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The effects of exercise on cardiovascular disease risk factors and cardiovascular physiology in rheumatoid arthritis

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Abstract

Cardiovascular disease (CVD) morbidity and mortality is highly prevalent in patients with rheumatoid arthritis (RA) with debilitating effects for the individual as well as significant healthcare impact. Current evidence demonstrates that engaging in aerobic and resistance exercise (i.e. structured physical activity) can significantly improve patient-reported and clinical index-assessed outcomes in RA. In addition to this, engagement in exercise programmes improves, in a dose-dependent manner, the risk of developing CVD as well as CVD symptoms and outcomes. The present narrative review uses evidence from systematic reviews and meta-analyses as well as controlled trials, to synthesize the current state-of-the-art on the potential effects of aerobic and resistance exercise on CVD risk factors as well as on cardiac and vascular function and structure in people with RA. Where there is a lack of evidence in RA to explain potential mechanisms, relevant studies from the general population are also discussed and linked to RA.

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Authors and Affiliations

  1. Faculty of Education, Health and Wellbeing, University of Wolverhampton, Gorway Road, Walsall Campus, Walsall, WS13BD, UK

    George S. Metsios, P. Vitalis & K. Tzika

  2. Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK

    George S. Metsios & George D. Kitas

  3. School of Physical Education and Sport Science, University of Thessaly, Volos, Greece

    George S. Metsios & Y. Koutedakis

  4. Department of Rheumatology, National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway

    R. H. Moe

  5. ACHIEVE-Center of Applied Research, Faculty of Health, Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands

    M. van der Esch

  6. School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK

    J. J. C. S. Veldhuijzen van Zanten, S. A. M. Fenton & George D. Kitas

  7. School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland

    N. Kennedy

  8. Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden

    N. Brodin & C. Bostrom

  9. Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium

    T. W. Swinnen

  10. School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland

    K. Niedermann

  11. Department of Academic Rheumatology, King’s College London, London, UK

    E. Nikiphorou

  12. Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK

    G. E. Fragoulis

  13. Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands

    T. P. V. M. Vlieland

  14. Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands

    C. H. M. Van den Ende

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  1. George S. Metsios
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GSM, PV and KT. The first draft of the manuscript was written by GSM and GDK and all authors commented on all versions of the manuscript and provided relevant comments for further amending the manuscript and produce the final draft. All authors read and approved the final manuscript.

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Correspondence to George S. Metsios.

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Metsios, G.S., Moe, R.H., van der Esch, M. et al. The effects of exercise on cardiovascular disease risk factors and cardiovascular physiology in rheumatoid arthritis. Rheumatol Int 40, 347–357 (2020). https://doi.org/10.1007/s00296-019-04483-6

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