A single session of aerobic exercise improves blood pressure in patients with rheumatoid arthritis

By Maria Fernanda Ziegler | FAPESP Agency – A 30-minute walk of moderate intensity is capable of temporarily reducing the blood pressure of patients with rheumatoid arthritis. What’s more, in tests carried out by researchers from the University of São Paulo (USP), in Brazil, women with this autoimmune disease and hypertension showed improvement after practicing physical exercises not only when they were at rest, but also during stressful episodes – such as cognitive tests and physical tests – which tend to raise the blood pressure of this type of patient.

Rheumatoid arthritis is an autoimmune inflammatory disease that is fundamentally characterized by joint pain and the functional disability it generates; and can cause elevated blood pressure as a secondary problem. So much so that cardiovascular diseases are the most important cause of death among people with rheumatoid arthritis. Previous studies have already shown that individuals with this autoimmune disease are subject to a 50% higher risk of cardiovascular death than the general population.

“Rheumatoid arthritis is intrinsically related to hypertension problems both due to the significant inflammation and the action of some medications (used in the treatment of this autoimmune disease) that can have a deleterious effect on the function and structure of Blood vesels. That is why the patient can have his arthritis under control while his blood pressure worsens, with variations that go beyond normal during the course of the day. In such cases, it is necessary to think about non-pharmacological strategies that complement blood pressure control,” he explains. Tiago Peçanhacollaborating researcher at the Faculty of Medicine of the University of São Paulo (FM-USP) and professor at the Department of Sport and Exercise Sciences at Manchester Metropolitan University (in the United Kingdom).

This study had the FAPESP support in the scope of a Thematic Project in which the effects of reducing sedentary lifestyle in different clinical populations are investigated.

Physical exercises are known to be one of the best non-pharmacological ways to control blood pressure in general. “But it was not yet known exactly what happened to people who have rheumatoid arthritis and hypertension as a result of this autoimmune disease. After all, stressful events such as mental stress or situations that cause pain can even increase the pressure of these individuals. Even so, the results of our study were extremely positive and reinforce the importance of physical exercises in cardiovascular management and as a complementary form of blood pressure control in these patients,” he states. Tatiane Almeida de Lunafirst author of the article, which is the result of her master’s thesis.

Peçanha states that the results of the study carried out with patients with rheumatoid arthritis can be extrapolated to other autoimmune inflammatory diseases such as lupus, psoriatic arthritis, inflammatory myopathies and juvenile lupus. “It turns out that rheumatoid arthritis constitutes a model of inflammatory disease that resembles these other diseases. Therefore, inflammation and its consequences, such as increased blood pressure, also occur in a similar way in these other diseases,” he explains.

blood pressure

Patients with rheumatoid arthritis tend to have high systolic blood pressure (when the heart contracts to pump blood into the arteries). It should be remembered that high blood pressure is a chronic disease characterized by high levels of blood pressure in the arteries. And it happens when the systolic and diastolic pressure values ​​are equal to or exceed 140/90 mmHg (or 14 by 9).

Previous studies show that around 50% of patients do not reach the value considered ideal for controlling systolic blood pressure (less than 140 mmHg), and this seems to happen even with those who adhere to antihypertensive treatments. Even during sleep, when blood pressure (systolic and diastolic) is expected to decrease slightly, patients with rheumatoid arthritis usually have their highest values.

The researchers explain that these patients also commonly exhibit an elevated blood pressure response when experiencing stressful situations, such as during mental stress, physical exertion, or in response to pain, which may have its share of contribution to high cardiovascular risk. in this disease. In a recent study by the same group of researchers, it was observed that postmenopausal women with rheumatoid arthritis exhibited an increase in blood pressure in response to exercise with the lower extremities, and the more severe the inflammation, the greater was the elevation of blood pressure.

A temporary decrease

In this work, published in it Journal of Human Hypertension, researchers evaluated 20 women diagnosed with rheumatoid arthritis and hypertension between the ages of 20 and 65. The study volunteers are treated at the outpatient Rheumatoid Arthritis clinic of the FM-USP Hospital de Clínicas. Notably, participants in their fertile period completed the study tests while they were in the initial follicular phase of the menstrual cycle (between one and seven days after the start of menstruation).

The study with the volunteers took place during three meetings. In the first session, once selected, the researchers measured the participants’ blood pressure and administered a physical test. During the second meeting, the volunteers’ blood pressure was measured before and after performing the 30-minute walk on a treadmill. And in the third session, they also remained standing on the treadmill at rest for 30 minutes, with their blood pressure measured before and after said period of time. As this was a randomized study, the order of performing the exercises and resting was therefore random.

After performing the physical exercises or remaining at rest, the volunteers underwent tests that simulate episodes of stressful stimuli that can impact the increase in their blood pressure. In the cognitive stress test, the participants had to answer a color questionnaire while they were given cards painted in one color and with their name written in another color. Meanwhile, in the physical pain stress test, they placed their open hand in a basin with water at 4 °C. During the two stages of the study, the volunteers continued to have their blood pressure monitored in real time 24 hours a day with an ambulatory monitor.

In this way, the researchers verified that systolic pressure remained stable in the 20 women during the period before and in the period immediately after the walk. However, it increased in the comparison made on the day they remained at rest. “This shows that the exercises prevented the increase in blood pressure,” says Peçanha.

Monitoring after the tests applied revealed that the exercises reduced systolic blood pressure on average by 5 mmHG. “This is in line with what a meta-analysis shows with this type of exercises in the general population. This decrease value is important, as it is associated with a 14% lower risk of mortality from stroke, a 9% lower risk of mortality from coronary artery disease, and a 7% lower risk of mortality in general among hypertensive individuals,” he adds.

“The temporal effect of a single session of aerobic exercise is extremely important, since acute decreases in blood pressure over consecutive days of exercise are expected to accumulate and lead to sustained decreases over time, which can contribute to achieving better control of hypertension in rheumatoid arthritis,” says Peçanha.

But the researcher highlights the importance of this finding about the role of aerobic exercise in lowering blood pressure even in tests that simulated stressful events.

“The cognitive stress test, for example, is widely applied in studies aimed at analyzing the cardiovascular response to mental stress. In general, for patients with rheumatoid arthritis, the mental stress caused by the cognitive stress test causes an average increase in systolic blood pressure. [a 16 mmHg]diastolic blood pressure [a 12 mmHg] and heartbeats [un incremento de 8 lpm]. However, after the exercises we observed that the patients’ systolic blood pressure dropped an average of 6 mmHg, something that did not happen during the session in which they remained at rest,” she comments.

Meanwhile, in relation to tests that simulate the stress caused by physical pain, an average increase in systolic blood pressure (to 18 mmHg), diastolic blood pressure (to 11 mmHg) and heartbeat ( an increase of 1 bpm). However, in the study, an even greater increase in systolic blood pressure (to 25 mmHg) was recorded in six patients. The day the volunteers did the 30-minute walk, the decrease in systolic blood pressure was 1 mmHg on average, while it increased 4 mmHg the day they remained at rest.

“As it is known that these stressful situations can increase the risk of cardiovascular events such as strokes and myocardial infarctions, the study indicates that the reduction in systolic blood pressure generated by physical exercise has the potential to reduce cardiovascular problems in people who suffer from rheumatoid arthritis,” he says.

You can read the study entitled A single session of aerobic exercise reduces systolic blood pressure at rest and in response to stress in women with rheumatoid arthritis and hypertension In the following link: www.nature.com/articles/s41371-023-00869-z.