Why is this study important?
Patients with rheumatoid arthritis (RA) have an elevated risk of cardiovascular diseases compared with the general population. Their higher risk is linked to the systemic inflammatory process in combination with increased levels of traditional risk factors, for example hypertension, hyperlipidemia, high body mass index and smoking.
Physical activity and cardiorespiratory fitness are inversely associated with an adverse cardiovascular disease risk profile in RA. This means that people with RA who are physically active and have better fitness are at a lower risk of heart disease. However, many patients with RA are not active on a high enough intensity level to improve cardiorespiratory fitness.
In a recent study summarised in this blog, we aimed to evaluate the effects of high-intensity interval training (HIIT) and strength exercise, tailor-made for patients with RA, on cardiovascular and physical health by a randomized controlled multicenter trial.
How did the study go about this?
The patients, n=87, mean age 48.1 (SD 9.66) years from rheumatology units in western Sweden were randomly assigned into an exercise group or a control group. Patients in the exercise group performed 12 weeks supervised HIIT exercise. Each session included alternating bouts of high intensity intervals (90-95% of heart rate maximum) with periods of lower intensity. This was followed by strength exercise of large muscle groups, such as leg press, squat, hip extension, pull down, biceps curl, rows to chest, sit ups and lumbar back extension.
The patients in the control group received individual information on the general recommendations of physical activity with encouragement to be active on a moderate intensity level of at least 150 min per week. A rigorous safety screening of contradictions to participate in high-intensity exercise was performed on all patients prior to inclusion.
What did the study find?
We found that supervised high-intensity interval training (HIIT) and strength exercise for 12 weeks significantly improved cardiorespiratory fitness (VO2 max), waist circumference, muscle strength, and overall health. Importantly, the intervention did not worsen disease activity and RA symptoms including pain
The mean treatment effect of 3.7 mL/ kg/min in VO2max, corresponding to 12.6% difference in change, indicates substantial health-related gains for the patients in the exercise group.
What are the key take-home points?
Supervised HIIT and strength exercise in combination appear to be feasible and well tolerated and could be recommended as a treatment option to improve cardiovascular and physical health in patients with well-controlled RA.
We strongly recommend pre-exercise safety screening before start-up of any high intensity aerobic exercise.
Author and Affiliations:
Annelie Bilberg, Jan Bjersing, Mats Börjesson, Eva Klingberg, Kaisa Mannerkorpi, Jenny Sivertsson, Sara Svedlund.
Associate professor, PhD Annelie Bilberg, Institute of Neuroscience, Department of Health and Rehabilitation, Gothenburg University, Goteborg, Sweden
annelie.bilberg@vgregion.se
References
- Agca R, Heslinga SC, van Halm VP, et al. Atherosclerotic cardiovascular disease in patients with chronic inflammatory joint disorders. Heart 2016;102:790–5.
- Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 2017;76:17–28.
- Hammam N, Ezeugwu VE, Rumsey DG, et al. Physical activity, sedentary behavior, and long-term cardiovascular risk in individuals with rheumatoid arthritis. Phys Sports med 2019;47:463–70.
- Liff MH, Hoff M, Wisloff U, et al. Reduced cardiorespiratory fitness is a mediator of excess all-cause mortality in rheumatoid arthritis: the Trøndelag Health Study. RMD Open 2021;7:e001545.
- Pelliccia A, Sharma S, Gati S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021;42:17–96.