Background Cardiovascular disease is increased in rheumatoid arthritis (RA) (1). Strong evidence shows that exercise reduces the CVD risk in the general population (2).
Objectives The aim of this study was to examine the effect of group cycling on risk factors for cardiovascular disease in patients with RA.
Methods 13 subjects with RA (12 female, 1 male, mean age 57 yrs, disease duration 12 yrs) exercised on stationary bikes at medium to high intensity for 45 min, 3 times a week for 10 weeks. A control group of 10 subjects (10 females, mean age 62.5 yrs, disease duration 11 yrs)continued their previous activities. Measurements were applied at baseline, at 10 weeks and at 25 weeks as follows: Aerobic capacity was calculated by a sub-maximal ergometer test according to Åstrand. Visual analogue scale (VAS) was used for self-assessment of pain and general health. The subjects performed self-assessments of functional ability using the health assessment questionnaire (HAQ) and the number of tender and swollen joints (28-joint count). Erythrocyte sedimentation rate (ESR), blood levels of C-reactive protein (CRP), lipids (cholesterol, % high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides), insulin and glucose were measured according to routine methods. Body mass index (BMI) and disease activity score (DAS 28) were calculated. Pulse wave analysis (PWA) was used to register augmentation index (AIx), a measure reflecting early endothelial dysfunction, shown to predict future cardiovascular events, pulse wave velocity (PWV), a proxy for arterial stiffness and systolic blood pressure in aorta (SBPao) besides peripheral blood pressure.
Results There were significant improvements in the exercise group at ten weeks compared to baseline regarding aerobic capacity (33 vs 26 ml O2/kg x min; p<0.05), systolic (126 vs 137.8 mm Hg; p<0.01) and diastolic (73 vs 83.8 mm Hg, p<0.05) peripheral blood pressure, SBPao (118 vs 137.7 mm Hg; p<0.01) and tender joint count (p<0.05). The improvement of the diastolic blood pressure was significantly larger in the exercise group compared to the controls at 10 weeks (p<0.05). Low aerobic capacity at baseline correlated with high disease activity (ESR, CRP) and low physical function (HAQ) at baseline. Blood pressure at baseline and at 10 weeks correlated with disease activity (DAS 28) at baseline. Improvements in blood pressure correlated with high physical function (HAQ) at baseline and at ten weeks and with low disease activity (tender joints, VAS pain, CRP, DAS 28) at ten weeks.
Conclusions Regular exercise on stationary bikes on medium to high intensity for 10 weeks increased aerobic capacity in this group of RA-subjects and produced changes of blood pressure to a level that is described to be clinically relevant (3). No detrimental effect on disease activity was seen.
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Lee IM et al. Circulation 2000;102: 981-6
Lewington S et al. Lancet 2002;360:1903-13
Disclosure of Interest None Declared
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