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Aspects of physical activity in Rheumatoid Arthritis: associations with inflammation and cardiovascular risk factors
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Rheumatoid Arthritis (RA) is associated with an increased risk for cardiovascular disease (CVD), partially attributable to systemic inflammation and traditional risk factors for CVD. Since physical activity (PA) is strongly related to CVD in the general population, the aim of this thesis was to describe aspects of PA in patients with RA, and further to analyse associations with disease activity, traditional risk factors for CVD and subclinical atherosclerosis.

Methods: In papers I and II, newly diagnosed RA patients were followed for two (n=66) and mean (SD) 16 (2) (n=25) years respectively. Disease activity and aerobic capacity were measured in both groups.​ In paper II, the 25 patients were also examined for traditional risk factors for CVD, body composition, with pulse wave analysis and carotid ultrasound. Self-efficacy was assessed using a questionnaire. In paper III, a combined heart rate and movement monitor was used to measure PA in 84 patients with early (<2 years) and 37 patients with long-standing (mean [SD] 16 [2] years) RA. Data were analysed for associations with disease activity, traditional risk factors for CVD and subclinical atherosclerosis, as above. Finally, in paper IV, a pilot study including 13 patients, median (Q1-Q3) age 57 (44-64) years, was conducted to analyse the feasibility as well as the effects of ten weeks of spinning exercise, on aerobic capacity, traditional risk factors for CVD and inflammation.

Results: In papers I and II, aerobic capacity was maintained at follow-up. In paper I, median (Q1-Q3) aerobic capacity was 31 (27-39) ml/kg x min at baseline and 33 (25-38) ml/kg x min after two years. In paper II, median (Q1-Q3) aerobic capacity was 32 (28-42) ml/kg x min at baseline and 33 (28-39) ml/kg x min after 16 years. In multiple linear regression analyses, adjusted for baseline aerobic capacity, disease activity during the first two years after diagnosis explained 53 % of the aerobic capacity level after 16 years [b=-0.14, p<0.004]. Higher aerobic capacity was associated with more favourable measures of risk factors for CVD and self-efficacy over time and at follow-up. In paper III, 37 % of the patients with early and 43 % of the patients with long-standing RA, did not reach the national recommendations of PA. Total PA as well as more time spent in moderate to vigorous PA were associated with more favourable risk factors for CVD. Patients with higher disease activity and functional disability were less physically active. In paper IV, intensive spinning exercise proved to be a feasible method, that significantly improved aerobic capacity, systolic blood pressure and the number of tender joints.

Conclusions: Aerobic capacity, which could be maintained despite several years of disease, was related to risk factors for CVD and to self-efficacy. Higher disease activity in early disease predicted lower aerobic capacity after 16 years. Higher PA level was associated with a more beneficial cardiovascular profile, however, an insufficient level of PA was found in a substantial proportion of patients. Furthermore, we found, that intensive spinning exercise was a feasible method for the group included, to improve aerobic capacity and blood pressure without detrimental effects on disease activity. Physical activity and aerobic capacity have roles to play in the cardio protective management and are, as other modifiable risk factors, suggested to be estimated regularly. Higher disease activity is known to increase the risk of CVD in RA, and as disease activity also seems to negatively impact future aerobic capacity, interventions and support for health enhancing PA should have high priority in these patients. 

Place, publisher, year, edition, pages
Umeå, Sweden: Umeå University , 2018. , p. 84
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1949
Keywords [en]
physiotherapy, rheumatoid arthritis, cardiovascular disease, aerobic capacity, physical activity, exercise, primary prevention
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:umu:diva-145637ISBN: 978-91-7601-850-7 (print)OAI: oai:DiVA.org:umu-145637DiVA, id: diva2:1189540
Public defence
2018-04-06, Aulan, Vårdvetarhuset, Lasarettsbacken 7, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-03-16 Created: 2018-03-12 Last updated: 2018-06-09Bibliographically approved
List of papers
1. Body function in patients with early rheumatoid arthritis: a 2-year prospective study
Open this publication in new window or tab >>Body function in patients with early rheumatoid arthritis: a 2-year prospective study
2007 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Advances in physiotherapy, ISSN 1403-8196, Vol. 9, no 4, p. 144-150Article in journal (Refereed) Published
Abstract [en]

The aim of this prospective study was to analyse joint and muscle function and aerobic capacity over 2 years in a group of patients with early rheumatoid arthritis (RA; i.e. symptomatic for <12 months) in relation to age, pain and disease activity. Sixty-six patients with early RA were followed for 24 months. Joint and muscle function was measured using Signals of Functional Impairment (SOFI) index and aerobic capacity with sub-maximal test on ergometer bicycle. Pain was estimated on Visual Analogue Scale (VAS) and disease activity using 28-joint count Disease Activity Score (DAS 28). Joint and muscle function was impaired in almost all patients at inclusion and after 24 months. Male patients were more affected compared with females and the significant correlation with pain and DAS 28 decreased over time. Aerobic capacity was maintained and not influenced by sex, age or pain but related significantly to disease activity. The majority of the patients with early RA had impairments of the joint and muscle function over 24 months, even though disease activity decreased significantly. There is a need for regular evaluations of physical functions besides disease activity to prevent continuous development of functional losses.

Place, publisher, year, edition, pages
Taylor & Francis, 2007
Keywords
aerobic capacity, disease activity, impairment, joint and muscle function, pain, physical therapy
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-7561 (URN)10.1080/14038190701433274 (DOI)
Available from: 2008-01-10 Created: 2008-01-10 Last updated: 2018-06-09Bibliographically approved
2. Aerobic capacity over 16 years in patients with rheumatoid arthritis: relationship to disease activity and risk factors for cardiovascular disease
Open this publication in new window or tab >>Aerobic capacity over 16 years in patients with rheumatoid arthritis: relationship to disease activity and risk factors for cardiovascular disease
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 12, article id e0190211Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to analyse the change in aerobic capacity from disease onset of rheumatoid arthritis (RA) over 16.2 years, and its associations with disease activity and cardiovascular risk factors. Twenty-five patients (20 f/5 m), diagnosed with RA 1995-2002 were tested at disease onset and after mean 16.2 years. Parameters measured were: sub-maximal ergometer test for aerobic capacity, functional ability, self-efficacy, ESR, CRP and DAS28. At follow-up, cardiovascular risk factors were assessed as blood lipids, glucose concentrations, waist circumference, body mass index (BMI), body composition, pulse wave analysis and carotid intima-media thickness. Aerobic capacity [median (IQR)] was 32.3 (27.9-42.1) ml O2/kg x min at disease onset, and 33.2 (28.4-38.9) at follow-up (p>0.05). Baseline aerobic capacity was associated with follow-up values of: BMI (rs = -.401, p = .047), waist circumference (rs = -.498, p = .011), peripheral pulse pressure (rs = -.415, p = .039) self-efficacy (rs = .420, p = .037) and aerobic capacity (rs = .557, p = .004). In multiple regression models adjusted for baseline aerobic capacity, disease activity at baseline and over time predicted aerobic capacity at follow-up (AUC DAS28, 0-24 months; β = -.14, p = .004). At follow-up, aerobic capacity was inversely associated with blood glucose levels (rs = -.508, p = .016), BMI (rs = -.434, p = .030), body fat% (rs = -.419, p = .037), aortic pulse pressure (rs = -.405, p = .044), resting heart rate (rs = -.424, p = .034) and self-efficacy (rs = .464, p = .020) at follow-up. We conclude that the aerobic capacity was maintained over 16 years. High baseline aerobic capacity associated with favourable measures of cardiovascular risk factors at follow-up. Higher disease activity in early stages of RA predicted lower aerobic capacity after 16.2 years.

Place, publisher, year, edition, pages
Public library science, 2017
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-143932 (URN)10.1371/journal.pone.0190211 (DOI)000418651500042 ()29272303 (PubMedID)
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2018-06-09Bibliographically approved
3. Physical activity in early and long-standing RA: relations to disease activity, cardiovascular risk factors and subclinicalatherosclerosis
Open this publication in new window or tab >>Physical activity in early and long-standing RA: relations to disease activity, cardiovascular risk factors and subclinicalatherosclerosis
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: The excess risk for cardiovascular disease (CVD) in Rheumatoid Arthritis (RA), is partly attributable to traditional cardiovascular risk factors for CVD and systemic inflammation, factors known to be modified by physical activity.

Objectives: The aim of this cross-sectional study was to objectively measure and compare the level of physical activity in patients with early and long-standing RA, and to investigate its associations with disease activity, risk factors for CVD and measures of subclinical atherosclerosis.

Methods: This study included 84 patients with early and 37 with long-standing RA (disease duration, mean [SD] 1.4 [0.4] and 16.3 [2.3] years respectively). Physical activity was measured using a combined accelerometer and heart rate monitor and included total physical activity (counts /min), proportion of moderate to vigorous physical activity (MVPA) and sedentary time. Further assessments were; disease activity (Erythrocyte sedimentation rate [ESR], Disease activity score [DAS28]), functional ability (Health Assessment Questionnaire [HAQ]), risk factors for CVD (blood lipids, i.e., triglycerides, high density lipoprotein [HDL], low density protein [LDL], blood glucose, blood pressure, waist circumference, body mass index [BMI]), body fat and subclinical atherosclerosis (pulse wave velocity [PWV], augmentation index [AIx] and carotid intima-media thickness [cIMT]).

Results: Physical activity variables did not differ between patients with early and long-standing RA. Thirty- seven % of the patients with early and 43% of the patients with long-standing RA did not reach WHOs recommended levels of MVPA. Univariate linear regression analyses with the two groups combined, showed associations between total physical activity and younger age, lower values for HAQ and ESR, as well as more beneficial values for blood glucose, triglycerides, waist circumference, BMI, body fat, sleeping heart rate (SHR), systolic and diastolic blood pressure, aortic blood pressure and pulse pressure (PP), AIx, PWV, and cIMT. After adjusting each variable for age, sex, disease duration and Actiheart wear time, associations remained for all variables except triglycerides, aortic PP, PWV, AIx and cIMT. In a final regression model, the association with ESR was no longer evident. More time spent in MVPA was associated with younger age and with favourable values of blood glucose, HDL, LDL, waist circumference, SHR and PWV. After the same adjustments, associations remained for HAQ, HDL, blood glucose and SHR.

Conclusions: Physical activity behaviour was similar in patients with early and long-standing RA. Total physical activity as well as more time spent in moderate to vigorous physical activity were associated with more favourable risk factors for CVD and measures of subclinical atherosclerosis. Patients with lower functional ability were less physically active. These results stress the importance of promoting physical activity in patients with RA. 

National Category
Rheumatology and Autoimmunity
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-145633 (URN)
Available from: 2018-03-12 Created: 2018-03-12 Last updated: 2018-03-14
4. Benefits of spinning exercise on cardiovascular risk factors in rheumatoid arthritis: a pilot study
Open this publication in new window or tab >>Benefits of spinning exercise on cardiovascular risk factors in rheumatoid arthritis: a pilot study
2014 (English)In: Cardiopulmonary Physical Therapy Journal, ISSN 1541-7891, Vol. 25, no 3, p. 68-74Article in journal (Refereed) Published
Abstract [en]

Purpose: Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). Exercise is known to reduce this risk in the general population but the cardiovascular effects in patients with RA need further study. The purpose of this pilot study was to examine the effects of spinning exercise on the traditional risk factors for CVD, aerobic capacity and inflammation in patients with RA.

Methods: Thirteen subjects (12 females, 1 male; median age 57 years) attended intensive spinning sessions lasting 45 minutes, 3 times per week for 10 weeks. Measurements at baseline and at 10 and 25 weeks were aerobic capacity, pulse wave analysis with aortic and peripheral blood pressure (BP), disease activity (CRP, ESR, tender and swollen joints and global health assessment), blood lipid levels, body mass index (BMI), functional ability, and subjective diary notes. Friedman's test and the paired Wilcoxon rank sum test were used to measure changes over time. Correlation analyses were made by the Spearman rank correlation method.

Results: There were significant improvements over time in aerobic capacity, systolic BP, BMI and tender joint count (p<0.05). After 10 weeks the subjects showed significant improvements in terms of aerobic capacity (+7 ml O2/kg x min; p<0.05), systolic BP (-10.8 mm Hg; p<0.01) and tender joint count (p<0.05). After 25 weeks there was still a significant improvement in systolic BP (p<0.05) compared to baseline.

Conclusions: Intensive spinning exercise for 10 weeks induced a clinically relevant improvement in aerobic capacity and BP. No detrimental effect on disease activity was recorded.

Place, publisher, year, edition, pages
Wolters Kluwer, 2014
Keywords
aerobic capacity, exercise, blood pressure
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:umu:diva-120817 (URN)
Available from: 2016-05-23 Created: 2016-05-23 Last updated: 2019-10-24Bibliographically approved

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