SP0087 How to deal with cardiovascular risk factors for physical activity and implement the pa recommendations in the rheumatologic practice?
Authors: M. Nurmohamed
Journal: Annals of the Rheumatic Diseases (2018)

<h3></h3> How to deal with cardiovascular risk factors for physical activity and implement the PA recommendations in the rheumatologic practice? Nowadays, physical activity is increasingly advocated not only for the general population but also for patients with inflammatory arthritis as well as osteoarthritis. Generally, physical activity has favourable effects on cardiovascular risk factors. A recent systematic review revealed moderate , statistically significant improvements in blood pressure, LDL-cholesterol , and total cholesterol levels after about one year (additional) physical activity. Also the BMI improved and the effects appear to be a dose-related but not with all cardiovascular risk factors.Nevertheless, these favourable modest effects on cardiovascular risk factors could result in a clinically relevant reduction of cardiovascular events, provided that the physical activity remains enhanced albeit that thus far the evidence towards a reduction of cardiovascular events is not equivocal. It is important to realise that this review generally comprised persons without cardiovascular disease or risk factors for cardiovascular disease. It’s well known that (very) high intensity exercise results in a small absolute increase of myocardial infarction in comparison to those who have less strenuous physical exertion. The risk is the highest in those who exercised less than one time per week. Therefore, the American College of Sports Medicine (ACSM) developed an exercise preparticipation health screening process to mitigate these risks. Recommendations were developed for those 1) who should receive medical permission before starting a physical exercise program 2) with clinically significant disease(s) who may benefit from physical activity under medical supervision and 3) with medical conditions that excludes them from participation in physical activity programs. The health screening advices of the ASCM are based on an health screening logic model for aerobic exercise participation that takes the current level of physical activity, 2) presence of signs or symptoms and/or known cardiovascular disease/risk factors and 3) desired physical activity into account. However, the ASCM guidelines do not apply for patients with inflammatory joint disorders such as rheumatoid arthritis (RA). RA is associated with increased overall mortality compared to the general population, with cardiovascular diseases as one of the main causes. The optimisation of management of cardiovascular risk in RA patients is an important aim in the treatment. Active counselling is indispensable, including also attention to exercise, particularly in RA patients with a high CV risk, defined as a 10 year CV risk of 20% or higher. Physical exercise for these patients is necessary and challenging since professionals should take multiple factors into account, such as comorbid conditions related to CV risk (e.g. hypertension, diabetes mellitus and obesity). However, the effects of exercise therapy on CV risk in RA patients are unknown and the required intensity is also unknown. Therefore, we are currently developing a tailor-made exercise therapy program for these complex patients that will evaluate the effects of exercise therapy on cardiorespiratory fitness and several secondary outcomes. <h3>References</h3> [1] Patnode, et al. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without known cardiovascular disease risk factors: updated systematic review for the U.S. <i>Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US)</i>2017July. http://www.ncbi.nlm.nih.gov/books/NBK476368/ [2] Mittleman MA, et al. Triggering of acute myocardial infarction by heavy physical exertion: Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med1993;329(23):1677–83. [3] <i>Dutch Trial Register: Exercise in patients with Rheumatoid Arthritis and Cardiovascular risks.</i>http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6726 <h3>Disclosure of Interest</h3> None declared