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Individualised exercise improves endothelial function in patients with rheumatoid arthritis
  1. George S Metsios1,2,3,
  2. Antonios Stavropoulos-Kalinoglou2,3,
  3. Jet JCS Veldhuijzen van Zanten2,4,
  4. Peter Nightingale5,
  5. Aamer Sandoo2,
  6. Theodoros Dimitroulas1,
  7. George D Kitas2,6,
  8. Yiannis Koutedakis1,3,7
  1. 1School of Sport, Performing Arts & Leisure, Wolverhampton University, Walsall, West Midlands, UK
  2. 2Department of Rheumatology, Dudley Group NHS Foundation Trust, Russell's Hall Hospital, Dudley, West Midlands, UK
  3. 3Institute of Human Performance & Rehabilitation, Centre for Research and Technology Thessaly, Trikala, Greece
  4. 4School of Sport and Exercise Science, University of Birmingham, Edgbaston, West Midlands, UK
  5. 5Queen Elizabeth Hospital Birmingham, Welcome Trust Clinical Research Facility, Birmingham, West Midlands, UK
  6. 6Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK
  7. 7Department of Sport and Exercise Science, University of Thessaly, Trikala, Greece
  1. Correspondence to Dr George S Metsios, University of Wolverhampton, Walsall Campus, Room, WD Building, Gorway Road, Walsall, West Midlands WS1 3BD, UK; G.Metsios{at}


Background We investigated the effects of individualised combined resistance and aerobic exercise on microvascular and macrovascular function in rheumatoid arthritis (RA) patients.

Methods Forty age-matched, gender-matched and body mass index (BMI)-matched patients were allocated to either an exercise group, receiving a 6 months tailored aerobic and resistance exercise intervention, or controls receiving only information about the benefits of exercise. Participants were assessed for microvascular (acetylcholine (Ach) and sodium nitroprusside (SNP)) and macrovascular (flow-mediated dilatation (FMD) and glyceryl trinitrate (GTN)) endothelial function, maximal oxygen uptake, disease activity and severity (C-reactive protein (CRP), disease activity score 28 and health assessment questionnaire). Data were collected at baseline, 3 months and at the end of the intervention (6 months).

Results At baseline, demographic, anthropometric, disease-related characteristics and endothelial function parameters were similar between the exercise and control groups (p>0.05). Repeated measures analysis of variance revealed a significant improvement in endothelial function parameters at 3 (GTN: p<0.001) or 6 months (Ach: p=0.016, SNP: p=0.045, FMD: p=0.016) in the exercise but not in the control group. Generalised estimated equations detected that maximal oxygen uptake was a strong predictor for the observed changes in Ach (p=0.009) and GTN (p<0.001) whereas logCRP for SNP (p=0.017) and GTN (p=0.008).

Conclusions An exercise programme designed to meet individual needs and physical abilities significantly improves microvascular and macrovascular function in parallel with disease-related characteristics in RA patients. The potential long-term beneficial effects of such interventions at reducing cardiovascular risk in these patients merit further exploration.

Clinical Trial Registration ISRCTN50861407.

  • Cardiovascular Disease
  • Inflammation
  • Rheumatoid Arthritis
  • Rehabilitation

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