Are persons with rheumatoid arthritis deconditioned? A review of physical activity and aerobic capacity

Abstract

BackgroundAlthough the general assumption is that patients with rheumatoid arthritis (RA) have decreased levels of physical activity, no review has addressed whether this assumption is correct.MethodsOur objective was to systematically review the literature for physical activity levels and aerobic capacity (VO2max). in patients with (RA), compared to healthy controls and a reference population. Studies investigating physical activity, energy expenditure or aerobic capacity in patients with RA were included. Twelve studies met our inclusion criteria.ResultsIn one study that used doubly labeled water, the gold standard measure, physical activity energy expenditure of patients with RA was significantly decreased. Five studies examined aerobic capacity. Contradictory evidence was found that patients with RA have lower VO2max than controls, but when compared to normative values, patients scored below the 10th percentile. In general, it appears that patients with RA spend more time in light and moderate activities and less in vigorous activities than controls.ConclusionPatients with RA appear to have significantly decreased energy expenditure, very low aerobic capacity compared to normative values and spend less time in vigorous activities than controls.

Exercise as an anti-inflammatory therapy for rheumatic diseases—myokine regulation

“…9-11 One sys tematic review indicated that patients with RA have decreased energy expenditure and spend less time in vigorous activities, compared with healthy individuals. 63 We hypothesize that the physically inactive lifestyle of patients with rheumatic diseases leads to an accumula tion of visceral and ectopic fat (fat accumulated in non adipose tissue cells), which might exacerbate systemic inflammation and consequently activate a network of inflammatory pathways that promote the development of insu lin resistance, atherosclerosis and neurodegeneration, as well as a network of chronic diseases, including cardio vascular diseases (CVDs), type 2 diabetes, Alzheimer disease and other disorders belonging to the 'diseasome' of physical inactivity. 64 Whereas subcutaneous adipose tissue, particularly in lowerbody fat depots, might be protective against chronic diseases, strong evidence exists that the detrimental effects of the accumulation of vis ceral fat, and fat in the liver and in the skeletal muscle 65 might stimulate an inflammatory response.…”

Exercise prescription in the management of rheumatoid arthritis

“…18 Unemployment, possibly related to RA impairment, seems to contribute to diminished physical activity levels. 12 Furthermore, exercise restrictions, traditionally given to patients with RA because of concerns about aggravating joint inflammation and accelerating joint damage, may also contribute to inactivity and deconditioning. 19 In general, it appears that patients with RA spend more time than controls in participating in light and moderate activities, and less in vigorous activities.…”

Preserved cardiorespiratory function and NT-proBNP levels before and during exercise in patients with recent onset of rheumatoid arthritis: the clinical challenge of stratifying the patient cardiovascular risks

“…In adults, during a maximal exercise testing, VO 2 reaches a plateau at VO 2 max, and no further increase is observed with further increases in the rate of work [10]. Patients with rheumatic diseases are believed to be less physically fit and deconditioned compared to healthy individuals [22]. Together with chronic joint pain, stiffness may lead to impaired physical activity and unsatisfactory lifestyle.…”