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Exercise intervention on cardiorespiratory fitness in rheumatoid arthritis patients with high cardiovascular disease risk: a single-arm pilot study

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Abstract

Objective

In patients with rheumatoid arthritis (RA) with cardiovascular disease risk, it is unknown whether exercises are safe, improve cardiorespiratory fitness and reduce disease-related symptoms and cardiovascular-disease (CVD) risk factors. We aimed to investigate in RA patients with CVD risk: (1) safety of medium to high-intensity aerobic exercises, (2) potential changes of cardiorespiratory fitness and (3) disease activity and CVD risk factors in response to the exercises.

Methods

Single-arm pilot-exercise intervention study including 26 consecutive patients (21 women) with > 4% 10-year risk of CVD mortality according to the Dutch Systematic Coronary Risk Evaluation. Aerobic exercises consisted of two supervised-sessions and five home-sessions per week for 12 weeks. Patients were required to exercise at intensities between 65 and 85% of their maximum heart rate. To assess safety, we recorded exercise related adverse events. Before and after the exercises, cardiorespiratory fitness was assessed with a graded maximal oxygen-uptake exercise test, while disease activity was evaluated via the Disease Activity Score-28 (DAS28) using the erythrocyte segmentation rate (ESR). Resting blood pressure, ESR and total cholesterol were assessed as CVD risk factors.

Results

Twenty out of 26 patients performed the 12-week exercises without any adverse events. According to patients, withdrawals were unrelated to the exercises. Exercises increased cardiorespiratory fitness (pre: 15.91 vs. post: 18.15 ml.kg−1 min−1, p = 0.003) and decreased DAS28 (pre: 2.86 vs. post: 2.47, p = 0.04). No changes were detected in CVD risk factors.

Conclusion

A 12-week exercise intervention seems to be safe and improves cardiorespiratory fitness and disease activity in patients with RA with a high risk for cardiovascular diseases.

Key Points

1. Rheumatoid arthritis patients with high cardiovascular disease risk were able to perform a maximum exercise test and a 12-week aerobic-based medium-to-high intensity exercise intervention.

2. The exercise intervention improved cardiorespiratory fitness and disease activity in rheumatoid arthritis patients with high cardiovascular disease risk.

3. Cardiorespiratory fitness levels were still low post-exercise intervention (i.e. 18.15 ml.kg−1min−1 compared to the 20.9 ml.kg−1min−1 baseline mean of the RA patients without CVD risk).

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Data availability

The data that support the findings of this study are available on request from the corresponding author [m.vd.esch@reade.nl].

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Author information

Authors and Affiliations

  1. Reade, Centre for Rehabilitation and Rheumatology, Amsterdam Rehabilitation Research Centre | Reade, PO Box 58271, Amsterdam, 1040 HG, The Netherlands

    M. Sobejana, J. van den Hoek, M. van der Leeden, S. Verberne, W. F. Lems, M. T. Nurmohamed & M. van der Esch

  2. Department of Nutrition and Dietetics, University of Thessaly, Thessaly, Greece

    G. S. Metsios

  3. Dudley Group NHS Foundation Trust, Russells Hall Hospital, Clinical Research Unit, Dudley, UK

    G. D. Kitas

  4. Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands

    M. van der Leeden

  5. Department of Cardiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands

    H. T. Jorstad

  6. Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands

    M. Pijnappels

  7. Department of Rheumatology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands

    W. F. Lems & M. T. Nurmohamed

  8. Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, The Netherlands

    M. van der Esch

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  1. M. Sobejana
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Sobejana, M., van den Hoek, J., Metsios, G.S. et al. Exercise intervention on cardiorespiratory fitness in rheumatoid arthritis patients with high cardiovascular disease risk: a single-arm pilot study. Clin Rheumatol 41, 3725–3734 (2022). https://doi.org/10.1007/s10067-022-06343-4

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