The effects of exercise on cardiovascular disease risk factors and cardiovascular physiology in rheumatoid arthritis

© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Cardiovascular disease (CVD) morbidity and mortality is highly prevalent in patients with rheumatoid arthritis (RA) with debilitating effects for the individual as well as significant healthcare impact. Current evidence demonstrates that engaging in aerobic and resistance exercise (i.e. structured physical activity) can significantly improve patient-reported and clinical index-assessed outcomes in RA. In addition to this, engagement in exercise programmes improves, in a dose-dependent manner, the risk of developing CVD as well as CVD symptoms and outcomes. The present narrative review uses evidence from systematic reviews and meta-analyses as well as controlled trials, to synthesize the current state-of-the-art on the potential effects of aerobic and resistance exercise on CVD risk factors as well as on cardiac and vascular function and structure in people with RA. Where there is a lack of evidence in RA to explain potential mechanisms, relevant studies from the general population are also discussed and linked to RA.Published versio

A modification to the isotope-dilution technique for estimating milk intake of pigs using pig serum

The aim of this study was to compare the measurement of deuterium oxide (D2O) directly in pig serum with that in sublimed whole blood. This was to assess whether excluding vacuum sublimation before analysis would cause any significant loss of accuracy in estimates of pig milk intake. Water and serum standards were made in deionized water and serum, respectively, and were assayed with samples under the same conditions on a fixed-filter, infrared spectrophotometer. The mean concentration of D2O in sublimed samples was 2,244 microg/mL of body water, and the mean concentration of D2O in serum samples was 2,184 microg/mL of body water. The mean ratio of D2O concentration in deionized water to the D2O concentration in serum was 1.0275, which was used as a correction factor to convert serum D2O concentration to D2O concentrations in body water. Using this method, the mean concentration of D2O in all serum samples was identical to that in sublimed samples (i.e., 2,244 microg/mL of body water). Mean milk intake of pigs based on sublimed samples was 1,006 g/d and that based on serum samples was 1,012 g/d. This confirms that milk intake determined from measurement of D2O directly in pig serum is sufficiently precise

Implementation of physical activity into routine clinical practice in rheumatic musculoskeletal disease: The IMPACT-RMD study protocol and rationale

Physical activity is an important intervention for improving disease-related symptoms and systemic manifestations in rheumatic and musculoskeletal disease (RMDs). However, studies suggest that RMD patients report that the lack of individualized and consistent information about physical activity from managing doctors and healthcare professionals, acts as a barrier for engagement. On the other hand, managing doctors and healthcare professionals report lack of knowledge in this area and thus lack of confidence to educate and advise RMD patients about the beneficial effects of physical activity. The aim of the present study therefore, is to develop two e-Learning courses for RMD doctors and health professionals: a) the first one to provide consistent information about the collective benefits of physical activity in RMDs and b) the second on how to implement physical activity advice in routine clinical practice. Methods: An international collaboration of seven countries, consisting of one academic institution and one patient organization from each country, will co-develop the two e-Learning courses. The final e-Learning courses will primarily target to improve-through physical activity advice-RMD symptoms which are important for patients. Discussion: The main result of this study will be to co-develop two e-Learning courses that can be used by managing RMD doctors and healthcare professionals to be made aware of the overall benefits of physical activity in RMDs as well as how to implement physical activity advise within their practice. © Metsios GS, Fenton SAM, Moe RH, et al

Position Statement on Exercise Dosage in Rheumatic and Musculoskeletal Diseases: The role of the IMPACT-RMD Toolkit

There is convincing evidence to suggest that exercise interventions can significantly improve disease-related outcomes as well as comorbidities in rheumatic and musculoskeletal diseases (RMDs). All exercise interventions should be appropriately defined by their dose, which comprises of two components: a) the FITT (frequency, intensity, time and type) and b) the training (ie, specificity, overload, progression, initial values, reversibility, and diminishing returns) principles. In the published RMD literature, exercise dosage is often misreported, which in “pharmaceutical treatment terms”, this would be the equivalent of receiving the wrong medication dosage. Lack of appropriately reporting exercise dosage in RMDs, therefore, results in limited clarity on the effects of exercise interventions on different outcomes while it also hinders reproducibility, generalisability and accuracy of research findings. Based on the collective but limited current knowledge, the main purpose of the present Position Statement is to provide specific guidance for RMD researchers to help improve the reporting of exercise dosage and help advance research into this important field of investigation. We also propose the use of the IMPACT-RMD toolkit, a tool that can be used in the design and reporting phase of every trial. © This work is licensed under a Creative Commons Attribution 4.0 International License