Rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) are inflammatory diseases which involve increased risk of cardiovascular disease (CVD). High intensity interval training (HIIT) is known to be effective in improving cardiovascular health. The aim of this study was to investigate whether 10 weeks of HIIT at 85–95 % of HRmax would improve important risk factors of CVD in rheumatic patients, and if these patients would tolerate exercise intensities above today’s recommendations.
Seven women with RA and eleven with adult-JIA, 20–50 years, were recruited to this cross-over study. Participants performed HIIT, consisting of 4 × 4 min intervals at 85–95 % of HRmax twice a week for 10 weeks on spinning bikes. Maximal oxygen uptake (VO2max), heart rate recovery, blood pressure, body composition, and blood variables were measured before and after the exercise and control period. Disease activity was determined and questionnaire data were collected.
HIIT resulted in 12.2 % increase in VO2max and 2.9 % improvement in heart rate recovery (p < 0.05). BMI, body fat, and waist circumference decreased 1.2, 1.0, and 1.6 %, respectively, whereas muscle mass increased 0.6 % (p < 0.05). A trend toward decreased CRP was detected after HIIT (p = 0.08). No changes were detected in disease activity or pain.
Despite rigorous high intensity exercise, no increase was detected in disease activity or pain, indicating that HIIT was well tolerated by these patients. Furthermore, HIIT had positive effects on several CVD risk factors. In light of this pilot study, HIIT seems like a promising non-pharmacological treatment strategy for patients with RA and adult-JIA.
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Body mass index
Cartilage oligomeric matrix protein
Coronary artery diseases
High intensity interval training
Insulin-like growth factor
Juvenile idiopathic arthritis
- HRmax :
Maximal heart rate
- VO2max :
Maximal oxygen uptake
One-minute heart rate recovery
Visual analog scale
Alamanos Y, Voulgari PV, Drosos AA (2006) Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of rheumatology criteria: a systematic review. Semin Arthritis Rheum 36(3):182–188. doi:10.1016/j.semarthrit.2006.08.006
Andersson ML, Thorstensson CA, Roos EM, Petersson IF, Heinegard D, Saxne T (2006) Serum levels of cartilage oligomeric matrix protein (COMP) increase temporarily after physical exercise in patients with knee osteoarthritis. BMC Musculoskelet Disord 7:98. doi:10.1186/1471-2474-7-98
Aspenes ST, Nilsen TI, Skaug EA, Bertheussen GF, Ellingsen O, Vatten L, Wisloff U (2011) Peak oxygen uptake and cardiovascular risk factors in 4631 healthy women and men. Med Sci Sports Exerc 43(8):1465–1473. doi:10.1249/MSS.0b013e31820ca81c
Avina-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D (2008) Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 59(12):1690–1697. doi:10.1002/art.24092
Baillet A, Zeboulon N, Gossec L, Combescure C, Bodin LA, Juvin R, Dougados M, Gaudin P (2010) Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: meta-analysis of randomized controlled trials. Arthritis Care Res 62(7):984–992. doi:10.1002/acr.20146
Beard J, Tobin B (2000) Iron status and exercise. Am J Clin Nutr 72(2 Suppl):594S–597S
Bjornadal L, Baecklund E, Yin L, Granath F, Klareskog L, Ekbom A (2002) Decreasing mortality in patients with rheumatoid arthritis: results from a large population based cohort in Sweden, 1964–95. J Rheumatol 29(5):906–912
Brady TJ, Kruger J, Helmick CG, Callahan LF, Boutaugh ML (2003) Intervention programs for arthritis and other rheumatic diseases. Health Educ Behav: Off Publ Soc Public Health Educ 30(1):44–63
Crnkic M, Mansson B, Larsson L, Geborek P, Heinegard D, Saxne T (2003) Serum cartilage oligomeric matrix protein (COMP) decreases in rheumatoid arthritis patients treated with infliximab or etanercept. Arthritis Res Ther 5(4):R181–R185. doi:10.1186/ar760
Crowson CS, Rahman MU, Matteson EL (2009) Which measure of inflammation to use? A comparison of erythrocyte sedimentation rate and C-reactive protein measurements from randomized clinical trials of golimumab in rheumatoid arthritis. J Rheumatol 36(8):1606–1610. doi:10.3899/jrheum.081188
de Jong Z, Munneke M, Zwinderman AH, Kroon HM, Jansen A, Ronday KH, van Schaardenburg D, Dijkmans BA, Van den Ende CH, Breedveld FC, Vliet Vlieland TP, Hazes JM (2003) Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial. Arthritis Rheum 48(9):2415–2424. doi:10.1002/art.11216
Ekdahl C, Broman G (1992) Muscle strength, endurance, and aerobic capacity in rheumatoid arthritis: a comparative study with healthy subjects. Ann Rheum Dis 51(1):35–40
Fagard RH (2001) Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc 33(6):S484–S492 ; discussion S493–S484
Foster HE, Marshall N, Myers A, Dunkley P, Griffiths ID (2003) Outcome in adults with juvenile idiopathic arthritis: a quality of life study. Arthritis Rheum 48(3):767–775. doi:10.1002/art.10863
Goodson NJ, Wiles NJ, Lunt M, Barrett EM, Silman AJ, Symmons DP (2002) Mortality in early inflammatory polyarthritis: cardiovascular mortality is increased in seropositive patients. Arthritis Rheum 46(8):2010–2019. doi:10.1002/art.10419
Helgerud J, Hoydal K, Wang E, Karlsen T, Berg P, Bjerkaas M, Simonsen T, Helgesen C, Hjorth N, Bach R, Hoff J (2007) Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc 39(4):665–671
Howley ET, Bassett DR Jr, Welch HG (1995) Criteria for maximal oxygen uptake: review and commentary. Med Sci Sports Exerc 27(9):1292–1301
Ingjer F (1991) Factors influencing assessment of maximal heart rate. Scand J Med Sci Sports 1(3):134–140
Jae SY, Ahn ES, Heffernan KS, Woods JA, Lee MK, Park WH, Fernhall B (2007) Relation of heart rate recovery after exercise to C-reactive protein and white blood cell count. Am J Cardiol 99(5):707–710. doi:10.1016/j.amjcard.2006.09.121
Janssen I, Heymsfield SB, Allison DB, Kotler DP, Ross R (2002) Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat. Am J Clin Nutr 75(4):683–688
Jenny NS, Arnold AM, Kuller LH, Tracy RP, Psaty BM (2009) Associations of pentraxin 3 with cardiovascular disease and all-cause death: the cardiovascular health study. Arterioscler Thromb Vasc Biol 29(4):594–599. doi:10.1161/ATVBAHA.108.178947
Kasapis C, Thompson PD (2005) The effects of physical activity on serum C-reactive protein and inflammatory markers: a systematic review. J Am Coll Cardiol 45(10):1563–1569. doi:10.1016/j.jacc.2004.12.077
Kell DB, Pretorius E (2014) Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metall Integr Biometal Sci 6(4):748–773. doi:10.1039/c3mt00347g
Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, Yamada N, Sone H (2009) Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 301(19):2024–2035. doi:10.1001/jama.2009.681
Koster A, Leitzmann MF, Schatzkin A, Mouw T, Adams KF, van Eijk JT, Hollenbeck AR, Harris TB (2008) Waist circumference and mortality. Am J Epidemiol 167(12):1465–1475. doi:10.1093/aje/kwn079
Leitzmann MF, Moore SC, Koster A, Harris TB, Park Y, Hollenbeck A, Schatzkin A (2011) Waist circumference as compared with body-mass index in predicting mortality from specific causes. PLoS One 6(4):e18582. doi:10.1371/journal.pone.0018582
Lu Y, Hajifathalian K, Ezzati M, Woodward M, Rimm EB, Danaei G, Global Burden of Metabolic Risk Factors for Chronic Diseases C (2014) Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants. Lancet 383(9921):970–983. doi:10.1016/S0140-6736(13)61836-X
Luchetti MM, Piccinini G, Mantovani A, Peri G, Matteucci C, Pomponio G, Fratini M, Fraticelli P, Sambo P, Di Loreto C, Doni A, Introna M, Gabrielli A (2000) Expression and production of the long pentraxin PTX3 in rheumatoid arthritis (RA). Clin Exp Immunol 119(1):196–202
Makrides L, Heigenhauser GJ, Jones NL (1990) High-intensity endurance training in 20–30 and 60–70-year-old healthy men. J Appl Physiol 69(5):1792–1798
Mansson B, Carey D, Alini M, Ionescu M, Rosenberg LC, Poole AR, Heinegard D, Saxne T (1995) Cartilage and bone metabolism in rheumatoid arthritis. Differences between rapid and slow progression of disease identified by serum markers of cartilage metabolism. J Clin Investig 95(3):1071–1077. doi:10.1172/JCI117753
Mantovani A, Garlanda C, Doni A, Bottazzi B (2008) Pentraxins in innate immunity: from C-reactive protein to the long pentraxin PTX3. J Clin Immunol 28(1):1–13. doi:10.1007/s10875-007-9126-7
Maradit-Kremers H, Crowson CS, Nicola PJ, Ballman KV, Roger VL, Jacobsen SJ, Gabriel SE (2005) Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum 52(2):402–411. doi:10.1002/art.20853
McInnes IB, Schett G (2011) The pathogenesis of rheumatoid arthritis. N Engl J Med 365(23):2205–2219. doi:10.1056/NEJMra1004965
Moholdt T, Madssen E, Rognmo O, Aamot IL (2014) The higher the better? Interval training intensity in coronary heart disease. J Sci Med Sport Sports Med Aust 17(5):506–510. doi:10.1016/j.jsams.2013.07.007
Moorthy LN, Peterson MG, Hassett AL, Lehman TJ (2010) Burden of childhood-onset arthritis. Pediatr Rheumatol Online J 8:20. doi:10.1186/1546-0096-8-20
Nemoto K, Gen-no H, Masuki S, Okazaki K, Nose H (2007) Effects of high-intensity interval walking training on physical fitness and blood pressure in middle-aged and older people. Mayo Clin Proc 82(7):803–811
Norata GD, Garlanda C, Catapano AL (2010) The long pentraxin PTX3: a modulator of the immunoinflammatory response in atherosclerosis and cardiovascular diseases. Trends Cardiovasc Med 20(2):35–40. doi:10.1016/j.tcm.2010.03.005
Pahor A, Hojs R, Gorenjak M, Rozman B (2006) Accelerated atherosclerosis in pre-menopausal female patients with rheumatoid arthritis. Rheumatol Int 27(2):119–123. doi:10.1007/s00296-006-0176-6
Petersen AM, Pedersen BK (2005) The anti-inflammatory effect of exercise. J Appl Physiol 98(4):1154–1162. doi:10.1152/japplphysiol.00164.2004
Pincus T, Summey JA, Soraci SA Jr, Wallston KA, Hummon NP (1983) Assessment of patient satisfaction in activities of daily living using a modified Stanford health assessment questionnaire. Arthritis Rheum 26(11):1346–1353
Prevoo ML, van 't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38(1):44–48
Ross R (1999) Atherosclerosis—an inflammatory disease. N Engl J Med 340(2):115–126. doi:10.1056/NEJM199901143400207
Solomon DH, Karlson EW, Rimm EB, Cannuscio CC, Mandl LA, Manson JE, Stampfer MJ, Curhan GC (2003) Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation 107(9):1303–1307
Stenstrom CH, Minor MA (2003) Evidence for the benefit of aerobic and strengthening exercise in rheumatoid arthritis. Arthritis Rheum 49(3):428–434. doi:10.1002/art.11051
Stensvold D, Tjonna AE, Skaug EA, Aspenes S, Stolen T, Wisloff U, Slordahl SA (2010) Strength training versus aerobic interval training to modify risk factors of metabolic syndrome. J Appl Physiol 108(4):804–810
Tjonna AE, Lee SJ, Rognmo O, Stolen TO, Bye A, Haram PM, Loennechen JP, Al-Share QY, Skogvoll E, Slordahl SA, Kemi OJ, Najjar SM, Wisloff U (2008) Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome. A pilot study. Circulation 22(118):346–354
Tjonna AE, Stolen TO, Bye A, Volden M, Slordahl SA, Odegard R, Skogvoll E, Wisloff U (2009) Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents. Clin Sci Lond 116(4):317–326. doi:10.1042/CS20080249
van den Ende CH, Breedveld FC, le Cessie S, Dijkmans BA, de Mug AW, Hazes JM (2000) Effect of intensive exercise on patients with active rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis 59(8):615–621
Wandell PE, Carlsson AC, Theobald H (2010) Effect of heart-rate recovery on long-term mortality among men and women. Int J Cardiol 144(2):276–279. doi:10.1016/j.ijcard.2009.01.053
Wenger HA, Bell GJ (1986) The interactions of intensity, frequency and duration of exercise training in altering cardiorespiratory fitness. Sports Med Auckl NZ 3(5):346–356
Wewers ME, Lowe NK (1990) A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13(4):227–236
Wisloff U, Stoylen A, Loennechen JP, Bruvold M, Rognmo O, Haram PM, Tjonna AE, Helgerud J, Slordahl SA, Lee SJ, Videm V, Bye A, Smith GL, Najjar SM, Ellingsen O, Skjaerpe T (2007) Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation 115(24):3086–3094
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Norwegian Health Association, Revmafondet (foundation for rheumatic disease in Norway), Liaison Committee between the Central Norway Regional Health Authority (RHA) and the Norwegian University of Science and Technology (NTNU).
Communicated by Keith Phillip George.
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Sandstad, J., Stensvold, D., Hoff, M. et al. The effects of high intensity interval training in women with rheumatic disease: a pilot study. Eur J Appl Physiol 115, 2081–2089 (2015). https://doi.org/10.1007/s00421-015-3186-9
- Cardiovascular diseases