The impact of sedentary behavior on clinical symptoms and cardiometabolic risk factors in patients with rheumatoid arthritis: the take a Stand for health study.

Author(s)

Ana Jéssica Pinto

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Escola de Educação Física e Esportes (EEFE/BT)
• Defense date: 2021-05-13

Examining board members

Bruno Gualano; Paulo Andrade Lotufo; Camila Torriani Pasin

• Advisor: Bruno Gualano

Abstract

Rheumatoid arthritis patients spend most of daily hours in sedentary behavior. However, excessive sedentary time is associated with poor health outcomes and all-cause mortality in healthy and clinical populations. Studies on the health implications of sedentary behavior are scarce in this population. Therefore, a comprehensive investigation of the impact of sedentary behavior on overall health in rheumatoid arthritis patients is of clinical relevance. The aim of this thesis was to verify possible associations between sedentary behavior, clinical parameters and cardiometabolic risk factors in patients with rheumatoid arthritis, as well as to verify the acute and chronic effects of reducing sedentary time on clinical and cardiometabolic outcomes. To this end, three studies were conducted: (i) a cross-sectional study, in which 112 women with rheumatoid arthritis were assessed; (ii) a randomized crossover study, in which 15 patients completed three 8-h experimental conditions (SED, prolonged sedentary behavior; EX, physical exercise followed by prolonged sedentary behavior; AFL, brief light-intensity interruptions to sedentary behavior); and (iii) a randomized controlled trial, in which 86 patients were randomized in 2 groups (control [CON], in which patients received standard care; intervention [TS4H], in which patients performed an intervention to reduce sedentary time) and were followed up for 4 months. All patients underwent the following assessments: (1) sedentary behavior and physical activity level; (2) clinical parameters (i.e., disease activity, pain, fatigue, functional capacity and health-related quality of life); (3) 10-year cardiovascular risk score; (4) cardiometabolic risk factors (i.e., anthropometric measures and body composition, blood pressure, insulin sensitivity, lipid profile and inflammatory parameters); (5) protein and gene expression in the skeletal muscle. In Study 1, sedentary behavior was associated with reduced functional capacity (Timed Up and Go test: [95% CI], 0.74 s [0.32 to 1.15]) and increased body fat percentage (0.73% [0.13 to 1.32]), while active behaviors were associated with lower disease activity and C-reactive protein levels, greater functional capacity, lower 10-year risk of cardiovascular event, and a better cardiometabolic profile (all p<0,050). In x Study 2, glucose (-28%, p=0,036), insulin (-28%, p=0,016) and c-peptide (-27%, p=0,006) postprandial responses were attenuated in BR vs. SIT. IL-1 decreased during BR, but increased during EX and SIT (p=0,027 and p=0,085). IL-1ra and TNF- concentrations were significantly decreased during BR and increased during EX (p=0,002 and p=0,022). EX, but not BR, promoted hypotensive responses. Seven out of 36 lipid classes and subclasses were significantly different between conditions, with greater changes being observed in EX. In Study 3, the intervention was ineffective to reduce sedentary time (p=0,999); accordingly, there were no improvements on clinical parameters and cardiometabolic risk factors (all p> 0,050). However, in the sub-analysis performed only with patients who reduced sedentary time by at least 30 min/day, reducing sedentary time resulted in improved health-related quality of life (p=0,045) and there was a trend towards significance for a reduction in glycemic responses during the oral glucose tolerance test (p=0,068). In conclusion, these studies comprehensively demonstrate the negative impact of sedentary behavior on overall health of patients with rheumatoid arthritis. Sedentary behavior must be taken as a potential risk factor that can predispose patients to worsened clinical parameters and health outcomes. In contrast, reducing sedentary time emerges as a potential strategy to mitigate cardiometabolic risk and improve quality of life in this population, although further studies are necessary to determine the most effective interventions to achieve this objective (AU)

• FAPESP's process: 15/26937-4 - Studies on physical (in)activity in patients with rheumatoid arthritis: characterization, associations with disease and effects of breaking up sedentary time
• Grantee: Ana Jéssica Pinto
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)