Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
J Intern Med. 2018 Dec;284(6):664-673. doi: 10.1111/joim.12715. Epub 2017 Dec 13.
To establish how guided physical activity in patients with rheumatoid arthritis (RA) without known cardiovascular disease affected vascular and cardiac function, and how these two entities were prospectively interconnected in this patient group.
Prospective substudy of 29 participants in the Physical Activity in RA (PARA) 2010 trial. All subjects were examined at baseline, at year 1 and 2 with measures of pulse wave velocity and arterial augmentation index, as well as echocardiographic evaluation of diastolic parameters and ventricular-arterial coupling. Muscle strength and aerobic exercise capacity were assessed at baseline and yearly. All participants performed physiotherapist-guided aerobic and muscle strength exercise during 2 years and were reminded through SMS to report physical activity progress.
This cohort of patients with RA exhibited increased vascular stiffness despite normal blood pressure. At baseline, lower muscle strength was associated with increased vascular stiffness (β = 0.68; P = 0.004), whereas lower aerobic working capacity was associated with left ventricular diastolic dysfunction (β = 0.85; P = 0.03). There was a significant positive correlation between vascular stiffness and diastolic dysfunction at baseline (R = 0.64) and for the changes in those parameters observed during 2 years of guided physical activity. Finally, a significant improvement in ventricular-arterial coupling was observed after exercise (P < 0.001).
These results indicate that although differentially associated with physical capacity parameters, improved vascular stiffness and improved diastolic dysfunction are interrelated, and that an optimization of the ventricular-arterial coupling may contribute to the beneficial effects of physical activity in patients with RA.
研究类风湿关节炎（RA）患者在无已知心血管疾病的情况下进行指导下的身体活动如何影响血管和心脏功能，以及这两个实体在该患者群体中如何前瞻性地相互关联。
前瞻性亚研究纳入了 2010 年身体活动在类风湿关节炎（PARA）试验中的 29 名参与者。所有受试者均在基线、第 1 年和第 2 年接受脉搏波速度和动脉增强指数的检查，以及舒张参数和心室-动脉偶联的超声心动图评估。在基线和每年评估肌肉力量和有氧运动能力。所有参与者在 2 年内接受物理治疗师指导的有氧运动和肌肉力量锻炼，并通过短信提醒报告身体活动进展。
尽管血压正常，但患有 RA 的患者表现出血管僵硬增加。基线时，较低的肌肉力量与较高的血管僵硬相关（β=0.68；P=0.004），而较低的有氧运动能力与左心室舒张功能障碍相关（β=0.85；P=0.03）。基线时血管僵硬与舒张功能障碍之间存在显著正相关（R=0.64），并且在 2 年的指导下身体活动中观察到这些参数的变化也存在显著正相关。最后，在运动后观察到心室-动脉偶联显著改善（P<0.001）。
这些结果表明，尽管与身体能力参数有差异相关，但血管僵硬的改善和舒张功能障碍的改善是相互关联的，并且心室-动脉偶联的优化可能有助于 RA 患者身体活动的有益效果。
