The Effects of Exercise on Serum BDNF and Irisin Levels in Patients With Rheumatoid Arthritis
Condition: Rheumatoid Arthritis; Sleep Quality; Aerobic Exercise
MeSH terms: Arthritis; Arthritis, Rheumatoid
Study type: Interventional

Summary: 
      The aim of our study is to investigate the effects of aerobic exercise on sleep quality,
      fatigue, quality of life, depression and serum BDNF and irisin levels, which are important
      biomarkers of sleep in patients with rheumatoid arthritis.
    

Detailed description: 
      Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune disease characterized
      primarily by inflammation of synovial joints and tendon sheaths of synovial nature.

      Sleep disturbance in RA patients has a negative impact on their quality of life in addition
      to their mental and physical health. Exercise has been identified as an important
      non-pharmacological factor in improving sleep quality and mood in patients with rheumatoid
      arthritis.

      Irisin is a myokine and adipokine that has anti-inflammatory effects and can help regulate
      energy expenditure. It is secreted from skeletal muscles after exercise, as well as from
      other tissues such as the liver, nerves, heart, kidneys and skin. It has been observed that
      serum irisin levels are decreased in RA patients with poor sleep quality compared to RA
      patients with good sleep quality.

      BDNF, one of the biochemical parameters evaluating sleep, is a signal protein encoded by the
      BDNF gene located on chromosome 11. It belongs to the neurotrophin family, which regulates
      the survival, development and function of neurons. Neuronal activity is a powerful stimulant
      that elicits BDNF production. Thus, activation of brain areas associated with motor control
      during exercise contributes to increased BDNF production in the brain and additionally in
      plasma. During acute exercise, irisin stimulates BDNF expression in the hippocampus of the
      brain. In addition to the circadian variation of plasma BDNF, the blood concentration of BDNF
      has been shown to increase acutely in response to aerobic exercise that does not include
      resistance exercise. Moreover, it has been reported that people with higher basal serum BDNF
      concentrations have lower REM sleep and therefore less sleep disturbances.

      This investigation was designed as prospective randomized controlled study. Participants were
      randomized into 3 groups; RA patients receiving aerobic and home exercise, RA patients
      receiving only home exercise and healthy control group.

      As evaluation parameters, DAS28 Score, SF (Short form) -36 Quality of Life Scale, Pittsburgh
      Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), 6
      Minute Walk Test and Borg Scale will be evaluated with. It was planned that the evaluations
      were made and recorded by a blinded physician to the all patients with rheumatoid arthritis
      at the beginning of the treatment and at the end of the treatment.In the healthy control
      group, the evaluation parameters will be examined only once at the beginning of the study.

      At the beginning of the treatment and at the end of the treatment (4th week), serum BDNF and
      irisin levels will be tested using the ELISA kit, with blood samples taken from the RA
      patients in the early morning. It will be checked whether there is a difference between the
      basal serum BDNF and irisin levels of rheumatoid arthritis patients with the blood sample
      taken only once in the early morning from the healthy control group.
    

Intervention name(s): Aerobic and home exercise; Home exercise; Healthy control group
Intervention type(s): Device; Other; Other
Intervention description(s): A total of 20 sessions of aerobic exercises using bicycle ergometer, five times a week and once a day for four weeks, were applied to the patients.Maximum heart rate was calculated for each subject (220 - age) and a heart rate monitor will be used to follow subjects' heart rate during aerobic exercise.
Then the patients were showed a daily home exercise program to apply once a day at their home.
As a daily home exercise program:ROM exercises and strengthening exercises for major muscle groups (such as abdominal muscles, erector spinae, hamstring, quadriceps, hip flexors, strengthening exercises for all extremities) were showed.
At the beginning of the treatment and at the end of the treatment (4th week), serum BDNF and irisin levels will be tested using the ELISA kit, with blood samples taken from the RA patients in the early morning.; The patients were showed only a daily home exercise program to apply once a day at their home.
As a daily home exercise program:ROM exercises and strengthening exercises for major muscle groups (such as abdominal muscles, erector spinae, hamstring, quadriceps, hip flexors, strengthening exercises for all extremities) were showed.
At the beginning of the treatment and at the end of the treatment (4th week), serum BDNF and irisin levels will be tested using the ELISA kit, with blood samples taken from the RA patients in the early morning.; Serum BDNF and irisin levels will be tested using the ELISA kit, with blood samples taken only once from healthy control group in the early morning. It will be checked whether there is a difference between the basal serum BDNF and irisin levels of rheumatoid arthritis patients and healthy control group.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Rheumatoid Arthritis; Sleep Quality; Serum BDNF; Serum Irisin; Quality of Life; Fatigue; Depression