Moderate- to high intensity aerobic and resistance exercise reduces peripheral blood regulatory cell populations in older adults with rheumatoid arthritis

Abstract

Objective Exercise can improve immune health and is beneficial for physical function in patients with rheumatoid arthritis (RA), but the immunological mechanisms are largely unknown. We evaluated the effect of moderate- to high intensity exercise with person-centred guidance on cells of the immune system, with focus on regulatory cell populations, in older adults with RA. Methods Older adults (≥65 years) with RA were randomized to either 20-weeks of moderate – to high intensity aerobic and resistance exercise (n = 24) or to an active control group performing home-based exercise of light intensity (n = 25). Aerobic capacity, muscle strength, DAS28 and CRP were evaluated. Blood samples were collected at baseline and after 20 weeks. The frequency of immune cells defined as adaptive regulatory populations, CD4 + Foxp3 + CD25 + CD127- T regulatory cells (Tregs) and CD19 + CD24hiCD38hi B regulatory cells (Bregs) as well as HLA-DR−/lowCD33 + CD11b + myeloid derived suppressor cells (MDSCs), were assessed using flow cytometry. Results After 20 weeks of moderate- to high intensity exercise, aerobic capacity and muscle strength were significantly improved but there were no significant changes in Disease Activity Score 28 (DAS28) or CRP. The frequency of Tregs and Bregs decreased significantly in the intervention group, but not in the active control group. The exercise intervention had no effect on MDSCs. The reduction in regulatory T cells in the intervention group was most pronounced in the female patients. Conclusion Moderate- to high intensity exercise in older adults with RA led to a decreased proportion of Tregs and Bregs, but that was not associated with increased disease activity or increased inflammation. Trial registration Improved Ability to Cope With Everyday Life Through a Person-centered Training Program in Elderly Patients With Rheumatoid Arthritis - PEP-walk Study, NCT02397798. Registered at ClinicalTrials.gov March 19, 2015.

Effectiveness and safety of aerobic exercise for rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials

“…Aerobic exercise interventions included bicycle riding, running on a treadmill, jogging, and walking. The control group underwent a range of usual care in 7 studies [ 33 , 34 , 36 , 38 , 39 , 41 , 44 ], motion exercises in 1 study [ 35 ], education programs in 3 studies [ 37 , 40 , 45 ] and home-based nonaerobic exercises in 2 studies [ 42 , 43 ]. (Table 1 ).…”

“…Nineteen articles were excluded: 8 articles' intervention was not aerobic exercise; 7 articles' outcome indicators did not meet the inclusion criteria; 2 articles' study type did not match; and 2 articles had incomplete data results. Thirteen RCTs were finally included [33][34][35][36][37][38][39][40][41][42][43][44][45], studying a total of 967 RA patients. The study flow diagram for the systematic search process is shown in Fig.…”

“…VO 2 max A total of 5 RCTs [36,37,[42][43][44] were included, of 247 patients (170 patients in the experimental group and 171 patients in the control group). Randomeffects model analysis results showed that the VO 2 max change of the intervention group was significantly higher than thecontrol group [MD = 2.41, 95% CI (1.36, 3.45), P < 0.00001] In addition, compared to short-term aerobic exercise, long-term aerobic exercise had a better potential improvement trend, although at a significant difference was not shown (P = 0.07) (Fig.…”

Reframing How Physical Activity Reduces The Incidence of Clinically-Diagnosed Cancers: Appraising Exercise-Induced Immuno-Modulation As An Integral Mechanism

“…Intervention studies also show inconsistent effects of exercise training on T REG cells, which may be explained by differences in phenotyping approach, exercise prescription, or patient population. For example, CD4 + CD25 + CD127 − FoxP3 + T REG cells have been shown to decrease following 20 weeks of exercise training in individuals with rheumatoid arthritis ( 204 ). In contrast, T REG cells identified via CD25 + expression on CD4 + T cells increased following 12 weeks of tai chi training ( 205 ).…”

Exercise, infection and rheumatic diseases: what do we know?

“…In terms of assessing the effects of exercise on immune parameters, the results are mixed and disappointing given the large potential to shift biomarkers in the beneficial direction (table 1). [26][27][28][29] Contributing factors include weak study designs and lack of control for numerous potential confounding factors. For example, the study by Bartlett et al 27 with 12 physically inactive adults with rheumatoid arthritis (stable, no recent medication changes) showed that 10 weeks of high-intensity interval walking training reduced disease activity and improved several measures of innate immune function.…”