Reade, Centre for Rehabilitation and Rheumatology, Amsterdam Rehabilitation Research Centre | Reade, PO Box 58271, Amsterdam, 1040 HG, The Netherlands.
Department of Nutrition and Dietetics, University of Thessaly, Thessaly, Greece.
Clin Rheumatol. 2022 Dec;41(12):3725-3734. doi: 10.1007/s10067-022-06343-4. Epub 2022 Aug 25.
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.
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.
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 min, p = 0.003) and decreased DAS28 (pre: 2.86 vs. post: 2.47, p = 0.04). No changes were detected in CVD risk factors.
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).
在心血管疾病风险较高的类风湿关节炎（RA）患者中，尚不清楚运动是否安全，是否能改善心肺功能，降低疾病相关症状和心血管疾病（CVD）风险因素。我们旨在调查 RA 合并 CVD 风险患者：（1）中高强度有氧运动的安全性；（2）心肺功能的潜在变化；（3）运动对疾病活动和 CVD 风险因素的影响。
这是一项单臂试验性运动干预研究，纳入了 26 例连续患者（21 例女性），根据荷兰系统性冠状动脉风险评估，他们 CVD 死亡的 10 年风险超过 4%。有氧运动包括每周 2 次监督训练和 5 次家庭训练，共 12 周。患者需要以 65%至 85%的最大心率进行运动。为评估安全性，我们记录了与运动相关的不良事件。在运动前后，使用递增最大摄氧量运动试验评估心肺功能，同时通过红细胞分段率（ESR）评估疾病活动评分-28（DAS28）。静息血压、ESR 和总胆固醇作为 CVD 风险因素进行评估。
26 例患者中有 20 例完成了 12 周的运动，无任何不良事件。根据患者的报告，退出与运动无关。运动增加了心肺功能（运动前：15.91ml·kg-1·min-1；运动后：18.15ml·kg-1·min-1，p=0.003）和降低了 DAS28（运动前：2.86；运动后：2.47，p=0.04）。CVD 风险因素没有变化。
12 周的运动干预似乎是安全的，可提高心血管疾病高危 RA 患者的心肺功能和疾病活动。关键点 1. 患有高心血管疾病风险的类风湿关节炎患者能够进行最大运动测试和 12 周的基于有氧运动的中高强度运动干预。2. 运动干预改善了患有高心血管疾病风险的类风湿关节炎患者的心肺功能和疾病活动。3. 运动干预后心肺功能仍然较低（即 18.15ml·kg-1·min-1，而无 CVD 风险的 RA 患者的基线平均水平为 20.9ml·kg-1·min-1）。
