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

Tjerk Munsterman, Tim Takken, Harriet Wittink, Tjerk Munsterman, Tim Takken, Harriet Wittink

Abstract

Background: Although 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.

Methods: Our 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.

Results: In 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.

Conclusion: Patients 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.

Figures

Figure 1
Figure 1
Flow chart literature search.

References

    1. Plasqui G. The role of physical activity in rheumatoid arthritis. Physiol Behav. 2008;94:270–275. doi: 10.1016/j.physbeh.2007.12.012.
    1. van der Heijde D. Impact of rheumatoid arthritis on physical function during the first five years. No longer a question mark? Rheumatology (UK) 2000;39:579–580. doi: 10.1093/rheumatology/39.6.579.
    1. Peters MJ, Symmons DP, McCarey D, Dijkmans BA, Nicola P, Kvien TK. et al.EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2010;69:325–331. doi: 10.1136/ard.2009.113696.
    1. Turesson C, Jacobsson LT, Matteson EL. Cardiovascular co-morbidity in rheumatic diseases. Vasc Health Risk Manag. 2008;4:605–614.
    1. Mayoux-Benhamou A, Giraudet-Le Quintrec JS, Ravaud P, Champion K, Dernis E, Zerkak D. et al.Influence of patient education on exercise compliance in rheumatoid arthritis: a prospective 12-month randomized controlled trial. J Rheumatol. 2008;35:216–223.
    1. Giles JT, Bartlett SJ, Andersen RE, Fontaine KR, Bathon JM. Association of body composition with disability in rheumatoid arthritis: impact of appendicular fat and lean tissue mass. Arthritis Rheum. 2008;59:1407–1415. doi: 10.1002/art.24109.
    1. Elkan AC, Hakansson N, Frostegard J, Cederholm T, Hafstrom I. Rheumatoid cachexia is associated with dyslipidemia and low levels of atheroprotective natural antibodies against phosphorylcholine but not with dietary fat in patients with rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther. 2009;11:R37. doi: 10.1186/ar2643.
    1. Metsios GS, Stavropoulos-Kalinoglou A, Sandoo A, van Zanten JJ, Toms TE, John H. et al.Vascular function and inflammation in rheumatoid arthritis: the role of physical activity. Open Cardiovasc Med J. 2010;4:89–96.
    1. Elkan AC, Hakansson N, Frostegard J, Hafstrom I. Low level of physical activity in women with rheumatoid arthritis is associated with cardiovascular risk factors but not with body fat mass - a cross sectional study. BMC Musculoskelet Disord. 2011;12:13. doi: 10.1186/1471-2474-12-13.
    1. Metsios GS, Stavropoulos-Kalinoglou A, Panoulas VF, Wilson M, Nevill AM, Koutedakis Y. et al.Association of physical inactivity with increased cardiovascular risk in patients with rheumatoid arthritis. Eur J Cardiovasc Prev Rehabil. 2009;16:188–194. doi: 10.1097/HJR.0b013e3283271ceb.
    1. Baillet A, Zeboulon N, Gossec L, Combescure C, Bodin LA, Juvin R. et al.Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken ) 2010;62:984–992. doi: 10.1002/acr.20146.
    1. Eurenius E, Stenstrom CH. Physical activity, physical fitness, and general health perception among individuals with rheumatoid arthritis. Arthritis Rheum. 2005;53:48–55. doi: 10.1002/art.20924.
    1. van den Berg MH, de Boer I, le CS, Breedveld FC, Vliet Vlieland TP. Are patients with rheumatoid arthritis less physically active than the general population? J Clin Rheumatol. 2007;13:181–186. doi: 10.1097/RHU.0b013e318124a8c4.
    1. Mancuso CA, Rincon M, Sayles W, Paget SA. Comparison of energy expenditure from lifestyle physical activities between patients with rheumatoid arthritis and healthy controls. Arthritis Rheum. 2007;57:672–678. doi: 10.1002/art.22689.
    1. Sokka T, Hakkinen A, Kautiainen H, Maillefert JF, Toloza S, Mork HT. et al.Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Rheum. 2008;59:42–50. doi: 10.1002/art.23255.
    1. Tierney M, Fraser A, Kennedy N. Physical Activity in Rheumatoid Arthritis: A Systematic Review. J Phys Act Health. 2011.
    1. Chang CL, Chiu CM, Hung SY, Lee SH, Lee CS, Huang CM. et al.The relationship between quality of life and aerobic fitness in patients with rheumatoid arthritis. Clin Rheumatol. 2009;28:685–691. doi: 10.1007/s10067-009-1132-0.
    1. Gibbons RJ, Balady GJ, Beasley JW, FAAFP JW, Bricker JT, Duvernoy WFC. et al.ACC/AHA Guidelines for Exercise Testing: Executive Summary: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing) Circulation. 1997;96:345–354. doi: 10.1161/01.CIR.96.1.345.
    1. Deeks JJ, Dinnes J, D'Amico R, Sowden AJ, Sakarovitch C, Song F. Evaluating non-randomised intervention studies. Health Technol Assess. 2003;7
    1. Mallen C, Peat G, Croft P. Quality assessment of observational studies is not commonplace in systematic reviews. J Clin Epidemiol. 2006;59:765–769. doi: 10.1016/j.jclinepi.2005.12.010.
    1. West S, King V, Carey TS, Lohr KN, McKoy N, Sutton SF, Systems to rate the strength of scientific evidence. Evid Rep Technol Assess (Summ ) 2002. pp. 1–11.
    1. de Carvalho MR, Tebexreni AS, Salles CA, Barros NT, Natour J. Oxygen uptake during walking in patients with rheumatoid arthritis–a controlled study. J Rheumatol. 2004;31:655–662.
    1. Hakkinen A, Haanonan P, Nyman K, Hakkinen K. Aerobic and neuromuscular performance capacity of physically active females with early or long-term rheumatoid arthritis compared to matched healthy women. Scand J Rheumatol. 2002;31:345–350. doi: 10.1080/030097402320817068.
    1. Kurtais Y, Tur BS, Elhan AH, Erdogan MF, Yalcin P. Hypothalamic-pituitary-adrenal hormonal responses to exercise stress test in patients with rheumatoid arthritis compared to healthy controls. J Rheumatol. 2006;33:1530–1537.
    1. Rall LC, Meydani SN, Kehayias JJ, wson-Hughes B, Roubenoff R. The effect of progressive resistance training in rheumatoid arthritis. Increased strength without changes in energy balance or body composition. Arthritis Rheum. 1996;39:415–426. doi: 10.1002/art.1780390309.
    1. Roubenoff R, Roubenoff RA, Cannon JG, Kehayias JJ, Zhuang H, wson-Hughes B. et al.Rheumatoid cachexia: cytokine-driven hypermetabolism accompanying reduced body cell mass in chronic inflammation. J Clin Invest. 1994;93:2379–2386. doi: 10.1172/JCI117244.
    1. Roubenoff R, Walsmith J, Lundgren N, Snydman L, Dolnikowski GJ, Roberts S. Low physical activity reduces total energy expenditure in women with rheumatoid arthritis: implications for dietary intake recommendations. American Journal of Clinical Nutrition. 2002;76:774–779.
    1. Ekdahl C, Broman G. Muscle strength, endurance, and aerobic capacity in rheumatoid arthritis: a comparative study with healthy subjects. Ann Rheum Dis. 1992;51:35–40. doi: 10.1136/ard.51.1.35.
    1. Lemmey A, Maddison P, Breslin A, Cassar P, Hasso N, McCann R. et al.Association between insulin-like growth factor status and physical activity levels in rheumatoid arthritis. J Rheumatol. 2001;28:29–34.
    1. MacKinnon JR, Miller WC. Rheumatoid Arthritis and Self Esteem: The Impact of Quality Occupation. J Occupational Sc. 2003;10:90–98. doi: 10.1080/14427591.2003.9686515.
    1. Tourinho TF, Capp E, Brenol JC, Stein A. Physical activity prevents bone loss in premenopausal women with rheumatoid arthritis: A cohort study. Rheumatol Int. 2008;28:1001–1007. doi: 10.1007/s00296-008-0554-3.
    1. Arnett FC, Hunder GG. et al.The American Rheumatism Associatio 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis & Rheum. 1988;31:315–324. doi: 10.1002/art.1780310302.
    1. Hochberg MC, Chang RW, Dwosh I, Lindsey S, Pincus T, Wolfe F. The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis. Arthritis Rheum. 1992;35:498–502. doi: 10.1002/art.1780350502.
    1. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100:126–131.
    1. McArdle WD, Katch FI, Katch VL. Exercise physiology, sixth edition edn. Williams & Wilkins, Lippincott; 2007.
    1. Pols MA, Peeters PH, Kemper HC, Grobbee DE. Methodological aspects of physical activity assessment in epidemiological studies. Eur J Epidemiol. 1998;14:63–70. doi: 10.1023/A:1007427831179.
    1. Takken T, Hemel A, van der NJ, Helders PJ. Aerobic fitness in children with juvenile idiopathic arthritis: a systematic review. J Rheumatol. 2002;29:2643–2647.
    1. Lelieveld OT, van BM, Takken T, van WE, Van Leeuwen MA, Armbrust W. Aerobic and anaerobic exercise capacity in adolescents with juvenile idiopathic arthritis. Arthritis Rheum. 2007;57:898–904. doi: 10.1002/art.22897.
    1. van Brussel M, Lelieveld OT, van der Net J, Engelbert RH, Helders PJ, Takken T. Aerobic and anaerobic exercise capacity in children with juvenile idiopathic arthritis. Arthritis Rheum. 2007;57:891–897. doi: 10.1002/art.22893.
    1. Poole DC, Wilkerson DP, Jones AM. Validity of criteria for establishing maximal O2 uptake during ramp exercise tests. Eur J Appl Physiol. 2008;102:403–410. doi: 10.1007/s00421-007-0596-3.
    1. Robergs RA, Landwehr R. The surprising history of the "HRmax=220-age" equation. JEPonline. 2002;5
    1. Portney LG, Watkins MP. foundations of clinical research, applications to practice, second edition edn. Health, Prentice Hall; 2000.
    1. Piha SJ, Voipio-Pulkki LM. Elevated resting heart rate in rheumatoid arthritis: possible role of physical deconditioning. Br J Rheumatol. 1993;32:212–215. doi: 10.1093/rheumatology/32.3.212.
    1. Ebbeling CB, Ward A, Puleo EM, Widrick J, Rippe JM. Development of a single-stage submaximal treadmill walking test. Med Sci Sports Exerc. 1991;23:966–973.
    1. Minor MA, Johnson JC. Reliability and validity of a submaximal treadmill test to estimate aerobic capacity in women with rheumatic disease. J Rheumatol. 1996;23:1517–1523.
    1. Metsios GS, Stavropoulos-Kalinoglou A, Douglas KM, Koutedakis Y, Nevill AM, Panoulas VF. et al.Blockade of tumour necrosis factor-alpha in rheumatoid arthritis: effects on components of rheumatoid cachexia. Rheumatology (Oxford) 2007;46:1824–1827. doi: 10.1093/rheumatology/kem291.
    1. Byrne NM, Hills AP, Hunter GR, Weinsier RL, Schutz Y. Metabolic equivalent: one size does not fit all. J Appl Physiol. 2005;99:1112–1119. doi: 10.1152/japplphysiol.00023.2004.
    1. Geuskens GA, Burdorf A, Hazes JM. Consequences of rheumatoid arthritis for performance of social roles–a literature review. J Rheumatol. 2007;34:1248–1260.
    1. Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, Van den Ende EC. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev. 2009. p. CD006853.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe