Exercise in patients with Rheumatoid Arthritis and Cardiovascular risks

Rationale:

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.



Objectives:

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).



Study design:

An experimental pre-posttest within-study design.



Study population:

Study population: 30 consecutive patients with RA recruited from an existing RA cohort with known risk factors.

Main study parameters/endpoints:

Primary outcome of the study is cardiorespiratory fitness assessed with a graded exercise tolerance test, either on a treadmill or an exercise bike (Lode, the Netherlands).

Secondary outcomes are functional performance, CV risk factors and disease activity.

The overall hypothesis is that the developed exercise therapy program is feasible, safe and improves cardiorespiratory fitness, functional performance, reduces CV risk factors and disease activity in patients with RA and high CV risk.

before and after the intervention outcomes wil be assessed

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)