Progressive Resistance Training in Patients With Shoulder Impingement Syndrome: A Randomized Controlled Trial IMPE ´ RIO LOMBARDI, JR., A ˆ NGELA GUARNIERI MAGRI, ANNA MARIA FLEURY, ANTONIO CARLOS DA SILVA, AND JAMIL NATOUR Objective. To assess pain, function, quality of life, and muscle strength in patients with shoulder impingement syndrome who participated in muscle strengthening exercises. Methods. A total of 60 patients diagnosed with shoulder impingement syndrome were selected from the clinics of the Federal University of Sa˜ o Paulo and randomly distributed into experimental and control groups. Patients were evaluated regarding pain, function, quality of life, muscle strength, and the number of antiinflammatory drugs and analgesics taken. Patients then participated in the progressive resistance training program for the musculature of the shoulder, which was held twice a week for 2 months, while the control group remained on a waiting list. Results. Sixty patients were randomly allocated to the experimental group (21 women and 9 men, mean age 56.3 years) and control group (25 women and 5 men, mean age 54.8 years). Patients from the experimental group showed an improvement from 4.2 cm to 2.4 cm on a 10-cm visual analog scale (P < 0.001) regarding pain at rest and from 7.4 cm to 5.2 cm (P < 0.001) regarding pain during movement. Function went from 44.0 to 33.2 (P < 0.007) using the Disabilities of the Arm, Shoulder, and Hand assessment and domains from the Short Form 36. There was a statistically significant difference in improvement in pain and function between patients in the experimental group and those in the control group (P < 0.05). Conclusion. The progressive resistance training program for the musculature of the shoulder in patients with shoulder impingement syndrome was effective in reducing pain and improving function and quality of life. INTRODUCTION Tendinitis of the rotator cuff and shoulder impingement syndrome are considered the most common intrinsic causes of shoulder pain and disability (1,2). The upper limbs perform a number of functions related to activities of daily living and labor (3). Shoulder problems are among the most common peripheral complications, and activities in which the arms or hands are used increase the risk of developing shoulder pain (4). It is estimated that the inci- dence of shoulder problems ranges 7–25 per 1,000 consul- tations with general physicians (2). The prevalence of shoulder pain among adults younger than 70 years of age is 7–27%, whereas this figure is between 13.2–26% among those older than age 70 (5). Interest in resistance training received a considerable boost during World War II, when DeLorme demonstrated the importance of progressive resistance training for im- proving muscle strength and hypertrophy during rehabil- itation programs for soldiers (6). Progressive resistance training is the gradual increase of load. Tolerance to exer- cises should be monitored by the health care professional and adapted to the individual. The following items should be considered in order to achieve an increase in strength, improved resistance, and muscle hypertrophy: 1) an in- crease in local resistance, 2) number of repetitions, 3) speed of repetitions, 4) rest period, and 5) volume of train- ing (number of repetitions  resistance and number of repetitions  sets and number of sets per exercise) (7). Progressive resistance training is a muscle strengthening method. The term progressive resistance training is as yet little used in physiotherapy. A number of studies that used the term strengthening in fact used progressive resistance training. Because strengthening is a generic term and has received criticism for being a vague term that most often fails to define the type of strengthening used (8), Taylor et ISRCTN: 16447. Impe´rio Lombardi, Jr., PhD, A ˆ ngela Guarnieri Magri, PT, Anna Maria Fleury, PT, Antonio Carlos Da Silva, PhD, Jamil Natour, PhD, MD: Federal University of Sa˜o Paulo, Sa˜o Paulo, Brazil. Address correspondence to Jamil Natour, PhD, MD, Rheu- matology Division, Rua Botucatu, 740, 04023-900 Sa˜ o Paulo, SP, Brazil. E-mail: jnatour@reumato.epm.br. Submitted for publication April 20, 2007; accepted in revised form November 9, 2007. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 59, No. 5, May 15, 2008, pp 615– 622 DOI 10.1002/art.23576 © 2008, American College of Rheumatology ORIGINAL ARTICLE 615