Effects of exerc

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Rece ved / Gel ş: 31.07.2020 · Accepted / Kabul: 22.08.2020 · Publ shed / Yayın Tar h : 10.11.2020

Correspondence / Yazışma: Iván Chulv Medrano · Department of Phys cal Act v ty and Sports, Un vers ty of Valenc a, Valenc a, Spa n · van.chulv @uv.es C te th s art cle as: Alonso-Aubin DA, Chulvi-Medrano I, Picón-Martínez M, Metsios GS. Effects of exercise on life quality in a rheumatoid arthritis patient. Turk J Sports Med.

2021;56(1).48-50.; http://dx.doi.org/10.47447/tjsm.0482

Spor Hek ml ğ Derg s , 56(1):48-50; 2021 Turk sh Journal of Sports Med c ne Turk J Sports Med. DOI: 10.47447/tjsm.0482

Case Report / Olgu Sunumu

Effects of exerc se on l fe qual ty n a rheumato d arthr t s pat ent B r romato d artr t hastasında egzers z n yaşam kal tes üzer ne etk ler

D ego Alexandre Alonso-Aub n¹ , Iván Chulv -Medrano² , Mo sés P cón-Mart nez³ , George S Mets os⁴

1W ngsport, Sc ence and Academy, Torrejon De Ardoz, Spa n 2Department of Phys cal Act v ty and Sports, Un vers ty of Valenc a, Valenc a, Spa n 3Department of General and Spec f c D dact cs, Un vers ty of Al cante, Al cante, Spa n 4Faculty of Health Educat on and Wellbe ng, Un vers ty of Wolverhampton, Wolverhampton, Un ted K ngdom

ABSTRACT

Rheumatoid arthritis (RA) is a chronic-degenerative disease characterized by symptoms that signiﬁcantly impact on the functional capacity and thus, the ability to carry out daily functional activities reducing the quality of life (QoL). The aim was to evaluate the effects of a strength and conditioning (S&C) program on the quality of life (QoL), the self-perception disease impact, the self-fatigue perception and cardiovascular risk factors in a patient with rheumatoid arthritis (RA) and cardiovascular disease (CVD).

34-year-old woman (height: 1.40m; weight: 36.1kg) diagnosed with RA and CVD underwent a six-month S&C program with aerobic training 2-3 times a week in 1-3 sets of 5-15 minutes at a moderate to vigorous intensity on a treadmill and/or outdoors and resistance training performed 2-3 times a week in different days from aerobic training, in 1-3 sets of 10-15 repetitions at 5-8 RPE intensity following Borg Scale.

Positive improvement in the total QoL score (52,71 points vs 62,50 points), self-perception disease impact (1,73 points vs 3,72 points), self-fatigue perception with 24,4% for waking up (45 to 56 points) and 51,8% after training session (28 to 54 points) and CVD risk factors; cholesterol (pre:324;

inter:215; post:228mg/dl), triglycerides (pre:98; inter:77; post:70 mg/dl), LDL (pre:239; inter:132; post:141 mg/dl), HDL (pre:64.7; inter:67.9;

post:72.2 mg/dl) and glucose (pre:99; inter:72; post:72 mg/dl). A S&C program could be a useful tool for the QoL improvement in RA patients.

Keywords: Exercise, cardiovascular risk factors; osteoarthritis, resistance training ÖZ

Romatoid artrit (RA), fonksiyonel kapasiteyi ve dolayısıyla yaşam kalitesini (QoL) düşüren günlük fonksiyonel aktiviteleri gerçekleştirme becerisini önemli ölçüde etkileyen semptomlarla karakterize kronik-dejeneratif bir hastalıktır. Bu olgu sunumunun amacı romatoid artrit (RA) ile birlikte kardiyovasküler hastalığı (KVH) da olan bir hastada kuvvet ve kondisyon (K&K) programının yaşam kalitesi (QoL), algılanan hastalık etkisi, yorgunluk algısı ve kardiyo‐

vasküler risk faktörleri açısından etkilerini değerlendirmekti.

RA ve KVH tanısı konulan 34 yaşındaki kadın hasta (boy: 1.40m; ağırlık: 36.1kg) haftada 2-3 kez 1-3 set 5-15 dakikalık aerobik antrenmanla birlikte altı aylık bir kuvvet ve kondisyon (K&K) programına tabi tutuldu. Koşu bandında ve/veya açık havada orta ila şiddetli yoğunluktaki aerobik egzersize ek ola‐

rak Borg Ölçeği’ne göre 5-8 RPE yoğunluğunda 1-3 set 10-15 tekrarlı direnç egzersizleri aerobik eğitimden farklı günlerde olmak üzere, haftada 2-3 kez gerçekleştirildi.

Toplam QoL skorunda (52,71 puana karşılık 62,50 puan) olumlu iyileşme, hastalığı algılama etkisinde (1,73 puan ve 3,72 puan) ve yorgunluk algısında sabah uyandığında %24,4 (45 ve 56 puan), eğitimden sonra ise %51,8 (28 ve 54 puan) iyileşme, KVH risk faktörleri açısından; kan kolesterol (ilk: 324;

ara: 215; son: 228 mg / dl), trigliserid (ilk:98; ara:77; son:70 mg/dl), LDL (ilk:239; ara:132; son:141 mg/dl), HDL (ilk:64.7; ara:67.9; son:72.2 mg/dl) ve glikoz (ilk:99; ara:72; son:72 mg/dl) değerlerinde olumlu iyileşmeler görüldü. K&K programı, RA hastalarında yaşam kalitesini iyileştirmek için yararlı bir araç olabilir.

Anahtar Sözcükler: Egzersiz, kardiyovasküler risk faktörleri, osteoartrit, direnç egzersizi

INTRODUCTION

Rheumato d arthr t s (RA) s a chron c-degenerat ve d sease character zed by symptoms that s gn f cantly mpact on the funct onal capac ty (1) and thus, the ab l ty to carry out da- ly funct onal act v t es reduc ng the qual ty of l fe (QoL) (2).

RA s also accompan ed by system c man festat ons, w th one the most mportant be ng card ovascular d sease (CVD) (3,4). Collect ve ev dence reveals that exerc se can amel - orate – at the same t me – both RA and CVD related man -

festat ons (5). However, no reports ex st to date w th re- gards to the e ects of exerc se on RA pat ents that also have CVD.

Therefore, the f rst a m of th s study was to evaluate the effects of a strength and cond t on ng program (S&C) on the QoL, an mportant pat ent-centered cl n cal outcome. The secondary object ves were to evaluate the e ects of the

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Turk J Sports Med D.A. Alonso-Aub n, I. Chulv -Medrano, M. P cón-Martínez, et al.

49 same program on self-percept on d sease mpact, self-fat - gue percept on and card ovascular (CVD) r sk factors.

CASE REPORT

Our part c pant was a 34-year-old woman (he ght: 1.40m;

we ght: 36.1kg) d agnosed w th RA at the age of 9, who also had tr cusp d valve repa r due to preserved heart fa lure ( .e. eject on fract on of 48%) w th a stage C accord ng the Amer can Heart Assoc at on gu del nes (6) and an mportant self-reported funct onal d sab l ty due to the RA deve- lopment. The pat ent was d agnosed by her card olog st w th a level III-moderate card ac funct onal capac ty follo- w ng the New York Heart Assoc at on gu del nes (NYHA) (7), character zed by a marked l m tat on n act v ty due to symptoms of fat gue and dyspnea, even dur ng less-than- ord nary act v ty but comfortable at rest n the prev ous s x months before tra n ng ntervent on.

The pat ent was nformed about the purpose of the study, exper mental procedures and potent al r sk of the study.

A er be ng nformed she s gned the nformed consent form.

The pat ent underwent a s x-month S&C program, wh ch comb ned aerob c and res stance tra n ng. Aerob c tra n ng was performed 2-3 t mes a week n 1-3 sets of 5-15 m nutes at a moderate to v gorous ntens ty [4-8 rat ng of perce ved exert on (RPE) based on a 0-10 Borg Scale (8)] on a tread- m ll and/or outdoors. Res stance tra n ng was performed 2- 3 t mes a week n d erent days from aerob c tra n ng, n 1-3 sets of 10-15 repet t ons at 5-8 RPE ntens ty. F rst day was lower-body, second day upper-body and th rd day whole body exerc ses. All the tra n ng sess ons were superv sed by a Cert f ed Strength and Cond t on ng Spec al st (CSCS) w th more than 7 years of exper ence w th spec al populat ons.

QoL: We used the Health Survey Manual (SF-36v2, Stan- dard, Span sh Vers on 2.0) as well as the Rheumato d Arth- r t s Impact of D sease (RAID) quest onna re (9). The latter was used to evaluate the pat ent’s self-percept on about the mpact of RA on h s/her health. QoL and self-percept on d - sease mpact were evaluated basel ne and every s ngle month, nclud ng the end of the ntervent on on the s xth month.

Fat gue: RPE control, developed by us to mon tor fat gue n an eas er way for the pat ent, was f lled n da ly where the pat ent had to categor ze her level of fat gue from 0 to 5 (0:

total rest, 1: l ght t redness, 2: med um t redness; 3: h gh t - redness, 4: very h gh t redness, 5: extreme t redness) at 10 m nutes of wak ng-up n the morn ng and 30 m nutes a er the tra n ng sess on n order to evaluate her fat gue percept on.

CVD r sk factors: Three blood samples were collected at the basel ne, th rd and s xth month to evaluate changes n CVD r sk factors and spec f cally, cholesterol, tr glycer des, low- and h gh- dens ty l poprote ns (LDL and HDL), and glucose.

Our results revealed a pos t ve mprovement n the total QoL score from the basel ne (52.71 po nts) to the end of the S&C program (62.50 po nts). No mprovement were seen, however, n soc al role funct on ng, v tal ty and general health percept ons (Graph c 1).

Graphic 1. SF-36 survey results through six months

Results from the RAID quest onna re demonstrated a pos t - ve change n the self-percept on w th a 47% general mprovement (1.73 po nts) vs. basel ne (3.72 po nts). In add t on, we observed pos t ve changes n all RAID categor es, except cop ng.

Results on fat gue showed an mprovement n self-fat gue percept on less fat gue between the f rst and s xth month:

24,4% for wak ng up (45 to 56 po nts) and 51,8% a er tra- n ng sess on (28 to 54 po nts).

CVD r sk factors mproved throughout the tra n ng program: cholesterol (pre:324; nter:215; post:228mg/dl), tr glycer des (pre:98; nter:77; post:70 mg/dl), LDL (pre:239; n- ter:132; post:141 mg/dl), HDL (pre:64.7; nter:67.9; post:72.2 mg/dl) and glucose (pre:99; nter:72; post:72 mg/dl).

DISCUSSION

RA s assoc ated w th a decrease n QoL and an ncrease n the nc dence of comorb d t es, such as CVD. We have sho- wn for the f rst t me that an nd v dual zed S&C program re- sulted n better QoL and health self-percept on as well as a reduct on n well-establ shed CVD r sk factors n a pat ent that had both RA and CVD (heart fa lure).

Our results are n l ne w th collect ve ev dence from syste- mat c rev ews and meta-analyses on exerc se and RA (10), clearly demonstrat ng a s multaneous benef c al e ect of exerc se n d erent outcomes. Our case study adds to the body of the l terature as t s the f rst study that nvest gated

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Turk J Sports Med E ects of Exerc se n Rheumato d Arthr t s

50 the e ects of an S&C program on a pat ent that had both RA and heart fa lure, w th benef c al e ects.

We have not found mprovements n soc al role funct - on ng, v tal ty and general health percept ons. That can be attr buted to the fact that n the th rd month of the program, the pat ent rejo ned her work l fe.

Tra n ng ntervent on mproved the NYHA from group III to group II, character zed by m ld symptoms and sl ght l m ta- t on dur ng ord nary act v ty and th s could be assoc ated to the reported mprovement n qual ty of l fe n the pat ent.

Fat gue rema ns a major symptom n RA pat ents and a bar- r er for engag ng w th exerc se. However, engagement n exerc se s gn f cantly reduces fat gue n RA (11). Eas ly me- asurable outcomes, such as RPE, can be used by pat ents to self-mon tor the r fat gue levels when exerc s ng. Improve- ments n self-reported scores may prov de pos t ve behav - oral responses to engag ng w th exerc se. In our study, we observed ncreases n self-fat gue percept on, however, the pat ent d d not w thdraw from the tra n ng program. Th s could be attr buted to the exerc se var ab l ty of the tra n ng program wh ch comb nes aerob c and res stance tra n ng and her self-mot vat on as she felt a better QoL.

The pos t ve e ect of exerc se on heart fa lure has been reported w dely (12). The novelty of our results s that a perso- nal zed/ nd v dual zed concurrent tra n ng (e.g. res stance tra n ng and aerob c exerc se) let mprove nd v dual percept ons about RA symptoms and fat gue and the comorb - d ty related to heart fa lure (CVD r sk factors).

Conﬂict of Interest / Çıkar Çatışması

The authors declared no con cts of nterest w th respect to authorsh p and/or publ cat on of the art cle.

Financial Disclosure / Finansal Destek

The authors rece ved no f nanc al support for the research and/or publ - cat on of th s art cle.

REFERENCES

S ngh JA, Saag KG, Br dges Jr SL, Akl EA, Bannuru RR, Sull van MC, et al. 2015 Amer can College of Rheumatology gu del ne for the treatment of rheumato d arthr t s. Arthr t s Rheuma- tol. 2016;68(1):1–26.

Koj ma T, Ish kawa H, Tanaka S, Haga N, N sh da K, Yuk oka M, et al. Character st cs of nct onal mpa rment n pat ents w th long-stand ng rheumato d arthr t s based on range of mot on of jo nts: Basel ne data from a mult center prospect ve observat onal cohort study to evaluate the e ect veness of jo nt surgery n the. Mod Rheumatol. 2018;28(3):474–81.

Mets os GS, Stavropoulos-Kal noglou A, Panoulas VF, W lson M, Nev ll AM, Koutedak s Y, et al.

Assoc at on of phys cal nact v ty w th ncreased card ovascular r sk n pat ents w th rheumato d arthr t s. Eur J Card ovasc Prev Rehab l. 2009;16(2):188–94.

Mets os GS, Stavropoulos-Kal noglou A, K tas GD. The role of exerc se n the management of rheumato d arthr t s. Expert Rev Cl n Immunol. 2015;11(10):1121–30.

Ph lb n EF, R es MD, Gro GD, Sheesley KA, French TS, Pearson TA. Osteoarthr t s as a determ - nant of an adverse coronary heart d sease r sk prof le. J Card ovasc R sk. 1996;3(6):529–33.

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA gu del - ne for the management of heart fa lure: A report of the Amer can College of Card ology founda- t on/Amer can Heart Assoc at on task force on pract ce gu del nes. C rculat on. 2013;128(16):e240–327.

Fleg JL, P na IL, Balady GJ, Cha tman BR, Flether B, Lav e C, et al. Assessment of nct onal capac ty n cl n cal and research appl cat ons: An adv sory from the Comm ttee on Exer se, Reha- b l tat on, and Prevent on, Counc l on Cl n cal Card ology, Amer can Heart Assoc at on. C rculat on. 2000;102(13):1591–7.

Borg G. Psychophys cal scal ng w th appl cat ons n phys cal work and the percept on of exert - on. Scand J Work Env ron Health. 1990;16(Suppl-1):55–8.

Gossec L, Dougados M, R ncheval N, Balanescu A, Boumpas DT, Canadelo S, et al. Elaborat on of the Prel m nary Rheumato d Arthr t s Impact of D sease (RAID) score: A EULAR

n t at ve. Ann Rheum D s. 2009;68(11):1680–5.

Hurkmans E, van der G esen FJ, Vl eland TPMV, Schoones J, Van den Ende ECHM. Dynam c exerc se programs (aerob c capac ty and/or muscle strength tra n ng) n pat ents w th rheuma- to d arthr t s. Cochrane Database Syst Rev. 2009;(4):CD006853

Rongen-van Dartel SAA, Repp ng-Wuts H, Flendr e M, Ble jenberg G, Mets os GS, van Den Hout WB, et al. E ect of aerob c exerc se tra n ng on fat gue n rheumato d arthr t s: A meta- analys s. Arthr t s Care Res. 2015;67(8):1054-62.

P ña IL, Apste n CS, Balady GJ, Belard nell R, Cha tman BR, Duscha BD, et al. Exerc se and heart fa lure: A statement from the Amer can Heart Assoc at on Comm ttee on exerc se, rehab l tat - on, and prevent on. C rculat on. 2003;107(8):1210–25.

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