Background/Purpose:  Cardiovascular disease (CVD) is increased in rheumatoid arthritis (RA) (1). Strong evidence shows that exercise reduces the CVD risk in the general population (2). In the present study we examined the effect of group cycling on risk factors for CVD in patients with RA.

Methods: 13 subjects (12 women and 1 man, median age 57 years) with RA exercised on stationary bikes at medium to high intensity for 45 min, 3 times a week for 10 weeks. A control group of 10 subjects continued their previous activities. The following measurements were made at baseline, at 10 weeks and at 25 weeks: Aerobic capacity calculated by a sub-maximal ergometer test according to Åstrand; Visual analogue scale (VAS) for self-assessment of pain and general health;  self-assessments of functional ability, using the health assessment questionnaire (HAQ), and the number of tender and swollen joints (28-joint count). Analyses of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lipids (cholesterol, % high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides), insulin and glucose according to routine methods; Body mass index (BMI) and disease activity score (DAS 28) were calculated; Pulse wave analysis (PWA) (Arteriograph^TM) was used to register augmentation index (AIx), a measure reflecting early endothelial dysfunction shown to predict future cardiovascular events, pulse wave velocity (PWV), a proxy for arterial stiffness, and systolic blood pressure in aorta (SBPao) besides peripheral blood pressure.

Results: In the exercise group there were significant improvements at 10 weeks compared to baseline regarding aerobic capacity (33 vs 26 ml O2/kg x min; p<0.05), systolic (126 vs 137.8 mm Hg; p<0.01) and diastolic (73 vs 83.8 mm Hg, p<0.05) peripheral blood pressure, SBPao (118 vs 137.7 mm Hg; p<0.01) and tender joint count (p<0.05). The improvement of the diastolic blood pressure was significantly larger in the exercise group compared to the controls at 10 weeks (-7.0 vs +2.6 mm Hg; p<0.05). Low aerobic capacity at baseline correlated with high disease activity (ESR; r_s=-.687, p<0.01, CRP; r_s=-.727, p<0.01) and low physical function (HAQ; r_s=-.572, p<0.05) at baseline. Swollen joint count at baseline correlated with AIx at 10 weeks (r_s= .641, p<0.05). Improvements in blood pressure correlated with high physical function (HAQ) at baseline and at 10 weeks and with low disease activity (tender joints, VAS pain, CRP, DAS 28) at 10 weeks.

Conclusion: Regular exercise on stationary bikes on medium to high intensity for 10 weeks increased aerobic capacity in a group of RA-subjects and produced changes of blood pressure to a level that is described to be clinically relevant (3). Subjects also reported fewer tender joints after the exercise period.

References: (1) Wållberg-Jonsson S et al. J Rheumatol. 1997; 24: 445-51, (2) Lee IM et al. Circulation 2000;102:981-6, (3) Lewington S et al. Lancet 2002;360:1903-13

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/group-cycling-in-rheumatoid-arthritis-positive-effects-on-aerobic-capacity-and-blood-pressure/