LONGSTANDING EXERCISE THERAPY RESULT IN POSITIVE CLINICAL IMPLICATIONS FOR CARDIOVASCULAR HEALTH IN

Following a program of longstanding exercise (L-EX) therapy over a 52-week period indicated positive clinical implications for a unique rheumatoid arthritis (RA) subpopulation, with a likelihood that adherence to physical activity will improve cardiovascular fitness levels and potentially decrease cardiovascular risk in all RA age groups.

In general, 47-53% of the RA population have moderate to severe limitations due to high disease activity, joint damage, deformities, and comorbidities leading to severe physical limitations in function. The author stated that despite advances in pharmacological treatment, a subgroup of people with RA still experience severe limitation in physical function, including risk of cardiovascular disease (CVD) that further increases with age.

Globally, the most frequent inflammatory condition amongst the elderly is RA, with 50% of people living with RA over the age of 65. Worldwide we expect an increase in the ageing population, more specifically in the Netherlands we predict 4.9 million citizens over the age of 65 by 2040. “With this extended human lifespan, we could anticipate an increase in inflammatory conditions and associated cardiovascular disease,” said Isolde van Oostenrijk from the department of Vitality and Ageing at Leiden University.

This nationwide random control trial conducted in the Netherlands with an impartial population size (N= 189) studied the effect of L-EX on cardiovascular fitness in a unique RA subpopulation (heterogenous in age and homogenous in severe functional limitations and active disease). The author stated that L-EX significantly improved cardiovascular fitness in this RA population with severe limitations in physical function, and that all age groups could benefit from this safe and effective intervention (Change of 6MWT-distance overtime between L-EX (68 ± 66 m) and usual care (12 ± 63 m) with a mean difference of 56 (95% CI: [38 to 75]).

“This does not come as a surprise” exclaimed Ms. van Oostenrijk. “It is a well-known fact that regular physical exercise improves strength, function, aerobic fitness, and can even improve non-inflammatory complaints e.g., pain and fatigue, without further harming joints or boosting disease activity in rheumatic conditions”. EULAR (the European alliance of associations for rheumatology) and the WHO (World Health Organization) promote physical activity and exercise as safe and appropriate management tool for non-communicable conditions such as RA and CVD. Additionally, sedentary lifestyle has been connected to CVD, comorbidities, and lower fitness levels. Often 6MWT-distances below 345 meters are linked to poorer cardiovascular outcomes. The author confirmed that L-EX in this study improved 50% of the intervention group’s 6MWT-distance to above 345 meters.

“Even though we know from evidence-based research that younger adults can generate greater exercise associated physiological responses, the age trend in this study indicated that all ages can still safely benefit from exercise as non-pharmacological intervention for RA and associated cardiovascular risk,” said Ms. van Oostenrijk.