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The improvement in aerobic capacity, disease activity, and function in patients with rheumatoid arthritis following
Hülya Peynirci Cerşit1, İlker Yağcı1, Sinan Cerşit2
1Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey.
Insights
Cardiac rehabilitation (CR) significantly improved fitness, disease activity, and function in rheumatoid arthritis (RA) patients. However, it did not reduce cardiovascular disease (CVD) risk scores, though it improved some CVD risk factors.
Area of Science:
- Rheumatology
- Cardiology
- Exercise Physiology
Background:
- Rheumatoid arthritis (RA) is associated with increased cardiovascular disease (CVD) risk.
- Moderate disease activity in RA patients necessitates interventions to improve health outcomes.
- Cardiac rehabilitation (CR) is a potential intervention to mitigate risks in RA patients.
Purpose of the Study:
- To evaluate the impact of a supervised cardiac rehabilitation (CR) program versus a home exercise program (HEP) on disease activity, functional status, fitness, and CVD risk factors in RA patients.
- To assess changes in Disease Activity Score-28 (DAS28), Health Assessment Questionnaire (HAQ), and cardiovascular parameters.
Main Methods:
- A controlled study involving 60 female RA patients with moderate disease activity.
- Patients were randomized into a CR group (n=30) or a HEP group (n=30).
- Evaluations included exercise tolerance tests (MET, VO2 max), 6MWT, DAS28, HAQ, mSCORE, SF-36, and BDI at baseline, week 10, and week 24.
Main Results:
- The CR group showed significant improvements in VO2 max, MET, DAS28, HAQ, BDI, SF-36 physical function, pain, vitality, and 6MWT compared to the HEP group.
- While the mSCORE did not change significantly, systolic blood pressure and resting heart rate improved in the CR group.
- Compliance with HEP was higher in the CR group by week 24.
Conclusions:
- Supervised exercise programs, like CR, enhance physical fitness, functional capacity, and disease control in RA patients.
- CR did not reduce CVD risk as measured by mSCORE, but improvements in traditional CVD risk factors were observed.
- CR offers benefits for RA patients by improving overall health and potentially mitigating some CVD risks.
Objectives:
This study aims to evaluate the effect of cardiac rehabilitation (CR) on disease activity, functional status, fitness, and modified cardiovascular disease (CVD) risk factors in patients with rheumatoid arthritis (RA) with a moderate disease activity.
Patients And Methods:
This single-center, controlled study included a total of 60 female RA patients (mean age 57.5 years; range, 50 to 64 years) with moderate disease activity according to the Disease Activity Score-28 (DAS28) between January 2014 and June 2015. The patients were divided into two equal groups as those receiving CR program (n=30) and those receiving home exercise program (HEP; n=30). The patients were evaluated at baseline, at Weeks 10 and 24 using exercise tolerance test (i.e., The Metabolic Equivalent of Task [MET] and maximal oxygen uptake [VO2 max]), Six-Minute Walk Test (6MWT), DAS28, Health Assessment Questionnaire (HAQ), modified Systematic Coronary Risk Evaluation (mSCORE), Short Form Health Survey-36 (SF-36), and Beck Depression Inventory (BDI).
Results:
There was a significant improvement in the VO2 max (p<0.001), MET (p<0.001), DAS28 (p<0.001), HAQ (p<0.001), BDI (p=0.005), SF-36 physical function (p=0.039), pain (p<0.001) and vitality subscale scores (p=0.008), and 6MWT (p<0.001), after the initial and repetitive exercise programs in the CR group compared to the HEP group. At the end of Week 24, full compliance with HEP was higher in the patients with CR group, compared to the HEP group (p<0.001). There was no significant effect of supervised exercise program on the mSCORE, although systolic blood pressure (p=0.033) and resting heart rate (p=0.049) were significantly improved in the CR group versus HEP group.
Conclusion:
Based on our study results, supervised exercise program cannot reduce CVD risk as assessed by the mSCORE, although it improves physical fitness, disease activity, and functional outcomes which may reduce traditional CVD risk factors in patients with RA.
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