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A Prescription of Aerobic Exercise for Rheumatic Disorders

EXERCISE reduces the risk of cardiovascular disease in those with rheumatic disorders. Individuals with autoimmune rheumatic diseases (ARDs), such as rheumatoid arthritis and lupus, are more likely to develop atherosclerosis and are thereby at a higher risk of a heart attack and other cardiovascular disorders. A collaboration between research groups in São Paulo, Braziland Liverpool, UKperformed a systematic review of clinical trials studying the effects of physical activity in patients with ARDs. They found that regular exercise in these patients had a clear and beneficial effect against vascular dysfunction.  

The systematic review analysed 10 studies (11 trials) with a total of 355 participants with a variety of ARDs, including spondylarthritis, rheumatoid arthritis, and lupus. The individuals had undertaken a range of physical activity (e.g., walking, strength training, cycling, or high-intensity interval training) for an average of 12 weeks. The research group performed a meta-analysis on the following three outcomes in response to physical activity intervention: macrovascular structure (aortic pulse wave velocity); microvascular function (skin blood flow, response to acetylcholine, or administration of sodium nitroprusside); and macrovascular function (brachial flow-mediated dilation or brachial responses to glyceryl trinitrate). Physical activity led to significant improvement in both the micro- and macrovascular functionhowever, there was no observed benefit of exercise on macrovascular structure.  

While there is treatment to control ARDs, such as immunosuppressants, anti-inflammatory drugs, and biologics, there is no definitive cure. “Treatment does not prevent patients from developing certain co-morbidities. Cardiovascular disease is the most worrisome,” said first author Tiago Peçanha, University of São Paulo Medical School“The risk of heart attack is twice as high for people with rheumatoid arthritis as for healthy people. For people with lupus or psoriatic arthritis, the incidence of ischaemic events is between twice and five times as high.” 

This analysis provides insight into how improvement in vascular function can be tackled in rheumatic patients. However, the small number of studies reviewed calls for further analysis“This area is still new, so more research is needed to identify the best exercise protocols and investigate such aspects as safety and adherence,” Peçanha commented. “In any event, the data in our study underlines the importance of regular exercise to prevent and treat cardiovascular disease in these patients.” 

Provisionally, Peçanha recommends at least 150 minutes of moderatetovigorous exercise per week, predominantly aerobic along with activities that improve balance and strength.