title: Factors associated with parasympathetic activation following exercise in patients with rheumatoid arthritis: a cross-sectional study.
abstract: BACKGROUND
  Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD) with poor parasympathetic function being implicated as an underlying factor. Factors related to parasympathetic function, commonly assessed by heart rate recovery (HRR) following maximal exercise, are currently not known in RA. We aimed to explore the association between HRR with CVD risk factors, inflammatory markers, and wellbeing in patients with RA.
  
  
  METHODS
  Ninety-six RA patients (54.4 ± 12.6 years, 68 % women) completed a treadmill exercise test, during which heart rate (HR) was monitored. HRR1 and HRR2 were defined as the absolute change from HR peak to HRR 1 min post HR peak and 2 min post HR peak, respectively. Cardiorespiratory fitness, CVD risk factors, and serological markers of inflammation were measured in all patients. The Framingham Risk Score (FRS) was used as an assessment of global risk for CVD events, and wellbeing was assessed by questionnaires.
  
  
  RESULTS
  Mean HRR1 and HRR2 were 29.1 ± 13.2 bpm and 46.4 ± 15.3 bpm, respectively. CVD risk factors as well as most inflammatory markers and measures of wellbeing were inversely correlated with HRR1 and HRR2. Multivariate regression analyses revealed that 27.9 % of the variance in HRR1 and 37.9 % of the variance in HRR2 was explained collectively by CVD risk factors, measures of inflammation, and wellbeing (p = 0.009, p = 0.001 respectively), however no individual measure was independently associated with HRR1 or HRR2.
  
  
  CONCLUSIONS
  Parasympathetic activation was associated with overall CVD risk, arthritis-related burden and wellbeing in patients with RA.
  
  
  BACKGROUND
  [Exercise, cardiovascular disease and rheumatoid arthritis, ISRCTN04121489 ].
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK. axo269@bham.ac.uk.|Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK. axo269@bham.ac.uk.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Osailan
authors.affiliation: Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK.|Department of Physical Activity Exercise and Health, University of Wolverhampton, Walsall, West Midlands, UK.
authors.forename: George S
authors.initials: GS
authors.lastname: Metsios
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK.|Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK.|Department for Health, University of Bath, Bath, UK.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rouse
authors.affiliation: School of Psychology & Speech Pathology, Curtin University, Perth, Australia.
authors.forename: Nikos
authors.initials: N
authors.lastname: Ntoumanis
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
authors.forename: Joan L
authors.initials: JL
authors.lastname: Duda
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK.|Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK.|Department of Physical Activity Exercise and Health, University of Wolverhampton, Walsall, West Midlands, UK.
authors.forename: George D
authors.initials: GD
authors.lastname: Kitas
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK.|Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK.
authors.forename: Jet J C S
authors.initials: JJ
authors.lastname: Veldhuijzen van Zanten
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D015415:Biomarkers / Q000097:blood; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D015444:Exercise; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006304:Health Status; D006321:Heart / Q000294:innervation*; D006339:Heart Rate; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010275:Parasympathetic Nervous System / Q000503:physiopathology*; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators
keywords: Autonomic function; Cardiovascular risk; Exercise testing; Parasympathetic function; Rheumatoid arthritis