title: Individualised exercise improves endothelial function in patients with rheumatoid arthritis.
abstract: BACKGROUND
  We investigated the effects of individualised combined resistance and aerobic exercise on microvascular and macrovascular function in rheumatoid arthritis (RA) patients.
  
  
  METHODS
  Forty age-matched, gender-matched and body mass index (BMI)-matched patients were allocated to either an exercise group, receiving a 6 months tailored aerobic and resistance exercise intervention, or controls receiving only information about the benefits of exercise. Participants were assessed for microvascular (acetylcholine (Ach) and sodium nitroprusside (SNP)) and macrovascular (flow-mediated dilatation (FMD) and glyceryl trinitrate (GTN)) endothelial function, maximal oxygen uptake, disease activity and severity (C-reactive protein (CRP), disease activity score 28 and health assessment questionnaire). Data were collected at baseline, 3 months and at the end of the intervention (6 months).
  
  
  RESULTS
  At baseline, demographic, anthropometric, disease-related characteristics and endothelial function parameters were similar between the exercise and control groups (p>0.05). Repeated measures analysis of variance revealed a significant improvement in endothelial function parameters at 3 (GTN: p<0.001) or 6 months (Ach: p=0.016, SNP: p=0.045, FMD: p=0.016) in the exercise but not in the control group. Generalised estimated equations detected that maximal oxygen uptake was a strong predictor for the observed changes in Ach (p=0.009) and GTN (p<0.001) whereas logCRP for SNP (p=0.017) and GTN (p=0.008).
  
  
  CONCLUSIONS
  An exercise programme designed to meet individual needs and physical abilities significantly improves microvascular and macrovascular function in parallel with disease-related characteristics in RA patients. The potential long-term beneficial effects of such interventions at reducing cardiovascular risk in these patients merit further exploration.
  
  
  BACKGROUND
  ISRCTN50861407.
authors.affiliation: School of Sport, Performing Arts & Leisure, Wolverhampton University, , Walsall, West Midlands, UK.
authors.forename: George S
authors.initials: GS
authors.lastname: Metsios
authors.forename: Antonios
authors.initials: A
authors.lastname: Stavropoulos-Kalinoglou
authors.forename: Jet J C S
authors.initials: JJ
authors.lastname: Veldhuijzen van Zanten
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.forename: Aamer
authors.initials: A
authors.lastname: Sandoo
authors.forename: Theodoros
authors.initials: T
authors.lastname: Dimitroulas
authors.forename: George D
authors.initials: GD
authors.lastname: Kitas
authors.forename: Yiannis
authors.initials: Y
authors.lastname: Koutedakis
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry / Q000379:methods; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000534:rehabilitation*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D055070:Resistance Training / Q000379:methods; D012720:Severity of Illness Index; D016037:Single-Blind Method; D014664:Vasodilation / Q000502:physiology
keywords: Cardiovascular Disease; Inflammation; Rehabilitation; Rheumatoid Arthritis