Why exercise is so difficult for people with rheumatoid arthritis

Researchers found gentle session of leg lifts set off exaggerated nervous system reaction

If you have been diagnosed with rheumatoid arthritis, talk with your physician or an exercise physiologist about how best to exercise

If you have been diagnosed with rheumatoid arthritis, talk with your physician or an exercise physiologist about how best to exercise

 

Exercise can feel more difficult and draining than usual if you have rheumatoid arthritis, and it’s not just because of the stiff and painful joints caused by this autoimmune disorder.

In a groundbreaking new experiment involving older women and exercise, researchers found that even a gentle session of leg lifts set off an exaggerated nervous system reaction in those with rheumatoid arthritis. Light exercise also negatively affected the inner workings of their muscles and blood vessels.

The findings build on earlier research about rheumatoid arthritis and the nervous system and raise pressing new questions about the best and safest ways for people with this disorder or similar autoimmune diseases to become and remain active.

Researchers found the sympathetic system seems stuck in overdrive, keeping people’s internal operations constantly on edge

Anyone who has rheumatoid arthritis or is close to someone who has it knows the havoc it creates in the body. Immune cells mistakenly attack healthy tissue, especially in joints, causing swelling, pain and deterioration, along with full-body inflammation and fatigue. Rheumatoid arthritis also often results in cardiovascular disease, which initially puzzled doctors, since the misguided immune cells do not directly target the heart or arteries.

But in recent years, researchers discovered that people with rheumatoid arthritis tend to have unusually twitchy sympathetic nervous systems. The sympathetic nervous system is the portion of our internal wiring that stimulates the fight-or-flight response, biochemically alerting our brains, heart, muscles and other bodily systems to brace ourselves for impending danger. The opposing parasympathetic nervous system, the Matthew McConaughey of our internal biology, lulls us, sending signals that quiet the sympathetic upsets.

But in rheumatoid arthritis patients, researchers found, the sympathetic system seems stuck in overdrive, keeping people’s internal operations constantly on edge. A result is a high risk for elevated blood pressure and heart rate, even when people are resting quietly, which contributes over time to cardiovascular disease.

Few of those earlier studies, though, looked at exercise, which also raises blood pressure and heart rate and changes nervous system reactions. Some past studies — and considerable anecdotal evidence — had indicated that people with rheumatoid arthritis feel more fatigue during and after activity than other exercisers. Their heart rate and blood pressure also remain stubbornly elevated for longer after workouts. But what might be going on inside their nerves and muscles leading to these reactions has been mostly unclear.

So, for the new study, which was published in February in The Journal of Physiology, scientists at the University of São Paulo in Brazil decided to ask people with rheumatoid arthritis to do a little resistance training. Turning to patients at the university’s rheumatology clinic, they recruited 33 older women with rheumatoid arthritis and 10 older women without the condition, to serve as controls. Most of them, in both groups, were on various medications.

They invited all of their volunteers to the lab, drew blood, asked about their current pain levels, tested blood pressure and other health markers, and gently embedded tiny sensors beneath the skin in one leg to measure nervous system activity. Finally, they asked each woman to complete leg lifts with that leg, using a standard weight machine set to a low resistance. The women were supposed to lift repeatedly for three minutes — although some quit earlier than that — while the researchers tracked their blood pressure, nervous system reactions and markers of muscular response during and immediately afterward.

What they found when they compared results was that “the women with RA showed greater blood pressure and sympathetic responses” to the light workout than those in the control group, said Tiago Peçanha, a postdoctoral research associate at the University of São Paulo who was a co-author of the new study with his doctoral adviser Hamilton Roschel, director of the university’s Laboratory of Assessment and Conditioning in Rheumatology, and others.

Their nerves seemed especially sensitive to the buildup of certain substances in the working muscles, the researchers concluded, which prompted the nerves to send urgent messages to nearby blood vessels, ordering them to contract. The result was high blood pressure during and after the workout.

If you begin a new routine, start slowly and perhaps keep a log of how you feel during workouts

These reactions were most marked among the rheumatoid arthritis patients with the highest levels of inflammatory activity in their blood before the exercise, the researchers found.

Taken as a whole, the findings indicate that physical activity can be extra difficult for people with rheumatoid arthritis because their nervous systems may overreact to relatively minor changes inside the muscles.

But the findings do not suggest that those with the autoimmune disorder should avoid exercise, Roschel said.

“Physical activity is highly recommended for people with RA,” he pointed out. “But these individuals may require additional attention and support to engage in physical activity programs.”

If you have been diagnosed with rheumatoid arthritis, talk with your physician or an exercise physiologist about how best to exercise, Roschel said. And if you begin a new routine, start slowly and perhaps keep a log of how you feel during workouts.

Of course, this study focused on older women with rheumatoid arthritis and a single session of very light resistance training. It is unknown whether the results apply equally to younger women or men with the condition, or whether other types of exercise, such as walking, may produce a similar response. – New York Times

The Irish Times Logo
Commenting on The Irish Times has changed. To comment you must now be an Irish Times subscriber.
SUBSCRIBE
GO BACK
Error Image
The account details entered are not currently associated with an Irish Times subscription. Please subscribe to sign in to comment.
Comment Sign In

Forgot password?
The Irish Times Logo
Thank you
You should receive instructions for resetting your password. When you have reset your password, you can Sign In.
The Irish Times Logo
Please choose a screen name. This name will appear beside any comments you post. Your screen name should follow the standards set out in our community standards.
Screen Name Selection

Hello

Please choose a screen name. This name will appear beside any comments you post. Your screen name should follow the standards set out in our community standards.

The Irish Times Logo
Commenting on The Irish Times has changed. To comment you must now be an Irish Times subscriber.
SUBSCRIBE
Forgot Password
Please enter your email address so we can send you a link to reset your password.

Sign In

Your Comments
We reserve the right to remove any content at any time from this Community, including without limitation if it violates the Community Standards. We ask that you report content that you in good faith believe violates the above rules by clicking the Flag link next to the offending comment or by filling out this form. New comments are only accepted for 3 days from the date of publication.