Patients with rheumatoid arthritis (RA) are characterized by reduced physical activity and increased morbidity and mortality from cardiovascular disease (CVD). The aim of this study was to investigate associations between levels of physical activity and CVD risk profile in RA patients.
Methods
Levels of physical activity were assessed in 65 RA patients (43 females). Using the International Physical Activity Questionnaire, patients were allocated into three groups: active, moderately active and inactive. Anthropometric characteristics, RA activity/severity, multiple classical and novel CVD risk factors and 10-year CVD event probability were assessed and compared among the three groups.
Results
Significant differences were detected among groups in systolic blood pressure (P = 0.006), cholesterol (P < 0.001), low-density lipoprotein (P = 0.01), homeostasis model assessment (P = 0.001), type-1 plasminogen activator inhibitor antigen (P < 0.001), tissue-type plasminogen activator antigen (P = 0.019), homocysteine (P = 0.027), fibrinogen (P = 0.001), apolipoprotein B (P = 0.002) and von Willebrand Factor (P = 0.001), with a consistent deterioration from the physically active to the physically inactive group. Multivariate analysis of variance revealed that levels of physical activity were significantly associated with the differences in all of the above variables (P < 0.05) after adjustment for age, weight, sex, smoking status, as well as RA disease activity and severity.
SymmonsDP. Epidemiology of rheumatoid arthritis: determinants of onset, persistence and outcome. Best Pract Res Clin Rheumatol2002; 16:707–722.
2.
Stavropoulos-KalinoglouAMetsiosGSKoutedakisYNevillAMDouglasKMJamurtasARedefining overweight and obesity in rheumatoid arthritis patients. Ann Rheum Dis2007; 66:1316–1321.
3.
MetsiosGSStavropoulos-KalinoglouAPanoulasVFKoutedakisYNevillAMDouglasKMNew resting energy expenditure prediction equations for patients with rheumatoid arthritis. Rheumatology (Oxford)2008; 47:500–506.
4.
MetsiosGSStavropoulos-KalinoglouAPanoulasVFKoutedakisYKitasGD. Metabolism in patients with rheumatoid arthritis: resting energy expenditure, physical activity and diet-induced thermogenesis. Invited review. Recent Patents Endocr Metabol Immune Drug Discov2008; 2:97–102.
ReillyPACoshJAMaddisonPJRaskerJJSilmanAJ. Mortality and survival in rheumatoid arthritis: a 25 year prospective study of 100 patients. Ann Rheum Dis1990; 49:363–369.
7.
WolfeFMitchellDMSibleyJTFriesJFBlochDAWilliamsCAThe mortality of rheumatoid arthritis. Arthritis Rheum1994; 37:481–494.
8.
PanoulasVFDouglasKMMilionisHJStavropoulos-KalinglouANightingalePKitaMDPrevalence and associations of hypertension and its control in patients with rheumatoid arthritis. Rheumatology (Oxford)2007; 46:1477–1482.
9.
SitunayakeRDKitasG. Dyslipidemia and rheumatoid arthritis. Ann Rheum Dis1997; 56:341–342.
10.
DesseinPHJoffeBI. Insulin resistance and impaired beta cell function in rheumatoid arthritis. Arthritis Rheum2006; 54:2765–2775.
11.
Del RinconIDWilliamsKSternMPFreemanGLEscalanteA. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum2001; 44:2737–2745.
12.
HanssonGK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med2005; 352:1685–1695.
13.
MyersJPrakashMFroelicherVDoDPartingtonSAtwoodJE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med2002; 346:793–801.
14.
LakkaTAVenalainenJMRauramaaRSalonenRTuomilehtoJSalonenJT. Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction. N Engl J Med1994; 330:1549–1554.
15.
NodaHIsoHToyoshimaHDateCYamamotoAKikuchiSWalking and sports participation and mortality from coronary heart disease and stroke. J Am Coll Cardiol2005; 46:1761–1767.
16.
ClerouxJFeldmanRDPetrellaRJ. Lifestyle modifications to prevent and control hypertension. 4. Recommendations on physical exercise training. Canadian hypertension society, Canadian coalition for high blood pressure prevention and control, laboratory centre for disease control at health Canada, heart and stroke foundation of Canada. CMAJ1999; 160:S21–S28.
17.
SenuzunFFadilogluCBurkeLEPayzinS. Effects of home-based cardiac exercise program on the exercise tolerance, serum lipid values and self-efficacy of coronary patients. Eur J Cardiovasc Prev Rehabil2006; 13:640–645.
18.
ThompsonPDCrouseSFGoodpasterBKelleyDMoynaNPescatelloL. The acute versus the chronic response to exerciseMed Sci Sports Exerc2001; 33:S438–S445; discussion S452–S453.
19.
EkdahlCBromanG. Muscle strength, endurance, and aerobic capacity in rheumatoid arthritis: a comparative study with healthy subjects. Ann Rheum Dis1992; 51:35–40.
20.
De JongZMunnekeMZwindermanAHKroonHMRondayKHLemsWFLong term high intensity exercise and damage of small joints in rheumatoid arthritis. Ann Rheum Dis2004; 63:1399–1405.
21.
ArnettFCEdworthySMBlochDAMcShaneDJFriesJFCooperNSThe American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum1988; 31:315–324.
22.
GenuthSAlbertiKGBennettPBuseJDefronzoRKahnRFollow-up report on the diagnosis of diabetes mellitus. Diabetes Care2003; 26:3160–3167.
23.
GrundySMCleemanJIDanielsSRDonatoKAEckelRHFranklinBADiagnosis and management of the metabolic syndrome: an American Heart Association/National heart, lung, and blood institute scientific statement. Circulation2005; 112:2735–2752.
24.
WilsonPWD'AgostinoRBLevyDBelangerAMSilbershatzHKannelWB. Prediction of coronary heart disease using risk factor categories. Circulation1998; 97:1837–1847.
25.
KatzANambiSSMatherKBaronADFollmannDASullivanGQuantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab2000; 85:2402–2410.
26.
PanoulasVFMetsiosGSPaceAVJohnHTreharneGJBanksMJHypertension in rheumatoid arthritis. Rheumatology (Oxford)2008; 47:1286–1298.
27.
DhawanSSQuyyumiAA. Rheumatoid arthritis and cardiovascular disease. Curr Atheroscler Rep2008; 10:128–133.
28.
KadoglouNPIliadisFAngelopoulouNPerreaDAmpatzidisGLiapisCDThe anti-inflammatory effects of exercise training in patients with type 2 diabetes mellitus. Eur J Cardiovasc Prev Rehabil2007; 14:837–843.
29.
EvansWJ. Protein nutrition, exercise and aging. J Am Coll Nutr2004; 23:601S–609S.
30.
PoirierPDespresJP. Exercise in weight management of obesity. Cardiol Clin2001; 19:459–470.
31.
GrahamIAtarDBorch-JohnsenKBoysenGBurellGCifkovaREuropean guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur Heart J2007; 28:2375–2414.
32.
LeviMvan der PollT. Two-way interactions between inflammation and coagulation. Trends Cardiovasc Med2005; 15:254–259.
33.
LauCSMcLarenMHanslipJKerrMBelchJJ. Abnormal plasma fibrinolysis in patients with rheumatoid arthritis and impaired endothelial fibrinolytic response in those complicated by vasculitis. Ann Rheum Dis1993; 52:643–649.
34.
HerbrigKHaenselSOelschlaegelUPistroschFFoersterSPassauerJ. Endothelial dysfunction in patients with rheumatoid arthritis is associated with a reduced number and impaired function of endothelial progenitor cells. Ann Rheum Dis2006; 65:157–163.
35.
RoubenoffRDellaripaPNadeauMRAbadLWMuldoonBASelhubJAbnormal homocysteine metabolism in rheumatoid arthritis. Arthritis Rheum1997; 40:718–722.
36.
LeeKWLipGY. Effects of lifestyle on hemostasis, fibrinolysis, and platelet reactivity: a systematic review. Arch Intern Med2003; 163:2368–2392.
37.
SixtSRastanADeschSSonnabendMSchmidtASchulerGExercise training but not rosiglitazone improves endothelial function in prediabetic patients with coronary disease. Eur J Cardiovasc Prev Rehabil2008; 15:473–478.
38.
HambrechtRFiehnEWeiglCGielenSHamannCKaiserRRegular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure. Circulation1998; 98:2709–2715.
39.
JoubertLMManoreMM. Exercise, nutrition, and homocysteine. Int J Sport Nutr Exerc Metab2006; 16:341–361.
40.
CraigCLMarshallALSjostromMBaumanAEBoothMLAinsworthBEInternational physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc2003; 35:1381–1395.
41.
MetsiosGSStavropoulos-KalinoglouADouglasKMKoutedakisYNevillAMPanoulasVFBlockade of tumour necrosis factor-alpha in rheumatoid arthritis: effects on components of rheumatoid cachexia. Rheumatology (Oxford)2007; 46:1824–1827.
42.
RosemannTKuehleinTLauxGSzecsenyiJ. Factors associated with physical activity of patients with osteoarthritis of the lower limb. J Eval Clin Pract2008; 14:288–293.
43.
QuinnADoodyCO'SheaD. The effect of a physical activity education programme on physical activity, fitness, quality of life and attitudes to exercise in obese females. J Sci Med Sport2008; 11:469–472.
44.
BrodinNEureniusEJensenINisellROpavaCH. Coaching patients with early rheumatoid arthritis to healthy physical activity: a multicenter, randomized, controlled study. Arthritis Rheum2008; 59:325–331.
45.
MetsiosGSStavropoulos-KalinoglouAVeldhuijzen van ZantenJJTreharneGJPanoulasVFDouglasKMRheumatoid arthritis, cardiovascular disease and physical exercise: a systematic review. Rheumatology (Oxford)2008; 47:239–248.
46.
EureniusEStenstromCH. Physical activity, physical fitness, and general health perception among individuals with rheumatoid arthritis. Arthritis Rheum2005; 53:48–55.
47.
LeonASConnettJJacobsDRJrRauramaaR. Leisure-time physical activity levels and risk of coronary heart disease and death. The multiple risk factor intervention trial. JAMA1987; 258:2388–2395.
48.
PaffenbargerRSJrHydeRTWingALLeeIMJungDLKampertJB. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med1993; 328:538–545.
49.
KrausWEHoumardJADuschaBDKnetzgerKJWhartonMBMcCartneyJSEffects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med2002; 347:1483–1492.
