Effect of Exercise On Cardiac Autonomic Function In Female Rheumatoid Arthritis Patients


Introduction: Cardiovascular morbidity and mortality is increased in rheumatoid arthritis(RA) patients(1,2). Autonomic dysfunction has been mentioned as part of the explanation(3). A literature search conducted(1963-2010) found only 27 publications, using 8 different testing protocols to determine the extent of autonomic nerve involvement in RA patients. Autonomic tests included were: sweat response(4,5), cardiovascular reflex tests(6-17), divergent autonomic reactions to specific tasks(18), pre-ejection period and respiratory sinus arrhythmia(19), sympathetic skin response and RR interval variation(20,21), pupillography(22,23), heart rate variability (HRV)(3,16,17,24-28) and Heart Rate Turbulence(29). Autonomic dysfunction was reported by some but not all authors. Review results were inconclusive as study results could not be compared due to numerous disparate tests used and heterogeneous study methodology. Problems identified were incomplete information on exclusion criteria, non-stabilisation of environment, males and females in the same small study groups and use of inappropriate statistical methods(3-29) I therefore firstly executed a study that confirmed cardiac autonomic dysfunction comparing females suffering from RA (n=45) to a healthy female group (n=39). This was subsequently followed by the undermentioned study. Methods:The aim of this study was to evaluate the effect of exercise on cardiac autonomic function as measured by short-term heart rate variability (HRV) in females suffering from RA. Females with confirmed Rheumatoid Arthritis (RA) were randomly assigned to an exercise group (RAE) and a sedentary group (RAC). RAE was required to train under supervision two to three times per week, for three months. Three techniques (time domain-, frequency domain-, and Poincaré plot analyses) were used to measure HRV at baseline and study completion. Results: At baseline RAC (n=18) had significantly better HRV compared to RAE (n=19). At study completion the variables showing significant changes (p=0.01 to 0.05) favoured RAE in all instances. Wilcoxon signed rank tests were performed to assess changes within groups from start to end. RAE showed significant improvement for most of the standing variables, including measurements of combined autonomic influence e.g. RRSTD (p=0.002) and variables indicating only vagal influence e.g. pNN50 (p=0.014). RAC mostly deteriorated with emphasis on variables measuring vagal influence [RMSSD, pNN50, SD1 and HF(ms2)]. Posture change showed a mixture of outcome for both groups. Discussion: Exercise intervention has an effect on cardiac autonomic function in RA patients. Especially the standing variables indicating improved vagal influence are affected positively. 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