Out of Breath and Out of Shape in RA

Aug 04, 2015

Cardiorespiratory fitness is low among patients with rheumatoid arthritis. Improving fitness improves risks for cardiovascular disease and coupled with combination therapy, may lower disease activity as well as foster increased physical activity, recent studies show.

The Benefits for Boosting Fitness

 Cardiorespiratory fitness is low among patients with rheumatoid arthritis. Improving fitness improves risks for cardiovascular disease and coupled with combination therapy, may lower disease activity as well as foster increased physical activity, recent studies show. RA patients are known to have a higher risk for CVD and the first study, published online July 25, 2015 in the journal

Rheumatology

, not only links increased risk to the classic cardiac risk factors, but also to low cardiorespiratory fitness.

Arthritis Care and Research

) Researchers, led by George S. Metsios, PhD, of the department of Physical Activity, Exercise, and Health at the University of Wolverhampton in the UK, grouped 144 RA according to their cardiorespiratory scores – maximal oxygen uptake (or VO2max) –during a treadmill test as being “unfit,” “moderately unfit” or of “average fitness.” Low VO2max (measured in ml/kg/min) is considered a good marker of cardiovascular risk, since muscles need more oxygen for energy during heavy aerobic exercise and the heart must work harder to pump that blood. Among the study group, mostly women – mean age 55 weighing around 170 pounds (76.6 kg) –the mean VO2max at baseline was 20.9 ml/kg/min, with those in the “unfit” group having a mean VO2max of 15.4. A multivariate analysis shows body fat, low high density lipoprotein (HDL) cholesterol, insulin resistance, and a greater 10-year CVD risk were significantly associated with a low VO2max – even after adjusting for disease activity and physical activity. Higher VO2max levels in men and women were associated with a better cardiovascular risk profile and a lower 10-year risk of CVD. The study was limited by not evaluating VO2max levels in equivalent age-and gender-matched populations. But “it seems reasonable to suggest that increased cardiorespiratory fitness may provide a measure of protection against CVD” in people with RA, the UK researchers say. 

RA Treatment May Prompt More Physical Activity

 Exercise is the main intervention for raising VO2max and it can “even ameliorate disease-related symptoms and the calculated risk for CVD,” the British researchers say. Could aggressive treatment early on reduce symptoms enough to prompt RA patients to exercise more?  [[{"type":"media","view_mode":"media_crop","fid":"40067","attributes":{"alt":"","class":"media-image media-image-left","id":"media_crop_4132829494774","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4059","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.0080003738403px; line-height: 1.538em; float: left;","title":" ","typeof":"foaf:Image"}}]]A second study suggests that it can. The study, conducted in the Netherlands among 140 early RA patients enrolled in a clinical trial of prednisolone, methotrexate (MTX), and the two drugs with sulfasalazine (SSZ), shows combination therapy can not only reduce disease activity but also boost self-reported physical activity during the first year of treatment. Investigators at the Amsterdam Rheumatology and Immunology Center measured physical activity in the two treatment groups using the SQUASH questionnaire (Short Questionnaire to ASsess Health-enhancing physical activity) at baseline, 13 weeks, 26 weeks, and 52 weeks after the start of treatment. Patients were judged as meeting or not meeting the World Health Organization (WHO) exercise guideline of 150 minutes of moderate-intense activity per week or the Dutch recommendation of 30 minutes of moderate to intense activity at least five days per week. At the start of the trial 69% of the patients (over half of them women, mean age 52 years) reported meeting the WHO guidelines in the past week, with the numbers increasing to 90% at 13 weeks and leveling off at 89% at one year. Patients also increased the number of minutes spent in moderate to intense activity, according to Dutch guidelines, from 370 minutes at baseline to 540 minutes at one year, mostly in walking, cycling and gardening, the researchers reported online July 26 in the journal

Arthritis Care & Research

. Improved disease activity scores in 44 joints (DAS44) were significantly associated with increased physical activity. Mean DAS scores dropped from 4.0 to 1.8 during the first year of treatment, and patients with clinically relevant responses had higher physical activity levels – regardless of whether their responses were DAS remission, European League Against Rheumatism (EULAR) good responses or 70% improvement by American College of Rheumatology (ACR) criteria. The Dutch researchers say theirs is the first study to show such a link between decreased disease activity and increased physical activity in early RA. Even in a disease such as RA, “characterized by significant disability, pain and fatigue, exercise is recommended; in fact, it can even ameliorate disease-related symptoms and the calculated risk for CVD,” the British authors of the Rheumatology study write. “Therefore, RA patients can and should exercise.”  

References:

  • Metsios GS, Koutedakis Y, Veldhuijzen van Zanten JJ, et al., Cardiorespiratory fitness levels and their association with cardiovascular profile in patients with rheumatoid arthritis: a cross-sectional study. Rheumatology (Oxford).pii: kev035. Published online July 25, 2015. 

 

  • Konijn NPC, van Tuyl LHD, Boers M, et al., Effective treatment rapidly improves both disease activity and self-reported physical activity in early rheumatoid arthritis. Arthritis Care & Research. 2015. Accepted Article. Published online July 26, 2015. DOI 10.1002/acr.22668. 

  

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