Exercises have traditionally been recommended as part of the management program for patients with rheumatic diseases, and the main aim has been on flexibility exercises for improved or maintained joint mobility. However, the last decade has brought new insight into the increased risk of cardiovascular disease following inflammatory diseases. To meet this challenge, the focus for exercise programs should be broadened to target also cardiorespiratory fitness (CRF) and muscle strength.
Effects of CRF and strength training are dependent on the intensity, duration and frequency of exercises and evidence-based recommendations for quantity and quality of exercise for developing and maintaining CRF and muscle strength are published (Garber et al 2011). These recommendations may apply also for most people with rheumatic diseases, but individual adjustments may be needed, taking disease activity and severity into account.
As defined levels of intensity are needed to obtain specific physiological responses of exercises, testing and monitoring patients are required. Maximal oxygen uptake (VO2max) can be measured by direct and indirect methods. Direct tests (measuring gas exchange during maximal work) are regarded as the gold standard, but are not feasible for use in clinical practice, as advanced laboratory device is required. Several indirect tests are available for prediction of VO2max from different mathematical equations. The estimation is based on the heart rate response to submaximal work on a treadmill or a bicycle ergometer. A heart rate monitor and/or a scale for personal rating of exertion (i.e Borg Scale) may be used to control the intensity level.
For research purpose, muscle strength can be measured by isokinetic tests with advanced equipment. In clinical practice, the 1 repetition maximum method (1RM) method can be used for measuring dynamic body-strength, and grip strength can easily be measured with a dynamometer. Further, a wide range of functional tests are available, often useful in rehabilitation, as they capture a combination of muscular strength, CRF, functional capacity and balance.
Disclosure of Interest None declared