ReviewPhysical activity in patients with rheumatoid arthritis
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 :
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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.
References (60)
- et al.
Cardiovascular risk in rheumatoid arthritis
Joint Bone Spine
(2014) - et al.
Recommendations of the French Society for Rheumatology for managing rheumatoid arthritis
Joint Bone Spine
(2014) - et al.
Low physical activity reduces total energy expenditure in women with rheumatoid arthritis: implications for dietary intake recommendations
Am J Clin Nutr
(2002) - et al.
Is dynamic exercise beneficial in patients with rheumatoid arthritis?
Joint Bone Spine
(2008) - et al.
Endothelial dysfunction in joint disease
Joint Bone Spine
(2014) - et al.
Exploratory analysis of the relationships between aerobic capacity and self-reported fatigue in patients with rheumatoid arthritis, polymyositis, and chronic fatigue syndrome
PM R
(2009) - et al.
Association of functional status with changes in physical activity: insights from a behavioral intervention for participants with arthritis
Arch Phys Med Rehabil
(2012) - et al.
Therapeutic patient education: from infantilization to critical thinking
Joint Bone Spine
(2015) - et al.
Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies
Arthritis Rheum
(2008) - et al.
Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study
Arthritis Rheum
(2008)
The clinical utility of accelerometry in patients with rheumatoid arthritis
Rheumatology
Physical activity measured by the SenseWear Armband in women with rheumatoid arthritis
Phys Ther
Study to determine the criterion validity of the SenseWear Armband as a measure of physical activity in people with rheumatoid arthritis
Arthritis Care Res
Physical activity and energy expenditure in rheumatoid arthritis patients and matched controls
Rheumatology
Are patients with rheumatoid arthritis less physically active than the general population?
J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis
Comparison of energy expenditure from lifestyle physical activities between patients with rheumatoid arthritis and healthy controls
Arthritis Rheum
Low aerobic capacity and physical activity not associated with fatigue in patients with rheumatoid arthritis: a cross-sectional study
J Rehabil Med
Disease activity and low physical activity associate with number of hospital admissions and length of hospitalisation in patients with rheumatoid arthritis
Arthritis Res Ther
Association of physical inactivity with increased cardiovascular risk in patients with rheumatoid arthritis
Eur J Cardiovasc Prev Rehabil
Public health impact of risk factors for physical inactivity in adults with rheumatoid arthritis
Arthritis Care Res
Exploring the public health impact of an intensive exercise program for patients with rheumatoid arthritis: a dissemination and implementation study
Arthritis Care Res
Patients with regular physical activity before onset of rheumatoid arthritis present with milder disease
Ann Rheum Dis
Blood transfusion, alcohol use, and anthropometric risk factors for rheumatoid arthritis in older women
J Rheumatol
Physical activity and risk of rheumatoid arthritis in women: a population-based prospective study
Arthritis Res Ther
Individualised exercise improves endothelial function in patients with rheumatoid arthritis
Ann Rheum Dis
Vascular function and inflammation in rheumatoid arthritis: the role of physical activity
Open Cardiovasc Med J
Physical inactivity and arterial dysfunction in patients with rheumatoid arthritis
Scand J Rheumatol
Effect of exercise on cardiac autonomic function in females with rheumatoid arthritis
Clin Rheumatol
Long term high intensity exercise and damage of small joints in rheumatoid arthritis
Ann Rheum Dis
Effect of a high-intensity weight-bearing exercise program on radiologic damage progression of the large joints in subgroups of patients with rheumatoid arthritis
Arthritis Rheum
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