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Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis
  1. Antonios Stavropoulos-Kalinoglou1,2,3,
  2. Giorgos S Metsios1,4,
  3. Jet JJCS Veldhuijzen van Zanten1,5,
  4. Peter Nightingale6,
  5. George D Kitas1,7,
  6. Yiannis Koutedakis2,3,4
  1. 1Department of Rheumatology, Dudley Group NHS Foundation Trust, Russell's Hall Hospital, Dudley, UK
  2. 2Department of Sport and Exercise Science, University of Thessaly, Trikala, Greece
  3. 3Centre for Research and Technology Thessaly, Institute of Human Performance & Rehabilitation, Trikala, Greece
  4. 4School of Sport, Performing Arts & Leisure, Wolverhampton University, Walsall, UK
  5. 5School of Sports and Exercise, University of Birmingham, Edgbaston, UK
  6. 6Wellcome Trust Clinical Research Facility Birmingham, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  7. 7Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK
  1. Correspondence to Professor George D Kitas, Department of Rheumatology, Dudley Hospitals NHS Foundation Trust, Russell's Hall Hospital, Pensnett Road, Dudley DY1 2HQ, UK;kitas{at}


Background and objectives Low cardiorespiratory fitness (CRF) is a significant predictor of cardiovascular disease (CVD), and interventions aiming at increasing CRF are known to reduce CVD risk. The effects of such interventions on CVD risk have not been studied in patients with rheumatoid arthritis (RA).

Methods 40 age, gender, body mass index (BMI) and disease duration matched RA patients were allocated to either an exercise (receiving 6 months individualised aerobic and resistance high intensity exercise intervention, three times per week), or control (receiving advice on exercise benefits and lifestyle changes) arm. Participants were assessed at baseline, 3 and 6 months for aerobic capacity (VO2max), individual CVD risk factors (blood pressure, lipids, insulin resistance, body composition), 10-year CVD event probability and RA characteristics (C-reactive protein (CRP), Disease Activity Score 28 (DAS28) and Health Assessment Questionnaire (HAQ)).

Results There were no differences between groups at baseline in any of the assessed variables. VO2max (p=0.001), blood pressure (systolic: p<0.001; diastolic: p=0.003), triglycerides (p=0.030), high density lipoprotein (HDL; p=0.042), total cholesterol:HDL ratio (p=0.005), BMI (p=0.001), body fat (p=0.026), 10-year CVD event probability (p=0.012), CRP (p=0.042), DAS28 (p=0.008) and HAQ (p=0.003) were all significantly improved in the exercise versus the control group. The change in VO2max was the strongest predictor for the observed improvements in all of the assessed CVD risk factors and disease characteristics.

Conclusions Individualised aerobic and resistance exercise intervention can lead to significantly improved CRF, individual CVD risk factors, composite CVD risk, and disease activity and severity in RA patients.

  • Rheumatoid Arthritis
  • Cardiovascular Disease
  • Lipids

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