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



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.


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.


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).


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



Rheumatoid arthritis


Cardiovascular disease


American College of Sports Medicine


Anti-citrullinated protein antibody.


Disease modifying anti-rheumatoid drug


c-reactive protein


Erythrocyte sedimentation rate


Disease activity score


Health assessment questionnaire


Global fatigue index


Body mass index


Waist circumference


Maximal oxygen consumption


Montreal Cognitive Assessment


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).

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  • Rheumatoid arthritis
  • Exercise Programme
  • Cognition