The role of exercise in the management of rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with significant functional impairment and increased risk for cardiovascular disease. Along with pharmacological therapy, exercise seems to be a very promising intervention to improve disease-related outcomes, including functional ability and systemic manifestations, such as the increased cardiovascular risk. In this review, we discuss the physiological mechanisms by which exercise improves inflammation, cardiovascular risk and psychological health in patients with rheumatoid arthritis (RA) and describe in detail how exercise can be incorporated in the management of this disease using real examples from our clinical practice.

Keywords:

• arthritis
• cardiovascular disease
• exercise
• exercise as medicine
• inflammation
• physical activity
• rheumatoid arthritis

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Physical activity and/or cardiorespiratory fitness levels are alarmingly low in rheumatoid arthritis (RA) patients.

• Increased physical activity and/or exercise may have a protective cardiovascular effect in RA.

• Exercise significantly improves disease-related outcomes, including reductions in inflammation.

• Exercise may improve psychological health in RA.

• Aerobic and strengthening exercises do not exacerbate RA disease symptoms.

• Exercise prescription in RA has to be tailored to the patient’s functional limitations, performances and baseline levels of cardiorespiratory fitness.

• Interventions that aim to break barriers for non-participating in exercise are needed.

• Educational courses that improve knowledge of delivering tailored exercise programs for RA patients are currently needed.