Elsevier

Joint Bone Spine

Volume 83, Issue 3, May 2016, Pages 265-270
Joint Bone Spine

Review
Physical activity in patients with rheumatoid arthritis

https://doi.org/10.1016/j.jbspin.2015.10.002Get rights and content

Abstract

Introduction

Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease and is associated with an excess risk of cardiovascular disease. For the general population, the World Health Organization has issued detailed recommendations on the type of physical activity appropriate for decreasing the cardiovascular risk. The objective of this work is to review available data on the effects of physical activity in patients with RA.

Results

RA is responsible for a marked decrease in physical activity. Physical activity significantly diminishes both the cardiovascular risk and the DAS 28. Vascular benefits from physical activity include improved endothelial function and slowing of the atherosclerotic process. Physical activity also has favorable effects on bone, slowing radiographic disease progression in small joints and increasing bone mineral density at the femoral neck, although these effects are not statistically significant. Finally, engaging in physical activity increases self-esteem, alleviates symptoms of depression, improves sleep quality, and decreases pain perception. Aerobic exercise is the most commonly advocated type of physical activity. Most interventions were of short duration (4 weeks) and involved aerobic activity (running or cycling) for 60 minutes a day 5 days a week. Resistance training has been shown to decrease systemic inflammation and increase muscle strength. The main obstacles to physical activity in patients with RA are related to both the patients, who lack both motivation and knowledge, and the rheumatologists, who also lack knowledge and place insufficient emphasis on promoting physical activity.

Conclusion

Physical activity provides many benefits in patients with RA and should be widely performed. Promoting physical activity should be among the objectives of therapeutic patient education for RA.

Introduction

Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease, with a prevalence in France of 0.32%. RA is associated with excess mortality due to an increased risk of cardiovascular disease [1]. Importantly, the adverse cardiovascular effect of RA is considered similar in magnitude to that of diabetes [2]. Clearly, in addition to the symptomatic management of RA, a comprehensive approach including cardiovascular risk management is crucial.

The World Health Organization (WHO) defines physical activity as “any bodily movement produced by the skeletal muscles that requires energy expenditure”. The recommendation for the general population is 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous-intensity aerobic exercise. Physical inactivity is the fourth leading risk factor for death (6% of all deaths) worldwide. Regular physical activity is recommended as a component of cardiovascular risk management in the general population. However, the latest recommendations issued by the French Society for Rheumatology (SFR) provide no clear guidance on physical activity [3].

Whereas physical activity plays a major role in the general population, few data are available on the level of physical activity appropriate for patients with RA. In 2007, the French National Authority for Health (HAS) recommended moderate- to vigorous-intensity aerobic exercise (60% to 80% of the maximal heart rate) combined with a self-exercise program for all patients with RA. In contrast, the appropriateness of dynamic or isometric muscle strengthening exercises is considered dependent on disease activity. Clearly, such exercises raise major challenges in patients with joint problems. Nevertheless, their expected benefits are non-negligible and should be explained to the patients.

The objective of this work was to review the available data on the effects of physical activity in patients with RA.

Section snippets

Methods

We searched PubMed using the key terms “motor activity”, “physical activity”, “exercise” AND “rheumatoid arthritis”. We confined our review to publications in English reporting studies performed in humans older than 18 years of age and involving physical activity as the main intervention.

Effects of rheumatoid arthritis (RA) on the level of physical activity

When seeking to assess the impact of physical activity in a population, the first step is to evaluate not only the amount but also the intensity (in metabolic equivalent of task [MET]) of physical activity performed by patients in the absence of any specific program (Table 1). This evaluation is difficult and often relies on auto-questionnaires. The WHO developed the Global Physical Activity Questionnaire (GPAQ) to allow standardized physical-activity evaluations throughout the world. In

Conclusion

The current treatment approach to patients with RA consists in a multicomponent program that not only targets medical goals, but also seeks to improve psychological health, social well-being, and participation in physical activities. The available data suggest that physical activity is beneficial and should be encouraged in patients with RA :

  • physical benefits: physical activity may diminish disease activity, improve bone mineral density at the femoral neck, slow radiographic disease progression

Disclosure of interest

The authors declare that they have no competing interest.

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