Moderate-to-high intensity exercise with person-centered guidance influences fatigue in older adults with rheumatoid arthritis

Kucharski, D.; Lange, Elvira; Ross, Alastair B.; Svedlund, Sara; Feldthusen, Caroline; Önnheim, Karin; Mannerkorpi, Kaisa; Gjertsson, Inger

doi:10.1007/s00296-019-04384-8

Cited by 28 publications

(24 citation statements)

References 47 publications

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“…24,30) It induces IL-10-mediated anti-inflammatory response and IL-1ß inhibition. [23][24] This study confirmed the results of previous studies.…”

Section: Discussionsupporting

confidence: 92%

“…20) According to a study by the Diabetes Prevention Program (DPP), physical activity and weight loss interventions can reduce the risk of diabetes by 58%. [21][22][23] Physical activity and glycemic control may be beneficial in the inhibition of RA progression as well as in the reduction of its prevalence in patients with prediabetes. 24) However, T. Yates study reported that intensive physical intervention or previous physical activity level did not significantly reduce 2-h post prandial or fasting blood glucose levels 25) in adults with prediabetes and the expression of inflammatory markers 14) in patients with either RA or prediabetes.…”

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confidence: 99%

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Physical Activity and Prevalence of Rheumatoid Arthritis in Korean Adults with Prediabetes in the 2009-2013 National Health Cohort Study

Sin

2019

Korean J Clin Pharm

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Prevalence of rheumatoid arthritis (RA) in patients with type2 diabetes mellitus (T2DM) and prediabetes was known to be higher than that of general population, 1-5) further increasing its risk for disease prevalence among adults with advanced age, 6-7) long disease duration, 6-7) and poor glycemic control. 1-2) RA is an autoimmune disease that causes chronic inflammation in the area surrounding musculoskeletal or synovial joints and connective tissues. 1-3,7-8) T2DM is significantly associated with bone, cartilage, ligament, and tendon damage. 2-3) RA development results from a multifactorial interaction of genes and the environment, including the abnormal response of anti-citrullinated protein antibodies (ACPAs) to antigens. These interactions result in synovial inflammation, bone, cartilage, and tissue damage, composed of pro-inflammatory cytokines. 4-5,8-9) Pro-inflammatory cytokines 5,9) such as interferongamma (IFN-γ), interleukin (IL)-1ß, IL-2, IL-5, IL-7, IL-8, and TNF-α, granulocyte macrophage-colony stimulating factor (GM-CSF), are also known to be high in overweight patients with prediabetes. [4][5]9) With biological pharmacotherapies, modifiable behavior such as physical activity has been shown to induce the antiinflammatory myokine IL-6, 10) which induces the release of ABSTRACT Background: Rheumatoid arthritis is highly prevalent in overweight patients with type 2 diabetes mellitus and can be reduced by physical activity via altered proinflammatory parameters. However, the association between the frequency of physical activity and the prevalence of rheumatoid arthritis in prediabetic patients remains unclear and was evaluated in this study. Methods: Utilizing the Korean National Health Insurance Sharing Service database, 58,391 adults, who met the research criteria and underwent a general medical check-up between 2009 and 2013, were selected for this study. To analyze the data, a logistic regression with a proc survey logistic procedure was used. Results: The study revealed that the cumulative rheumatoid arthritis prevalence was lower in prediabetic patients compared to that in the control group (OR, 0.64; 95% CI, 0.483-0.840; p=0.001). More frequent physical activity (>3 days/week) was significantly associated with a reduced rheumatoid arthritis prevalence in both groups (OR, 0.28; 95% CI, 0.039-0.521; p=0.044 vs. OR, 0.15; 95% CI, 0.063-0.237; p=0.007). Additionally, a 3.8-fold higher risk of rheumatoid arthritis development was observed in prediabetic adults with less frequent baseline physical activity (≤2 days/week). Overall, in prediabetes, the prevalence of rheumatoid arthritis was associated with the frequency of physical activity and not with the fasting plasma glucose levels. Conclusion: More frequent physical activity is associated with a low risk of developing rheumatoid arthritis in prediabetic patients. Thus, further studies are needed to confirm the clinical outcomes of frequent physical activity in rheumatoid arthritis prevention and control.

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“…24,30) It induces IL-10-mediated anti-inflammatory response and IL-1ß inhibition. [23][24] This study confirmed the results of previous studies.…”

Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Physical Activity and Prevalence of Rheumatoid Arthritis in Korean Adults with Prediabetes in the 2009-2013 National Health Cohort Study

Sin

2019

Korean J Clin Pharm

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“…However, the ESR increased in both groups, which is to be expected with increased age [28]. Exercise is known to possibly slow down the aging of the immune system and diminish the effects of "inflamaging" [29][30][31] but neither in this 4 year follow-up study nor directly after the intervention were any changes of inflammatory markers found [32]. Of all participants 21.3% reported maintained healthenhancing physical activity (including both aerobic and resistance training) for the last 6 months before inclusion in the present study.…”

Section: Discussionmentioning

confidence: 60%

“…For every rated mm (0-100) on VAS fatigue the chance of increasing physical activity over 4 years only decreased by 4%, but with clinically relevant fatigue being defined as VAS > 20 [61], a participant presenting a clinically relevant fatigue at baseline could be considered to be at 56% less chance of increasing LTPAI over 4 years. However, this cohort only showed limited fatigue at baseline and the intervention was found to reduce fatigue [32].…”

Section: Discussionmentioning

confidence: 75%

Long-time follow up of physical activity level among older adults with rheumatoid arthritis

Lange

Gjertsson

Mannerkorpi

2020

Eur Rev Aging Phys Act

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Background: Physical activity and exercise are acknowledged as important parts in the management of rheumatoid arthritis (RA). However, long-term maintenance of exercise is known to be difficult. The aim of this study was to evaluate change in physical activity and physical fitness after four years in older adults with RA who had previously participated in exercise with person-centred guidance compared to controls. Method: A follow-up study was performed where older adults (> 65 years) who had participated in a randomized controlled trial where they were allocated to either exercise with person-centred guidance or home-based, lightintensity exercise (controls) were invited to one visit and assessed with performance-based test, blood-sampling and self-reported questionnaires. Forty-seven out of 70 older adults accepted participation, 24 from the exercise group and 23 from the control group. Comparisons of the result with baseline values were performed and explanatory factors for increase of physical activity were examined with logistic regression. Results: The result show that there was no significant difference in weekly hours of physical activity when groups where compared. However, participants in the exercise group rated significantly increased weekly hours of physical activity after four years (p = 0.004) when compared to baseline. Higher levels of fatigue, BMI and physical activity, at baseline were negatively associated with increased physical activity after four years. There was no significant difference in change of physical fitness between the groups. Within group analysis showed that the control group reported increased pain (p = 0.035), fatigue (p = 0.023) increased number of tender joints (p = 0.028) higher disease activity (p = 0.007) and worsening of global health (p = 0.004) when compared to baseline while the exercise group remained at the same level as at baseline. Conclusion: These results indicate that introducing moderate-to high intensity exercise with person-centred guidance might favor increased physical activity after four years in older adults with RA. Previous partaking in moderate-to high intensity exercise might also be protective against increased disease activity, pain and fatigue over time.

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“…It promotes acute release of anti-inflammatory myokines from skeletal muscle and causes reduction of visceral fat releasing pro-inflammatory adipokines [13,14] thereby it reduces the chronic low-grade inflammation known as inflamm-aging [12]. We have shown that older adults (≥65 years) with RA improve significantly with respect to aerobic capacity and muscle strength, fatigue and patient's global impression of change (PGIC) [15,16] after 20 weeks of moderate-to high intensity aerobic and resistance exercise with personcentred guidance [15].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Moderate-to-high intensity exercise with person-centered guidance influences fatigue in older adults with rheumatoid arthritis

Cited by 28 publications

References 47 publications

Physical Activity and Prevalence of Rheumatoid Arthritis in Korean Adults with Prediabetes in the 2009-2013 National Health Cohort Study

Physical Activity and Prevalence of Rheumatoid Arthritis in Korean Adults with Prediabetes in the 2009-2013 National Health Cohort Study

Long-time follow up of physical activity level among older adults with rheumatoid arthritis

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

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