AbstractBackground: Rheumatoid arthritis (RA) individuals are at greater morbidity and mortality risk from developing cardiac and pulmonary disorders than the general population, primarily due to a sedentary lifestyle. Aims: This project aimed to (1) obtain information on the rheumatic and musculoskeletal disease (RMD) patents’ achieved/preferred exercise principles and awareness, (2) investigate the need to implement and safety, as depicted when a verification phase is added at the cardiopulmonary exercise tolerance test (CPET) in RA, to confirm the attainment of maximal effort, (3) evaluate potential differences between RA individuals and non-RA controls regarding the cardiopulmonary physiology and its association with the cardiorespiratory fitness (CRF) level and (4) assess possible cardiopulmonary changes following a supervised three-month aerobic high-intensity interval training (HIIT) regimen and examine its adherence in RA. Methods: A total of 298 individuals were recruited. A newly developed questionnaire in RMDs explored qualitative data about exercise. CRF was evaluated through a combined CPET with verification phase protocol. CPET was analysed for its sensitivity, specificity, positive and negative likelihood ratios (LH+/LH-), and diagnostic odds ratio (DOR). The verifications’ phase safety was examined through CPET's absolute and relative contraindications during monitoring and patient’s acceptability. Cardiopulmonary physiology was investigated via both echocardiography and complete pulmonary function tests (PFTs). To estimate the disease activity score (DAS28) ‐ C‐reactive protein (CRP) was used in people living with RA. Results: Study 1: The most preferred exercise routine characterised by a frequency of “2-3 times per week”, moderate intensity, lasting “about an hour’’, with swimming being the best- suggested modality. In Study 2, a combined CPET with a verification phase protocol presented superior diagnostic accuracy and was free from safety issues for both people with RA and non-RA controls. In Study 3, in the absence of any overt cardiac and/or pulmonary disease, RA individuals presented with an eccentric cardiac remodelling and lung hyperinflation pattern compared to non-RA controls; CRF was associated (p<0.05) with left ventricular (LV) compliance and pulmonary function indices in both groups. Study 4: The HIIT programme revealed significant (p<0.05) improvements in pulmonary function, CRF, and reduced DAS28, while individuals adhered overall moderately to this regime. Conclusions: This Thesis concluded that: (1) exercise recommendations are not individualised according to the individuals’ needs and preferences in RMDs, (2) the combined CPET with a verification phase is a safe and necessary methodology to ensure a diagnostically accurate assessment of maximal effort for both people living with RA and non- RA controls, (3) people living with RA may present a parallel eccentric cardiac remodelling with a hyperinflation pattern in the subclinical phase, while CRF levels associate with cardiopulmonary function indices in both groups, and (4) a moderately adhered three-month aerobic HIIT exercise regimen can significantly improve pulmonary function, CRF, and RA's disease state.
PublisherUniversity of Wolverhampton
TypeThesis or dissertation
DescriptionA thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.
SponsorsUniversity of Wolverhampton.
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