title: The relevance of performing exercise test before starting supervised physical exercise in asymptomatic cardiovascular patients with rheumatic diseases.
abstract: OBJECTIVE
  To evaluate the impact and risk factors associated with an abnormal exercise test (ET) in systemic inflammatory rheumatic disease (SIRD) patients before commencing supervised physical exercise.
  
  
  METHODS
  A total of 235 SIRD patients were enrolled in three controlled clinical trials, including 103 RA, 42 SLE and 57 AS patients. The control group consisted of 231 healthy, sedentary subjects matched for age, gender and BMI. All performed an ET, according to Bruce's or Ellestad's protocol. Cardiovascular disease risk factors, medications, comorbidities and details of each SIRD were assessed.
  
  
  RESULTS
  SIRD patients had a higher percentage of abnormal ETs compared with the control group, especially exercise hypertensive behaviour, higher oxygen consumption, higher resting heart rate and heart rate at the first minute of recovery, and chronotropic incompetence (C-Inc) (P < 0.001). The disease itself was involved with higher likelihood of having an abnormal ET [Odds ratio (OR) = 12.0, 95% CI: 2.5, 56.7; P = 0.002 for SLE; OR = 13.56, 95% CI: 6.16, 29.8; P < 0.001 for RA; and OR = 4.31, 95% CI: 1.17, 15.8; P = 0.028, for AS]. Each 10-year increment of age increased the chance of having an abnormal ET by 13% (P = 0.008) in AS patients, as well as hypertension (OR = 7.14, 95% CI: 1.61, 31.6; P = 0.01). Regarding C-Inc, age played a protective role (OR = 0.88, 95% CI: 0.78, 0.99; P = 0.043) in SLE, and ASDAS-ESR was associated with a higher risk in AS (OR = 2.73, 95% CI: 0.93, 8.0; P = 0.067).
  
  
  CONCLUSIONS
  Our results showed a higher prevalence of abnormal ETs in asymptomatic cardiovascular SIRD patients, and the disease itself was associated with a higher likelihood of having an abnormal test, emphasizing the relevance and need of performing it before starting supervised physical exercise.
authors.affiliation: Rheumatology Division, Federal University of Sao Paulo (UNIFESP/EPM).
authors.forename: Bárbara Nascimento de Carvalho
authors.initials: BN
authors.lastname: Klemz
authors.affiliation: Rheumatology Division, Federal University of Sao Paulo (UNIFESP/EPM).
authors.forename: Edgard Torres Dos
authors.initials: ET
authors.lastname: Reis-Neto
authors.affiliation: Rheumatology Division, Federal University of Sao Paulo (UNIFESP/EPM).
authors.forename: Fábio
authors.initials: F
authors.lastname: Jennings
authors.affiliation: Rheumatology Division, Federal University of Sao Paulo (UNIFESP/EPM).
authors.forename: Usmary Sardinha
authors.initials: US
authors.lastname: Siqueira
authors.affiliation: Cardiology Department, Dante Pazzanese Hospital, Sao Paulo.
authors.forename: Fábio Kadratz
authors.initials: FK
authors.lastname: Klemz
authors.affiliation: School of Dentistry, Federal University of Para (UFPA), Para, Brazil.
authors.forename: Helder Henrique Costa
authors.initials: HH
authors.lastname: Pinheiro
authors.affiliation: Rheumatology Division, Federal University of Sao Paulo (UNIFESP/EPM).
authors.forename: Emília Inoue
authors.initials: EI
authors.lastname: Sato
authors.affiliation: Rheumatology Division, Federal University of Sao Paulo (UNIFESP/EPM).
authors.forename: Jamil
authors.initials: J
authors.lastname: Natour
authors.affiliation: Rheumatology Division, Federal University of Sao Paulo (UNIFESP/EPM).
authors.forename: Vera Lúcia
authors.initials: VL
authors.lastname: Szejnfeld
authors.affiliation: Rheumatology Division, Federal University of Sao Paulo (UNIFESP/EPM) mpinheiro@uol.com.br.
authors.forename: Marcelo de Medeiros
authors.initials: MM
authors.lastname: Pinheiro
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012216:Rheumatic Diseases / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors
keywords: ankylosing spondylitis; cardiovascular; exercise; rheumatoid arthritis; systemic lupus erythematosus