The effect of exercise on cardiorespiratory fitness in patients with Rheumatoid Arthritis and Cardiovascular risks

Rheumatoid arthritis (RA) is associated with increased overall mortality
compared to the general population, with cardiovascular diseases (CVD) as one
of the main causes. The optimization of management of CV risk in RA patients is
an important aim in the treatment. Active counseling is indispensable,
including also attention to exercise, particularly in RA patients with a high
CV risk, defined as a 10-year CV risk of 20% or higher. Physical exercise for
these patients is necessary and challenging since professionals should take
multiple factors into account, such as comorbid conditions related to CV risk
(e.g. hypertension, diabetes mellitus and obesity). However, the effects of
exercise therapy on CV risk in RA patients are unknown and the required
intensity is also unknown.

The first aim of the present study is to develop a tailor-made exercise therapy
program for these complex patients. The second aim is to evaluate the effect of
exercise therapy in a pilot study on cardiorespiratory fitness and several
secondary outcomes (i.e. safety, functional performance, CV risk factors, and
disease activity).

An experimental pre-posttest within-study design.

The exercise therapy program will include exercises that are primarily aimed at
improving cardiorespiratory fitness and functional performance in RA patients.
Frequency, intensity, time, type and progression of the exercises will be
performed according to the ACSM guideline (Durnstine 2009).

The workload and risks for patients are
1. The number of blood tests: 2x (in case of recent test, no repetition of
blood draw)
2. The number of visits to the physician / researcher: 1x at rheumatologist and
rehabilitation physician, then 3 measurements in the clinimetrical laboratory
and 12 weeks of training at a physiotherapist.
3. Physical examination: Standard protocol at physician and 2-3 x testing of
cardiorespiratory fitness
4. The number and type of questionnaires and / or diaries: 4x general
questionnaires are taken and RA specific questionnaires.
5. The physical discomfort: during cardiorespiratory exercise tests fatigue
occurs.
6. Possible adverse side effects of treatment. Dosage of exercises is related
to exercise tests, which means that the risk of overload is low.


In the light of the workload and / or risks, the measurements and treatment,
the conduct of the investigation is justified.