problems, inflammation, joint dryness, and progressive movement disorders, and sometimes progresses to the point that some of these patients lose their activity and mobility and become almost paralyzed. Motor problems will cause major complications and damage to the patient and society that can consist physical, psychological, social and economic problems [9].

The cause of this disease is still unknown and there is no definitive and certain treatment for it, so that even drug therapy with the method used is part of supportive treatment [10]. One of the most common methods used to treat inflammation caused by this disease is the use of nonsteroidal anti-inflammatory drugs. Since most drugs have many side effects, including gastrointestinal and blood side effects [11], the use of anti-inflammatory herbs such as celery seeds that have no side effects and have antioxidant properties can be effective [12]. Celery seed extract contains flavonoids (apigenin and apien) and resin, which due to these substances can have several nerve pathways that reduce neurological pain and inflammation; And the diuretic in celery seeds also eliminates uric acid crystals (causes crystals and crystals in the joints, tendons and surrounding tissues) so celery seeds can eliminate problems such as arthritis, muscle pain, inflammatory diseases and Eliminates joint pain [13, 14]. Studies show that lack of physical activity in patients with rheumatoid arthritis causes pain, fatigue, joint stiffness, and the patient is unable to move vigorously due to pain; And often the muscles around the joints are weakened and the patient's balance capacity is reduced [15].

Regular physical activity can reduce joint stiffness, improve joint mobility, and strengthen muscles [16]; It also promotes cardiovascular health, coronary heart disease, stroke, type 2 diabetes, lower blood pressure and lower abdominal fatty. This causes less pressure on the joints, increases muscle mass (due to strength training), strengthens bone density, improves balance and reduces falls [17].

Pilates is one of the most widely practiced exercises among exercise therapist and rehabilitation specialists in recent years. Pilates is a form of physical activity developed by the German-American Joseph Pilates (1968–1983) that combines sports, movement, philosophy, gymnastics, martial arts, and yoga to improve physical condition [18] and exercises designed to promote stability / strength of muscles in the central part of the body, flexibility, coordination and balance [19]. In the last few years, this sport has been increasingly used to increase fitness and has attracted the attention of researchers [18]. This sport is new in Iran and has started its activities since 2006 under the supervision of the Federation of Public Sports [20].

Pilates highly focuses on flexibility and muscular strength without muscular loading or destroying and also it reduces pain which is the most important factor in disabilities between chronic patients. Reducing pain can have a significant impact on improving the quality of life of these patients. Increasing muscle strength, physical endurance and increasing joint flexibility are effective contributors to reducing pain and improving quality of life in these patients [21].

Therefore, in order to further reduce the problems associated with this disease and in view of the above cases and the lack of a single study in this field, the purpose of this study was to investigate the effect of Pilates exercises with celery seed supplement as a stimulant, changes in anti-nuclear antibody level (ANA), the amount of muscle strength and flexibility in changing the level of daily activity of middle-aged women with rheumatoid arthritis.

2. Methodology

This research is in the group of applied and semi-experimental researches and the pre-test and post-test design has been used. The statistical population consists of all middle-aged female patients with rheumatoid arthritis in the age range of 40–60 years who referred to the clinic of Shariati Hospital in Tehran in the year (98 − 97). First, those who were eligible for the study were identified.

Inclusion criteria for the present study were: age range 40–60 years, living in Tehran for the entire duration of the study, lack of unstable blood pressure, no osteoporosis, having at least one year of rheumatoid arthritis, lack of regular exercise, no prohibition to exercise, non-smoking, and non-alcohol.

According to the basic principles of Pilates exercises and using the existing literature in this field; and the samples were divided into 4 equal groups of 10; and the consent form was given to all 4 groups; The first group of people in the control group went about their normal and daily lives, the second group were those who received only celery seed supplement, the third group did Pilates exercises and also took a placebo, and the fourth group was the group that received both supplement and Did Pilates exercises; They were collected two days before exercise and 48 hours after training in a blood sample from a brachial vein while sitting, which did not require fasting; The samples was asked not to change their diet during the study; To do this, we used a 24-hour food recall questionnaire to assess the diet of the samples during the study period. Also, some anthropometric features such as height, weight, BMI and flexibility test were performed before the start of the training period. Samples performed Pilates exercises for 8 weeks and 3 sessions per week for 20 to 55 minutes. Finally, after 8 weeks, the samples were tested. Pilates program for two groups of exercise and placebo and exercise group with celery supplement in 8 weeks, 3 sessions for 45 minutes with intensity equivalent to 55 to 70% of maximum heart rate and exercise on even days from 4 to 5 pm in the Apple Club Valiasr Karaj was done. The Pilates exercises included warming up for 10 minutes, performing exercises including advanced stretching, strength, balance, flexibility, and neuromuscular coordination, and focusing on the large muscles of the upper and lower body in three positions: standing, sitting, and lying down without the need for specialized equipment. At the end of the exercises, including cooling down and returning to the original state for 5 minutes, breathing exercises and muscle relaxation were performed.

2.1. Ethical considerations

Before the implementation of the test protocol, it was presented to the ethics committee and approved with the ethics ID IR.SHAHED.REC.1398.017.

Exercises include: Dedicating the arch of the waist and folding the legs, Sitting cat, leading the two legs together, Floating leg, One-legged stretching, Half-sitting squat, Bending the thigh, Opening the thigh while lying on the abdomen, squatting push-ups, extension With the help of the hand, lift the pelvis from the ground of the standing cat, fold the legs inside the chest and open it, mermaid, go down from the back to the ground, lying on the side, lift the leg from side to side and back, cradle, lying on the back of the knee. Bringing the fingertips to the knees, stretching one foot while lying down, stretching two legs while lying down, stretching one foot with the upper body screw, stretching one foot with straight legs, and stretching the foot while sitting. And the exercises become simpler in the first week and a little harder in the last week; And for the purpose of the principle of overload and intensity of training and to control the intensity of exercises from the scale of 10 points of the Burg scale (burg with intensity of work as (very very light), (very light), (light), (medium), Exercise duration (1 minute per session) was increased [22]. Exercises started from 5 repetitions with a time of 20 minutes and an intensity of 55% of the maximum heart rate and increased to 25 repetitions with a duration of 55 minutes and intensity 70% of the maximum heart rate was performed (Table 1). The formula for calculating the maximum heart rate, reserve heart rate and target heart rate was performed as follows:

1- Maximum heart rate = 220-age

2- Reserve heart rate = maximum heart rate - resting heart rate

3- Target heart rate = (% load * reserve heart rate) + resting heart rate

 
Table 1

Conditions for performing intensity, duration and repetition of exercises.

Week

1

2

3

4

5

6

7

8

Period

20

25

30

35

40

45

50

55

Replication

5

8

10

12

15

18

20

25

Intensity (%)

55

55

60

60

65

65

70

70

Samples in the supplement group and the exercise group received the supplement for 8 weeks, including celery seeds at a dose of 1.3 g, after a main meal with a glass of fluid. They received the placebo used as a medicine-like pill (starch pill) after the main meals of the Pilates exercise group [23]. The nutritional status of the samples was obtained using a 24-hour recall questionnaire. Samples were asked to record every food they ate during the day for 3 days. Samples were also advised to follow a normal diet during the study period (especially in the pre-blood sampling stages) [24].

2.2. How to measure lower body flexibility (hamstring)?

In this study, for lower body flexibility (hamstring), the sit and reach test with a chair according to the patient's functional capacity was used. The sample was asked to sit on a chair and open the test leg in front of the thigh, place the heel on the ground, and rotate approximately 90 degrees to the back; Bend the non-test leg while the open test leg is as flat on the ground as possible. His arms are on each other reaches the flattened foot (erect the spine as possible) and tries to touch the toes, placing the ruler parallel to the sample's thigh, and reaching the middle finger to leg indicates the zero point Failure to reach the big toe indicates a negative score and reaching further indicates a positive score [25].

2.3. How to measure upper body flexibility (shoulder joints)?

In this study, to measure upper body flexibility, the patient was asked to voluntarily extend one of the two hands (palm below open fingers) from shoulder to back to the other hand from bottom to top of the back half. (Palm up and fingers open) holds; the distance between the middle finger was measured with a ruler. If the fingers touch each other, the score is zero and if they do not reach each other, the negative score is crossed and the positive score is recorded [25].

2.4. Measurement of muscular strength of the lower body

In this study, to measure the lower body strength of the samples by getting up from the chair for 30 seconds was measured to the extent of the patient. We placed the chair against the wall to prevent it from slipping; the sample was asked to sit flat on a chair, with the soles of the feet flat on the floor and the arms crossed at the wrists. For each repetition, the sample rises to the point of complete standing. It then returns to a fully seated position at start. The sample does this for up to 30 seconds. Before performing the test, the samples performed the movement slowly to show the correct shape of the movement [25].

2.5. Measurement of hand muscle strength

To measure hand muscle strength in this study, a hand dynamometer was used. The device was zeroed by pressing the zero buttons on the screen, and then we pressed the start button. The sample was asked to push the handle upwards, and the result showed the maximum muscle strength of the paw and forearm of the handles on the screen.

2.6. Antinuclear Antibody Assay (ANA)

To measure ANA factor, samples did not need to fast and arrived at the relevant laboratory 48 hours before the first and last training session for blood test and with full consent to take a blood sample; And ANA assay by indirect immunofluorescence was used for analysis; The title is > 1.2 > 0 positive and 0 > 0.8 negative and between 1.2 and 0.8 is doubtful. Blood samples were taken from the main artery at a rate of 5 cc from each of the 4 groups; because these patients have weakened immune systems, they asked to check the blood collection site for signs of infection within 48 hours.

2.7. Statistical analysis

Descriptive statistics, tables and graphs were used to describe the collected information; One-way analysis of variance (ANOVA) was used to test the differences between groups; If a statistically significant difference was observed, Tukey post hoc test was used to determine the difference between the groups; and regular pair test (dependent t) was used for intragroup differences; and all statistical studies and plotting of graphs were performed using SPSS24 and EXCEL20013 software; And the significant level of the test was considered P ≤ 0.05.

3. Results

Descriptive information and general characteristics of the samples, including the mean and standard deviation by groups before the study are presented in Table 2.

Table 2

General characteristics of the samples (Mean ± SD) and N = 40.

Variable

Control

Exercise and placebo

Complement

Combined exercise

Age (Year)

53.30 ± 3.7

52.80 ± 3.0

53.80 ± 3.7

52.80 ± 3.0

Height (cm)

159.0 ± 4.2

163.3 ± 2.2

157.5 ± 2.1

159.5 ± 0.1

Weight (Kg)

62.0 ± 4.2

63.7 ± 7.2

65.8 ± 5.7

67.5 ± 7.8

BMI (kg/m2)

24.5 ± 0.3

24.2 ± 3.4

26.4 ± 1.8

26.6 ± 3.3

The results showed that 8 weeks of Pilates training with celery supplementation had a significant effect on levels of flexibility, muscle strength and ANA in middle-aged women with rheumatoid arthritis (P ≤ 0.05). In comparing the mean differences between the pretest-posttest means and the Tukey test, it was observed that between the levels of flexibility and muscle strength; there was a significant difference between the combined, control and supplement groups of celery, but no difference was observed in comparing the differences between ANA groups (P ≤ 0.05). Also, pre-test and post-test showed a significant difference between the combined and placebo-training groups with the dependent t-test (P < 0.001). Mean and standard deviation of dependent variables before and after the training program as well as the results of dependent t-test, one-way analysis of variance and Tukey's post hoc test are presented in Table 3.

Table 3

Results of dependent t-test, analysis of variance and Tukey post hoc test in determining the difference between research variables (Mean ± SD).

Variable

Control

Complement

Exercise and placebo

Combined exercise

Shoulder flexibility

12.15 ± 0.7 B

11.56 ± 1.1 B

1.55 ± 0.9 B

12.47 ± 0.8 B

12.16 ± 0.7 A

11.39 ± 0.9 A

2.12 ± 1.7 A

4.00 ± 0.9 A

0.01 ± 0.03a D

0.17 ± 0.12a D

10.43 ± 0.87ac D*

8.74 ± 0.09b D*

Hamstring flexibility

0.82 ± 0.3 B

0.30 ± 0.5 B

1.41 ± 0.3 B

2.25 ± 0.4 B

0.75 ± 0.2 A

0.64 ± 0.4 A

4.43 ± 0.6 A

7.97 ± 0.7A

0.07 ± 0.09a D

0.34 ± 0.09a D

0.04 ± 0.23b D*

5.72 ± 0.35c D*

MSLH

9.46 ± 0.9 B

8.30 ± 0.7 B

8.97 ± 0.5 B

6.83 ± 1.3 B

9.79 ± 0.8 A

9.74 ± 0.5 A

12.87 ± 0.7 A

10.72 ± 0.9 A

0.33 ± 0.07a D

1.44 ± 0.25a D

3.9 ± 0.13b D*

3.89 ± 0.39a D*

MSRH

11.42 ± 0.7 B

14.54 ± 0.8 B

14.51 ± 0.5 B

12.64 ± 0.8 B

11.52 ± 0.2 A

14.65 ± 0.8 A

17.24 ± 0.3 A

16.46 ± 0.4 A

0.01 ± 0.01a D

0.11 ± 0.04bd D

2.73 ± 0.14cd D*

3.82 ± 0.36d D*

MSLT

9.70 ± 0.8 B

7.30 ± 0.5 B

7.70 ± 0.6 B

8.00 ± 0.7 B

9.70 ± 0.8 A

7.50 ± 0.5 A

19.70 ± 1.0 A

18.80 ± 0.5 A

0.00 ± 0.01a D

0.20 ± 0.02a D

12.00 ± 0.71bc D*

10.80 ± 0.17c D*

ANA

1.51 ± 0.1 B

1.57 ± 0.2 B

1.29 ± 0.1 B

1.67 ± 0.0 B

1.06 ± 0.2 A

1.37 ± 0.1 A

1.10 ± 0.1 A

1.22 ± 0.1 A

0.45 ± 0.06a D

0.20 ± 0.08b D

0.19 ± 0.00c D#

0.45 ± 0.06a D#

B: Before test, A: After test, D: Differences between before and after test, *: Significant at p < 0.05, #: Significant between before and after using t-test, a-d: Significant between groups.

4. Discussion

According to the findings of this study, the amount of ANA did not show a significant difference in all groups. These results were in lined with study performed by Azamian et al. [26] in a study on the effects of aerobic exercise for 8 weeks of stationary cycling on some inflammatory indicators in patients with rheumatoid arthritis. In this study, no difference was observed between case and control groups and Pilates exercises with celery seed consumption had no effect on ANA level.

There was a significant difference in flexibility levels (upper body and lower body) in middle-aged women with rheumatoid arthritis in the pre-test stage before the start of the training program and after the post-test program. This indicates those eight weeks of Pilates training with celery seed supplementation both led to a significant change in the two experimental groups. Thus, the measurements before and after the research were different.

These results indicate a stronger effect of Pilates exercises on increasing flexibility compared to the supplement and control groups; According to previous findings, the effects of combined exercise intervention in reducing pain and inflammation due to the presence of flavonoids in celery seeds and its effect on the nervous system reduces pain and inflammation [27].

Salehzadeh et al. [28] conducted a study on the effect of Pilates exercises on fatigue and motor disability and muscle flexibility in patients with multiple sclerosis in Tabriz and reported that 8 weeks of Pilates exercises in the exercise group reduced fatigue, motor disability and increased flexibility occurs in patients. Skendiz et al. [21] conducted a study aimed at the effect of Pilates training on strength, endurance, low flexibility in sedentary adult women. The results showed that Pilates exercises had a positive effect on abdominal muscle strength, abdominal muscle endurance and posterior flexibility. In line with the results of the present study, a study conducted by Aires et al. [29] on 60 female volunteers showed that Pilates could improve flexibility; The present results also showed that Pilates exercises were more effective in the exercise group compared to other groups and also, Kloubec [30]. The effect of Pilates exercise on hamstring flexibility in 50 men and women for 12 weeks, each week. 2 sessions and 1hour session were performed that in this study, hamstring flexibility was significantly increased which was consistent with the present study.

Regarding the effect of eight Pilates exercises with celery seed supplementation on muscle strength in middle-aged women with rheumatoid arthritis, it should be said that; There was a significant difference between the pre-test stage before the start of the training program and the post-test in muscle strength levels (arms and lower body) in middle-aged women with rheumatoid arthritis in the exercise and training groups with celery seed supplementation. This shows that eight weeks of Pilates training and celery seed supplementation both led to a significant change in the two experimental groups and the measurements before and after the study were different. Findings in muscle strength (arms and lower body) indicate a significant difference in post-test between exercise and training groups with celery seed supplementation. This suggests that eight weeks of Pilates exercises combined with celery seed supplementation may lead to changes in muscle wasting.

Because people with rheumatoid arthritis often have, weaknesses, strength development involves the coordinated functioning of several processes. In fact, the ability to produce maximum force is attributed to both the nervous system and the muscular system. Adjustments created as a result of exercise lead to an increase in maximal strength, including neural adaptations such as increased motor unit calling, the use of motor units in agreeable muscles, stimulation of motor units with greater frequency, spontaneous inhibition, increased neuromuscular skills and coordination. In performing movements and muscle adaptations such as increasing the cross-sectional area of ​​the muscle and changing the muscle structure and metabolic adaptation [18].

According to the length of the present study, it seems that people who did the exercises in recalling and using the deep abdominal muscles and stability of the pelvic and paw muscles compared to people who did not do the exercises, had healed better. This coordination is probably due to neuromuscular adaptations. The findings of the present study on the effect of Pilates exercise on lower body muscle strength were consistent with the report of Ariera et al. [31](2017) who showed that the Pilates exercise group performed better than the control group in the post-test. Kamali and Norouzi 2016 [32] in a study that examined 8 weeks of Pilates training, observed an improvement in quadriceps and hamstring muscle strength scores in the experimental group. Also, the present study on the effect of Pilates training on upper body strength is in line with the findings of Bullo et al. [20] who reported that Pilates training is effective in increasing upper body strength. The results of Omidali et al. [25] by examining the effect of Pilates exercises on some physiological factors and physical fitness reported that training for 8 weeks, 3 sessions per week and 1 hour per session can improve hand strength; However, in this study, exercises for 8 weeks and 3 sessions and duration started from 20 minutes and ended at 55 minutes. Khalili et al. [33] study examined the effect of 8 weeks of Pilates exercises on pain and quality of life in men with rheumatoid arthritis. They also concluded that Pilates exercises increase the quality of life of these patients by increasing strength [33].

Studies have shown that age-related changes in skeletal muscle include muscle mass and strength 91% reduction in strength occurs through a reduction in the number and size of muscle fibers. Maximum muscle strength for men and women is generally between the ages of 20 and 30, when muscle is at its peak. Then there is a dramatic decrease in most muscle groups. Resistance exercise is an effective and healthy way to increase strength and muscle mass. These studies have examined the effect of Pilates exercises on muscle strength in different ways at different times. The present study aims to prevent the weakening of muscles and cartilage of secondary diseases due to inactivity that occurs in these patients with an exercise program. Decreased muscle strength in patients with rheumatoid arthritis is one of the main disorders that limit their daily activities, can worsen joint pain. Numerous studies have shown a decrease in isometric, isotonic and isokinetic force and muscle function in patients with rheumatoid arthritis. Their findings showed that Pilates exercises significantly improved muscle strength in the exercise group, which increased muscle strength could reduce the risk of falls and other injuries in these patients [29].

In general, the results of the present study show that 8 weeks of Pilates exercises with celery seed supplementation increase flexibility, muscle strength and reduce pain in patients with rheumatoid arthritis; This increase in flexibility, increase in muscle strength and decrease in pain was observed in the combined exercise groups and the exercise group with placebo more than the supplement and control groups increase muscle strength, flexibility and pain relief. These findings also indicate that regular physical activity and supplementation with celery seeds improve most of the important factors in patients with rheumatoid arthritis, which can be summarized as follows; Doing Pilates exercises and using celery seeds reduces pain in patients with rheumatoid arthritis, and better performance due to less pain can increase the motivation for these patients to participate in physical activity.

Also, according to the results of this study, the effect of celery seed supplement along with exercise can be considered more appropriate. Therefore, women with rheumatoid arthritis are advised to be sedentary and lack regular exercise, which is undoubtedly one of the most important causes of chronic diseases, increased secondary diseases and decreased muscle mass and a serious health risk. And Pilates largely avoids high impact, high power output, and heavy muscular and skeletal loading. And in general, the results of this research showed that a period of exercise can be effective in improving balance. Using these exercises by providing conditions to challenge the balance system can be an effective way to improve the subsequent balance and prevent falls among people with rheumatoid arthritis. According to the research findings, Pilates exercises can be used as a training method with a lasting effect to improve balance and reduce the risk of falls in patients with rheumatoid arthritis, which leads to increased muscle strength, flexibility and movement control. According to the research findings, Pilates exercises can be suggested as a safe and tolerable exercise method to improve balance and functional variables in middle-aged women without a history of regular exercise.

It is also recommended to use Pilates exercises with celery seed supplement to improve balance and restore mobility in patients with rheumatoid arthritis. In this regard, encouraging participation in physical activities can be useful in promoting community health and management of diseases associated with sedentary lifestyle; also, due to the lack of level change (ANA) in this study, the duration of the training program can be extended to get better results.

Statements And Declarations

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Touba Ahmadi Rostamkolai and Esmaeil Nasiri. The first draft of the manuscript was written by Touba Ahmadi Rostamkolai and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Competing Interests

The authors declare that they have no conflict of interest.

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