title: The practice of physical activity and cryotherapy in rheumatoid arthritis: systematic review.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) is an autoimmune, chronic and inflammatory disease, which the affected patients present a higher cardiovascular mortality rate. Physical activities have been identified as the most important strategy to prevent cardiovascular diseases. However, the articular damage and the chronic pain caused by RA challenges its regular practice. Moreover, persons with RA tend to avoid PA due to the fear of exacerbating the inflammatory potential and pain. One alternative to avoid the collateral effects of the PA could be the cryotherapy. Therefore, this study aimed to review studies focused on the use of both PA and cryotherapy in RA patients and to identify evidences that both therapies could be combined in order to optimize the symptomatic treatment.
  
  
  METHODS
  Four databases (MEDLINE, CINAHL, Elsevier and PEDro) were searched to identify publications regarding RA patients, PA and cryotherapy intervention by the terms and operators (rheumatoid arthritis AND exercise OR physical activity OR activity OR training OR reconditioning OR cryotherapy OR cold OR immersion). The selected studies should at least present one measure of the aerobic capacity, disease activity or pain relief. Among 19 studies with RA patients identified, only 4 studies used PA combined with cryotherapy. The other 13 studies used physical activities and 2 studies used cryotherapy intervention.
  
  
  RESULTS
  The results of the physical activities combined with cryotherapy studies showed an improvement in the disease activity and pain relief, however without details of the physical activities intervention and an aerobic capacity. Among the physical activities studies, evidence was found suggesting that aerobic exercises and multiactivity exercises with high intensity are the more effective for improve the aerobic capacity.
  
  
  CONCLUSIONS
  Even if few studies on cryotherapy were found, there are enough evidences in the literature that demonstrate the benefits of this intervention on pain relief and disease activity. In summary, neither study found associated physical activities to improve aerobic capacity with cryotherapy to improve disease activity and pain relief. This may be an innovative therapeutic strategy to improve the aerobic capacity in arthritis patients and consequently reduce their cardiovascular risk while minimizing pain and disease activity.
authors.affiliation: PEPITE EA4267 (Exercise Performance Health Innovation - EPHI) University of Bourgogne Franche-Comté, Besançon, France - daniele.peres@univ-fcomte.fr.
authors.forename: Daniele
authors.initials: D
authors.lastname: Peres
authors.affiliation: Laboratory of the Clinic Functional Exploration of the Movement (LEFCM), CHRU Besançon, Besançon, France.|Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Sagawa
authors.affiliation: Faculty of Sport Sciences, University of Poitiers, Laboratory &quot;Mobility, Aging and Exercise (MOVE)&quot;, Poitiers, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Dugué
authors.affiliation: Center of the Sciences in the Health and Sport - CEFID, University of the Santa Catarina State Florianópolis, Santa Catarina, Brazil.
authors.forename: Susana C
authors.initials: SC
authors.lastname: Domenech
authors.affiliation: PEPITE EA4267 (Exercise Performance Health Innovation - EPHI) University of Bourgogne Franche-Comté, Besançon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Tordi
authors.affiliation: PEPITE EA4267 (Exercise Performance Health Innovation - EPHI) University of Bourgogne Franche-Comté, Besançon, France.|Department of Rheumatology, CHRU Besançon, Besançon, France.
authors.forename: Clement
authors.initials: C
authors.lastname: Prati
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000534:rehabilitation*; D016022:Case-Control Studies; D017679:Cryotherapy / Q000379:methods*; D004185:Disability Evaluation; D019317:Evidence-Based Medicine; D015444:Exercise / Q000502:physiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome