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Benefits of exercise in patients with rheumatoid arthritis: a randomized controlled trial of a patient-specific exercise programme

Abstract

Background

Patients with rheumatoid arthritis (RA) tend to be more overweight, take less physical exercise, exhibit decreased cardiorespiratory fitness and demonstrate reduced muscle strength compared with age- and sex-matched controls. Impaired cognitive function in RA is an important associated factor, although it has been less well-recognized. The aim of this study was to investigate the effects of a specifically designed exercise programme on body composition, aerobic capacity, muscle strength and cognition in RA.

Methods

Sixty-six patients with RA were randomized to a specifically designed, personalized exercise programme or standard care. Assessments included body composition, fitness, grip strength and cognitive testing, in addition to disease related measures.

Results

Significant improvements in C-reactive protein (p = 0.025), fatigue scores (p = 0.047) and truncal fat (p = 0.004) were observed in the exercise group compared with controls. Median waist circumference was significantly reduced (94.0 to 91.4 cm, p < 0.0001). Improvements were also seen in aerobic capacity (23.2 to 27.6 ml/kg/min, p = 0.002) and in median right (12.0 to 13.0 kg, p = 0.025) and left grip strength (8.0 to 10 kg, p = 0.005). Cognitive function improved in the exercise group, with median Montreal Cognitive Assessment score 25.5 at 0 months compared to 28.0 at 3 months (p = 0.001).

Conclusion

This study demonstrates that exercise has a significant and positive impact on cognitive function in RA. Furthermore, physical activity is safe and effective in chronic inflammatory joint disease and is recommended as a vital component in the holistic management of these patients.

Key Points
• A dedicated physical exercise programme is feasible and safe in patients with rheumatoid arthritis (RA).
• Physical exercise helps reduce fatigue scores and improves cardiovascular fitness in stable RA patients.
• Physical exercise has a positive impact on cognition in patients with RA.
• A structured exercise programme should be an integral part of chronic disease management protocols for patients with RA.

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Fig. 1

Abbreviations

RA:

Rheumatoid arthritis

CVD:

Cardiovascular disease

ACSM:

American College of Sports Medicine

ACPA:

Anti-citrullinated protein antibody.

DMARD:

Disease modifying anti-rheumatoid drug

CRP:

c-reactive protein

ESR:

Erythrocyte sedimentation rate

DAS28:

Disease activity score

HAQ:

Health assessment questionnaire

GFI:

Global fatigue index

BMI:

Body mass index

WC:

Waist circumference

VO2Max:

Maximal oxygen consumption

MoCA:

Montreal Cognitive Assessment

SART:

Sustained attention reaction time

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Author information

Study design: MA, CL, FW, and GC. Patient recruitment and assessments: MA, CC, TOD. Data analysis and interpretation: MA, CL, and GC. Drafting of manuscript and review of manuscript for intellectual content: MA, CL, and GC. All authors have reviewed and approved the final version of the manuscript.

Correspondence to Maha Azeez.

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Azeez, M., Clancy, C., O’Dwyer, T. et al. Benefits of exercise in patients with rheumatoid arthritis: a randomized controlled trial of a patient-specific exercise programme. Clin Rheumatol (2020). https://doi.org/10.1007/s10067-020-04937-4

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Keywords

  • Rheumatoid arthritis
  • Exercise Programme
  • Cognition