The effects of exercise on cardiovascular disease risk factors and cardiovascular physiology in rheumatoid arthritis

  • George S. MetsiosEmail author
  • R. H. Moe
  • M. van der Esch
  • J. J. C. S. Veldhuijzen van Zanten
  • S. A. M. Fenton
  • Y. Koutedakis
  • P. Vitalis
  • N. Kennedy
  • N. Brodin
  • C. Bostrom
  • T. W. Swinnen
  • K. Tzika
  • K. Niedermann
  • E. Nikiphorou
  • G. E. Fragoulis
  • T. P. V. M. Vlieland
  • C. H. M. Van den Ende
  • George D. Kitas
  • The IMPACT-RMD Consortium


Cardiovascular disease (CVD) morbidity and mortality is highly prevalent in patients with rheumatoid arthritis (RA) with debilitating effects for the individual as well as significant healthcare impact. Current evidence demonstrates that engaging in aerobic and resistance exercise (i.e. structured physical activity) can significantly improve patient-reported and clinical index-assessed outcomes in RA. In addition to this, engagement in exercise programmes improves, in a dose-dependent manner, the risk of developing CVD as well as CVD symptoms and outcomes. The present narrative review uses evidence from systematic reviews and meta-analyses as well as controlled trials, to synthesize the current state-of-the-art on the potential effects of aerobic and resistance exercise on CVD risk factors as well as on cardiac and vascular function and structure in people with RA. Where there is a lack of evidence in RA to explain potential mechanisms, relevant studies from the general population are also discussed and linked to RA.


Exercise Physical activity Rheumatoid arthritis Non-communicable disease Autoimmune disease Cardiovascular disease Inflammation Rehabilitation 


Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GSM, PV and KT. The first draft of the manuscript was written by GSM and GDK and all authors commented on all versions of the manuscript and provided relevant comments for further amending the manuscript and produce the final draft. All authors read and approved the final manuscript.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of Education, Health and WellbeingUniversity of WolverhamptonWalsallUK
  2. 2.Department of RheumatologyRussells Hall Hospital, Dudley Group NHS Foundation TrustDudleyUK
  3. 3.School of Physical Education and Sport ScienceUniversity of ThessalyVolosGreece
  4. 4.Department of RheumatologyNational Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet HospitalOsloNorway
  5. 5.ACHIEVE-Center of Applied Research, Faculty of Health, Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research CenterAmsterdam University of Applied SciencesAmsterdamThe Netherlands
  6. 6.School of Sport, Exercise and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
  7. 7.School of Allied Health, Faculty of Education and Health Sciences and Health Research InstituteUniversity of LimerickLimerickIreland
  8. 8.Department of Neurobiology, Care Sciences and Society, Division of PhysiotherapyKarolinska InstitutetHuddingeSweden
  9. 9.Division of RheumatologyUniversity Hospitals LeuvenLeuvenBelgium
  10. 10.School of Health Professions, Institute of PhysiotherapyZurich University of Applied SciencesWinterthurSwitzerland
  11. 11.Department of Academic RheumatologyKing’s College LondonLondonUK
  12. 12.Institute of Infection, Immunity and InflammationUniversity of GlasgowGlasgowUK
  13. 13.Department of Orthopaedics, Rehabilitation and Physical TherapyLeiden University Medical CenterLeidenThe Netherlands
  14. 14.Department of RheumatologySint MaartenskliniekNijmegenThe Netherlands

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