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Effect of 8 wk of bicycle training on the immune system of patients with rheumatoid arthritis
Abstract
The effect of 8 wk of progressive bicycle training on the immune system was evaluated in a controlled study on 18 patients with rheumatoid arthritis and moderate disease activity. Maximal O2 uptake increased significantly, whereas heart rate at stage 2 and rate of perceived exertion decreased significantly, in the training group compared with the controls. Resting levels of a number of immune parameters were measured before and after 4 and 8 wk of training. Training did not induce changes in blood mononuclear cell subpopulations, proliferative response, or natural killer cell activity. Furthermore the plasma concentrations of interleukin-1 alpha, interleukin-1 beta, and interleukin-6 did not change in response to training. It is concluded that 8 wk of bicycle training does not influence the immune system of patients with rheumatoid arthritis.
... In 13 (33%) of the RA studies and four (16%) of the axSpA studies, the data collection on harms outcomes was described in the methods section [21,22,[25][26][27][28][29][30][31][32][36][37][38][39][40][41][42]. Of these, eight (20%) of the RA and two (8%) of the axSpA studies reported prespecified harms outcomes [21,22,26,27,29,31,32,36,37,42]. ...
... In 13 (33%) of the RA studies and four (16%) of the axSpA studies, the data collection on harms outcomes was described in the methods section [21,22,[25][26][27][28][29][30][31][32][36][37][38][39][40][41][42]. Of these, eight (20%) of the RA and two (8%) of the axSpA studies reported prespecified harms outcomes [21,22,26,27,29,31,32,36,37,42]. None of the included studies used a prespecified threshold of these outcomes to determine their occurrence in individual patients, but rather evaluated changes in these outcome measures over time on the group level. ...
... The description of the methodology for the ascertainment of harms comprised prespecified harms outcomes in the methods section in eight of the 13 selected studies in RA [21,22,26,27,31,32,36,37] and two of the four studies in axSpA [29,42]. Prespecified harms predominantly concerned measures of disease activity, pain, and/or biological markers for inflammation. ...
To describe the quality of reporting and the nature of reported harms in clinical studies on the effectiveness of supervised exercises in patients with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA). We performed a systematic review, searching eight databases up to February 2023. Randomized controlled trials (RCTs) evaluating supervised exercises in adults with RA or axSpA were considered eligible. Data on harms were extracted according to the CONSORT Harms 2022 Checklist. Among others, it was recorded if harms were prespecified or non-prespecified. Moreover, the nature of reported harms was listed. Forty RCTs were included for RA and 25 for axSpA, of which 29 (73%) and 13 (52%) reported information on harms. In 13 (33%) RCTs in RA and four (16%) in axSpA, the collection of harms outcomes was described in the methods section. Prespecified outcomes were reported by eight (RA) and two (axSpA) RCTs. Non-specified harms outcomes were reported by six (RA) and four (axSpA) RCTs. Prespecified harms outcomes included measures of pain, disease activity, inflammation, and structural joint changes. The nature of non-prespecified harms outcomes varied largely, with pain being most common. A considerable proportion of trials on supervised exercise in RA or axSpA does not or inadequately report harms outcomes. Pain was the most commonly reported prespecified or non-specified harm. For a considerate interpretation of the balance between benefits and harms of supervised exercise in RA or axSpA, use of the CONSORT Harms 2022 Checklist for the design, conduct and reporting of trials is advocated.
... 36 De otro lado, los niveles basales de actividad de las células NK en sujetos entrenados no han sido tan bien estudiados como los efectos agudos; algunos autores han mostrado una mejoría en la actividad de las células NK, mientras que otros han sido incapaces de confirmar estos hallazgos. 37 42,43 Podría ser que los cambios en las subpoblaciones de monocitos dependan de la duración y la intensidad del ejercicio, de modo que los monocitos maduros migrarían afuera de la vasculatura en el ejercicio de larga duración. 44 Sin embargo, una causa más probable de la monocitosis inducida por el ejercicio es la disminución en la marginación de los monocitos causada por alteraciones hemodinámicas vasculares o por cambios en las interacciones entre los monocitos y las células endoteliales mediados por catecolaminas. ...
Se ha demostrado que el ejercicio hecho a diferentes intensidades cumple una función moduladora sobre diversos sistemas, y que su acción sobre la respuesta inmune es de gran importancia. Por lo tanto, es necesario esclarecer si estos cambios constituyen efectos benéficos o perjudiciales en cuanto a las adaptaciones del hospedero frente a diversos agentes patógenos. El estudio de estos cambios inducidos por el estrés físico puede tener un impacto grande en la comprensión y prevención de algunas enfermedades que involucran la respuesta del sistema inmune como las alergias, las infecciones, las inmunodeficiencias y el cáncer. En este artículo se presenta una revisión actualizada de la información existente al respecto, con el propósito de aportar elementos que ayuden a comprender este fenómeno biológico, así como sus implicaciones para la salud humana. Se han estudiado varios parámetros de la respuesta inmune durante el ejercicio físico, entre ellos su relación con la respuesta hormonal al estrés y el comportamiento de las diferentes hormonas de acuerdo con la intensidad de aquél. También se han evaluado los cambios en las poblaciones de células sanguíneas (linfocitos, monocitos y neutrófilos) así como el comportamiento de las citoquinas y la síntesis de inmunoglobulinas específicas. Todo esto ha permitido establecer una relación entre los sistemas inmune y neuroendocrino, la cual explicaría en gran medida los diferentes cambios que ocurren durante la actividad física en la respuesta y la adaptación inmunes, así como las diferencias de acuerdo con la intensidad y la frecuencia del estrés físico.
... 19,20 Fear of acute post-exercise pain and disease aggravation (i.e., a flare-up) may partially explain this. 10,21 Therefore, their concerns regarding pain and disease activity post-exercise need to be addressed. 22 Furthermore, it is important to clarify the precise pain and inflammatory response following an acute bout of exercise. ...
Background
Exercise is advocated in the treatment of rheumatoid arthritis (RA). However, uncertainty around the acute effects of exercise on pain and inflammation may be stopping people with RA from exercising more regularly.
Objectives
To determine the acute effects of exercise on pain symptoms, clinical inflammatory markers, and inflammatory cytokines in RA.
Design
A systematic review of the literature.
Data sources and methods
Five databases were searched (PubMed, Cochrane Library, CINAHL, Scopus and SPORTDiscus); inclusion criteria were studies with acute exercise, a definite diagnosis of RA and disease characteristics assessed by clinical function (i.e., disease activity score, health assessment questionnaire and self-reported pain), clinical markers associated with inflammation (i.e., c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)), and inflammatory cytokines (i.e., interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α)).
Results
From a total of 1544 articles, initial screening and full text assessment left 11 studies meeting the inclusion criteria. A total of 274 people were included in the studies (RA = 186; control = 88). Acute bouts of aerobic, resistance, and combined aerobic and resistance exercise did not appear to exacerbate pain symptoms in people with RA.
Conclusion
Post-exercise responses for pain, clinical inflammatory markers and inflammatory cytokines were not different between people with or without RA. Exercise prescription was variable between studies, which limited between-study comparisons. Therefore, future investigations in people with RA are warranted, which combine different exercise modes and intensities to examine acute effects on pain symptoms and inflammatory markers.
Registration
The PROSPERO international prospective register of systematic reviews – CRD42018091155.
... However, our findings showed that salivary levels of testosterone significantly increased in the training group (P = 0.001). In previous studies, acute and short-term training with high intensity increased serum levels of testosterone and moderate physical activity increased the concentration of testosterone in the blood (34). These results are consistent with our findings. ...
Physical activity is essential for the prevention of numerous noncommunicable diseases and has also been suggested as a protective behavior against COVID-19. However, a major part of adults and even youth individuals are physically inactive while their inactivity raises with the age. Many noncommunicable diseases (diabetes, cardiovascular diseases, etc.) have been found to be related to the increase in risk/severity of COVID-19. In this Chapter, we analyze and highlight the effects of regular physical activity (aerobic and resistance modalities) on the risk of community-acquired infectious diseases, enhancement of the immune system, and the potency of vaccination with a special focus on the protective role of COVID-19. In addition, we will also discuss the implications of physical activity interventions for preventing COVID-19 incidence, or its severity and healthcare cost. Moreover, the particular evidence of the effectiveness of different exercise programs on many relevant outcomes in COVID-19 patients will be debated. We highlight that different exercise approaches (breathing, aerobic training, strength training, or their combination) could be helpful in different conditions. Thus, we will suggest to implement multidisciplinary programs of physical activity for prevention or management approaches to COVID-19 condition.KeywordsPhysical activityImmune functionCOVID-19HealthVaccination
Routine physical activity reduces the onset of pain and exercise is a first line treatment for individuals who develop chronic pain. In both preclinical and clinical research regular exercise (routine exercise sessions) produces pain relief through multiple mechanisms such as alterations in the central and peripheral nervous system. More recently, it has been appreciated that exercise can also alter the peripheral immune system to prevent or reduce pain. In animal models, exercise can alter the immune system at the site of injury or pain model induction, in the dorsal root ganglia, and systemically throughout the body to produce analgesia. Most notably exercise shows the ability to dampen the presence of pro-inflammatory immune cells and cytokines at these locations. Exercise decreases M1 macrophages and the cytokines IL-6, IL-1β, and TFNα, while increasing M2 macrophages and the cytokines IL-10, IL-4, and IL-1ra. In clinical research, a single bout of exercise produces an acute inflammatory response, however repeated training can lead to an anti-inflammatory immune profile leading to symptom relief. Despite the clinical and immune benefits of routine exercise, the direct effect of exercise on immune function in clinical pain populations remains unexplored. This review will discuss in more detail the preclinical and clinical research which demonstrates the numerous ways through which multiple types of exercise alter the peripheral immune system. This review closes with the clinical implications of these findings along with suggestions for future research directions.
Rheumatoid arthritis (RA) is a common systematic, chronic inflammatory, autoimmune, and polyarticular disease, causing a range of clinical manifestations, including joint swelling, redness, pain, stiffness, fatigue, decreased quality of life, progressive disability, cardiovascular problems, and other comorbidities. Strong evidence has shown that exercise is effective for RA treatment in various clinical domains. Exercise training for relatively longer periods (e.g., ≥ 12 weeks) can decrease disease activity of RA. However, the mechanism underlying the effectiveness of exercise in reducing RA disease activity remains unclear. This review first summarizes and highlights the effectiveness of exercise in RA treatment. Then, we integrate current evidence and propose biological mechanisms responsible for the potential effects of exercise on immune cells and immunity, inflammatory response, matrix metalloproteinases, oxidative stress, and epigenetic regulation. However, a large body of evidence was obtained from the non-RA populations. Future studies are needed to further examine the proposed biological mechanisms responsible for the effectiveness of exercise in decreasing disease activity in RA populations. Such knowledge will contribute to the basic science and strengthen the scientific basis of the prescription of exercise therapy for RA in the clinical routine.
Een 42-jarige vrouw krijgt last van pijn en zwellingen in verschillende handgewrichten. Klinisch onderzoek bij de reumatoloog en aanvullend laboratoriumonderzoek tonen wat de oorzaak is: reumatoïde artritis. De bespreking gaat dieper in op de oorzaak, criteria om tot de juiste diagnose te komen, de betrouwbaarheid van reumatests, complicaties die bij deze aandoening kunnen optreden, de differentiaaldiagnostiek en de behandeling, zowel medicamenteus als oefentherapeutisch.
Objective:
This guideline revises the 2008 Royal Dutch Society for Physical Therapy (KNGF) guideline for physical therapy for patients with rheumatoid arthritis (RA).
Method:
This revised guideline was developed according to the Appraisal of Guidelines for Research & Evaluation (AGREE) tool and the Guidelines International Network (GIN) standards. A multidisciplinary guideline panel formulated clinical questions, based on perceived barriers in current care. For every clinical question, a narrative or systematic literature review was undertaken, where appropriate. The guideline panel formulated recommendations based on the results of the literature reviews, the values and preferences of patients and clinicians, and the acceptability, feasibility, and costs, as described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence-to-decision framework.
Results:
The eventual guideline describes a comprehensive assessment, based on the International Classification of Functioning, Disability and Health Core Set for RA. It also includes a description of yellow and red flags to support direct access. Based on the assessment, 3 treatment profiles are distinguished: (1) education and exercise instructions with limited supervision; (2) education and short-term supervised exercise therapy; and (3) education and intensified supervised exercise therapy. Education includes RA-related information, advice, and self-management support. Exercises are based on recommendations concerning the desired frequency, intensity, type, and time-related characteristics of the exercises (FITT factors). Their interpretation is compliant with the individual patient's situation and with public health recommendations for health enhancing physical activity. Recommended measurement instruments for monitoring and evaluation include the Patient-Specific Complaint instrument, Numeric Rating Scales for pain and fatigue, the Health Assessment Questionnaire Disability Index, and the 6-Minute Walk Test.
Conclusions:
An evidence-based physical therapy guideline was delivered, providing ready-to-use recommendations on the assessment and treatment of patients with RA. An active implementation strategy to enhance its use in daily practice is advised.
Impact:
This evidence-based practice guideline guides the physical therapist in the treatment of patients with RA. The cornerstones of physical therapist treatment for patients with RA are active exercise therapy in combination with education. Passive interventions such as massage, electrotherapy, thermotherapy, low-level laser therapy, ultrasound, and medical taping play a subordinate role.
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