FRI0725-HPR A TAILOR-MADE EXERCISE PROGRAM DESIGNED FOR IMPROVING CARDIORESPIRATORY FITNESS IN PATIENTS WITH RHEUMATOID ARTHRITIS AND INCREASED CARDIOVASCULAR RISK
Authors: Joëlle van den Hoek, Martin van der Esch, Marike van der Leeden, Willem Lems, George Metsios, George D. Kitas, Joost Dekker, Wilma Scholte Op Reimer, Harald Jorstad, Merel J. L’ami, Maaike Heslinga, Michael Nurmohamed
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Rheumatoid arthritis (RA) is associated with low levels of cardiorespiratory fitness (CRF), especially in patients with RA and cardiovascular (CV) risk. The optimization of management of CV risk in patients with RA is an important aim in the treatment, including also exercise, particularly in patients with RA with a high CV risk, defined as a 10-year CV risk of 20% or higher. However, exercise to improve CRF in these patients is challenging since professionals should take multiple factors into account, such as comorbid conditions related to CV risk. It is unknown which intensity of exercise improves CRF and is safe for patients with RA and CV risk. <h3>Objectives</h3> To design a tailor-made exercise therapy program to improve CRF for RA patients with CV risk &gt;20%. <h3>Methods</h3> To design a tailor-made exercise therapy program, patients and experts' opinions were collected, and a systematic literature search on exercise programs in RA and CV risk factors was performed. The ACSM guidelines were also used to gain insight into frequency, intensity, type and progression of the exercises. In addition, a cardiology rehabilitation team and an arthritis rehabilitation team were consulted during the development of the program. The designed program was partly based on cardiac rehabilitation protocols and especially the way the training load was increased, taking into account the joint load. Finally, the developed exercise program was discussed and approved by an expert panel of patients, rheumatologists, a cardiologist, physical therapists and researchers in rheumatology. The designed program was tested on 10 patients in which the feasibility and safety was tested. <h3>Results</h3> Intensity of exercises was based on the results from the baseline exercise tests showing that on average the VO<sub>2</sub>max was under the standard. The maximum Heart Rate (HR max), which was on average (mean, SD) 140.6 (10.9) beats per minute, was used to determine the individually performed intensity of exercises. The duration of the program was 12 weeks. Patients had two training sessions per week with a duration of one hour each. To guarantee safety, the training load was progressively increased, and the tolerability was assessed at every training. Exercises consisted of aerobic and muscle strength exercises. The first four weeks patients trained 30 minutes (which were spread over three exercises) on 65% of the HR max which was gradually increased until 75% of the HR max in the sixth week. From the fifth week three exercises to improve muscle strength were added to the program. From the seventh week interval training started, with a peak of 85% of the HR max and a rest of 65% of the HR max. The program also included motivational interviewing because one of the main reasons for a high CV risk is the inactivity during daily life. All patients were motived to perform 30 minutes of moderate exercises every day at home. <h3>Conclusion</h3> A tailor-made exercise program to improve cardiorespiratory fitness in patients with RA and CV risk is developed, based on the opinion and experience of patients and health professionals and supported by a literature review and guidelines. A progressively increase in intensity of the exercise program, based on the individual maximum HR, is tolerable and safe and might increase cardiorespiratory fitness in patients with RA and CV risk. <h3>References</h3> [1] Metsios, et al. Rheumatology2015Dec;54(12):2215-20. <h3>Disclosure of Interests</h3> Joëlle van den Hoek : None declared, Martin van der Esch : None declared, Marike van der Leeden : None declared, Willem Lems Speakers bureau: Amgen Inc., Merck, Eli Lilly and Pfizer, George Metsios: None declared, George D Kitas Speakers bureau: GDK has received honoraria for lectures, participation in advisory boards and/or hospitality by Roche, Abbvie, Pfizer, Novartis, UCB, BMS, GSK and received grant support from Lilly., Joost Dekker: None declared, Wilma Scholte op Reimer : None declared, Harald Jorstad: None declared, Merel J. l'Ami: None declared, Maaike Heslinga: None declared, Michael Nurmohamed Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Menarini, MSD, Mundipharma, Pfizer, Roche, Sanofi and UCB, Consultant for: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Menarini, MSD, Mundipharma, Pfizer, Roche, Sanofi and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Menarini, MSD, Mundipharma, Pfizer, Roche, Sanofi and UCB