title: Cardiorespiratory fitness levels and their association with cardiovascular profile in patients with rheumatoid arthritis: a cross-sectional study.
abstract: OBJECTIVE
  The aim of this study was to investigate the association of different physical fitness levels [assessed by the maximal oxygen uptake (VO2max) test] with cardiovascular disease (CVD) risk factors in patients with RA.
  
  
  METHODS
  A total of 150 RA patients were assessed for cardiorespiratory fitness with a VO2max test and, based on this, were split in three groups using the 33rd (18.1 ml/kg/min) and 66th (22.4 ml/kg/min) centiles. Classical and novel CVD risk factors [blood pressure, body fat, insulin resistance, cholesterol, triglycerides, high-density lipoprotein (HDL), physical activity, CRP, fibrinogen and white cell count], 10-year CVD risk, disease activity (DAS28) and severity (HAQ) were assessed in all cases.
  
  
  RESULTS
  Mean VO2max for all RA patients was 20.9 (s.d. 5.7) ml/kg/min. The 10-year CVD risk (P = 0.003), systolic blood pressure (P = 0.039), HDL (P = 0.017), insulin resistance and body fat (both at P < 0.001), CRP (P = 0.005), white blood cell count (P = 0.015) and fibrinogen (P < 0.001) were significantly different between the VO2max tertiles favouring the group with the higher VO2max levels. In multivariate analyses of variance, VO2max was significantly associated with body fat (P < 0.001), HDL (P = 0.007), insulin resistance (P < 0.003) and 10-year CVD risk (P < 0.001), even after adjustment for DAS28, HAQ and physical activity.
  
  
  CONCLUSIONS
  VO2max levels are alarmingly low in RA patients. Higher levels of VO2max are associated with a better cardiovascular profile in this population. Future studies need to focus on developing effective behavioural interventions to improve cardiorespiratory fitness in RA.
authors.affiliation: Department of Physical Activity, Exercise and Health, University of Wolverhampton, Walsall, Department of Rheumatology, Dudley Group NHS Foundation Trust, Russell's Hall Hospital, Dudley, West Midlands, UK, Research Institute in Physical Performance and Rehabilitation, Centre for Research and Technology - Thessaly, Trikala, Greece and g.metsios@wlv.ac.uk.
authors.forename: George S
authors.initials: GS
authors.lastname: Metsios
authors.affiliation: Department of Physical Activity, Exercise and Health, University of Wolverhampton, Walsall, Research Institute in Physical Performance and Rehabilitation, Centre for Research and Technology - Thessaly, Trikala, Greece and.
authors.forename: Yiannis
authors.initials: Y
authors.lastname: Koutedakis
authors.affiliation: Department of Rheumatology, Dudley Group NHS Foundation Trust, Russell's Hall Hospital, Dudley, West Midlands, UK, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Jet J C S
authors.initials: JJ
authors.lastname: Veldhuijzen van Zanten
authors.affiliation: Research Institute in Physical Performance and Rehabilitation, Centre for Research and Technology - Thessaly, Trikala, Greece and.
authors.forename: Antonis
authors.initials: A
authors.lastname: Stavropoulos-Kalinoglou
authors.affiliation: Department of Physical Activity, Exercise and Health, University of Wolverhampton, Walsall.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Vitalis
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Joan L
authors.initials: JL
authors.lastname: Duda
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Nikos
authors.initials: N
authors.lastname: Ntoumanis
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rouse
authors.affiliation: Department of Rheumatology, Dudley Group NHS Foundation Trust, Russell's Hall Hospital, Dudley, West Midlands, UK, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
authors.forename: George D
authors.initials: GD
authors.lastname: Kitas
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D010809:Physical Fitness / Q000502:physiology*; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: cardiorespiratory fitness; cardiovascular disease; exercise; inflammation; physical activity; rheumatoid arthritis