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Abstract
Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). Advanced measures of cardiorespiratory fitness (CRF) are associated with CVD risk factors. The present study aimed to examine whether CVD risk factors can predict clinic-based measures of CRF, using the Siconolfi step test and to determine if exercise can improve RA patients’ cardiovascular health. Sixty-five RA patients (46 females, age 58 ± 11 years) completed assessments of CRF, CVD risk factors, body composition and RA characteristics. Ten patients participated in a follow-up 8-week exercise intervention. CRF was low (22 ml kg−1 min−1) and associated with higher diastolic blood pressure (r = − 0.37, p = 0.002), higher global CVD risk (r = − 0.267, p = 0.031) and worse body composition profile (body fat, r = − 0.48, p < 0.001; waist, r = − 0.65, p < 0.001; hip, r = − 0.58, p < 0.001). Regular exercise significantly improved CRF (p = 0.021), lower body strength (p < 0.001), agility (p < 0.001), systolic blood pressure (p = 0.021), body fat (p = 0.018), waist circumference (p = 0.035), hip circumference (p = 0.016), disease activity (p = 0.002), disability (p = 0.007) and QoL (p = 0.004). Elevated diastolic blood pressure and worse body composition profile are strong predictors of clinic-based measures of CRF. CRF is an important determinant of CVD risk and warrants inclusion in the routine assessment of RA patients. Regular exercise can improve CRF and CVD risk factors without any exacerbation of disease activity and should be offered as part of routine care.
Highlights
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that is associated with 50–60% increased mortality risk from cardiovascular disease (CVD) compared toThis work formed part of a PhD Thesis and the related publication can be found using the following link: http://e.bangor.ac. uk/5150/1/PhD%20Thesis%202012%20-%20Jennifer%20Cooney. pdf.Typically RA patients have a reduced cardiorespiratory fitness (CRF) with reductions of 20–30% being reported by Stenstrom and Minor [8]
RA patients were categorised as overweight (BMI > 25). 65% of RA patients were overweight or obese according to their body fat percent and the prevalence of being overweight or obese was higher in female RA patients (70%) compared to males (53%)
Patients were treated with disease-modifying anti-rheumatic drugs (DMARDs) including methotrexate (66%), leflunomide (18%), sulphasalazine (14%) and hydroxychloroquine (9%) and biologic therapy (23%). 57% of patients were receiving monotherapy, 37% of patients were receiving combination therapy and 6% of patients were not being treated with DMARDs
Summary
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that is associated with 50–60% increased mortality risk from cardiovascular disease (CVD) compared toThis work formed part of a PhD Thesis and the related publication can be found using the following link: http://e.bangor.ac. uk/5150/1/PhD%20Thesis%202012%20-%20Jennifer%20Cooney. pdf.Typically RA patients have a reduced CRF with reductions of 20–30% being reported by Stenstrom and Minor [8]. Compared to healthy adults of similar age, RA patients have a significantly reduced CRF [8, 11,12,13]. In rheumatology clinical practice, the measurement of CRF is generally nonexistent. One reason for this is that a simple method to assess fitness in a clinical setting did not previously exist. Our group has validated the Siconolfi step test in RA patients [10]. This simple test is a useful tool that can be used by health professionals in routine clinical practice to determine the CRF of their RA patients
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