AB1259 THE IMPACT OF DIFFERENT EXERCISE MODES AND INTENSITIES ON PAIN AND ENJOYMENT IN PEOPLE WITH EARLY RHEUMATOID ARTHRITIS
Authors: C. Balchin, A. L. Tan, L. A. Bissell, C. Reilly, J. Mckenna, O. Wilson, A. Stavropoulos-Kalinoglou
Journal: Annals of the Rheumatic Diseases (2020)

Background: The benefits of exercise for people with rheumatoid arthritis (RA) are now widely recognised [1]. However, exercise participation among people with RA remains low. A key reason for that could be the commonly held belief that exercise, may exacerbate disease activity while acutely increasing levels of joint pain. The association of acute exercise with pain has not been established in RA and especially in people with a recent diagnosis. Objectives: This study investigated the impact of acute aerobic-and resistance-type exercise on perceptions of pain in people with early RA. Methods: Following local NHS ethical approval, ten people with RA volunteered for the study (Age=46±13years; BMI=29.4±8.6kg/m 2 , RA diagnosis= 13±9months, mean±SD). Inclusion criteria were RA diagnosis (2010 EULAR criteria) within the last two years and not engaging in regular physical activity (i.e. no participation in structured exercise &gt;2 times per week). They were assessed for maximal aerobic capacity and maximal strength at chest press, leg press and wide-grip lateral pulldown to determine intensities for exercise conditions. Thereafter they completed one no-exercise control trial (CON) and four exercise trials: 30 minutes of sub-maximal cycling at a workload equivalent to 65% VO 2 max (CYCLE); high intensity interval exercise consisting of 10x1 minutes cycling intervals at a workload equivalent to 95% VO 2 max (HIIE); resistance exercise consisting of three sets of 12-15 repetitions at 70%1RM (RES-70); resistance exercise consisting of three sets of repetitions to failure at 30%1RM (RES-30). All trials were randomised and separated by a washout period of 3-7 days. Participants completed a a visual analogue scale (VAS) for pain at baseline then 2-and 24-hours post exercise; they also completed a questionnaire related to exercise enjoyment 2-and 24-hours post exercise. Results: Currently four RA participants have completed the study and all participants completed the prescribed exercises in full. Perceived pain was low at 2 hours (0.7±0.4) and 24 hours post-exercise (1.2±0.8) for all exercise conditions (see table 1). Importantly, a difference in heart rate between the aerobic conditions (heart rate during HIIE was 16% higher than during CYCLE), and a difference in workload between the resistance conditions (RES-30 was 117% higher than RES-70) did not result in a difference in pain perception. One participant reported increased pain at 24 hours (7cm vs 1cm at 2 hours) post RES-30, but claimed that this was purely muscular and not joint pain. Interestingly, all participants enjoyed the exercises with comparable high results across the exercise conditions (see table 1). Table 1 Pain and Enjoyment Descriptives Trial Baseline VAS pain (cm) 2-hour VAS pain (cm) 24-hour VAS pain (cm) 2-hour exercise enjoyment (1-119) 24-hour exercise enjoyment (1-119) CON 0.1±0.3 0.1±0.3 0.3±0.3 63.8±13.0 63.8±13.0 CYCLE 0.1±0.3 0.5±0.4 0.9±1.2 86.8±11.0 88.0±8.8 HIIE 0.1±0.3 1.3±1.9 1.1±1.7 85.0±27.8 88.3±19.1 RES-70 0.1±0.3 0.4±0.4 0.5±0.4 91.3±13.0 88.3±6.6 RES-30 0.1±0.3 0.4±0.5 2.4±3.1 88.5±17.1 85.0±13.1 (mean±SD) Conclusion: This study identified minimal exercise effect on perceived pain at 2 hours-and 24 hours-post exercise among participants with early RA. This suggests that exercise did not exacerbate pain and importantly, high intensities and high loads did not cause additional pain. Nevertheless, further larger studies are required to examine the role of acute exercise on disease activity, e.g. inflammation, and the association with perceived pain in people with early RA. References: [1]Combe B, et al. 2016 update of the EULAR recommendations for the management of early arthritis. Annals of the Rheumatic Diseases 2016; 76: 948-959. Disclosure of Interests: None declared