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Doctors newspaper online, 17.10.2019
Immunology
Many rheumatoid patients do not move enough – often out of concern that this could worsen joint function. Sport can positively influence the disease.
By Wiebke Kathmann
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DRESDEN. Sporting activity should be part of human life. The WHO recommends at least 150 minutes of moderate or 75 minutes of intense physical activity per week for each.
This recommendation also applies explicitly to patients with chronic diseases, such as Philipp Sewerin, Heinrich Heine University, Düsseldorf, in the session "Pain and Activity in Rheumatology" at the DGRh Congress in Dresden highlighted.
Today, this goal is more vision or desire than reality, as a survey of a German health insurance company revealed in 3000 insured. These activity goals reached only 54 percent of those surveyed.
Worrying about harmful effects
The situation is similar in international cohorts of rheumatoid arthritis (RA) patients. The vast majority of respondents did not move regularly. With the exception of Finland, less than 20 percent met the goal of at least three times a week physical training.
Inactivity was more common among women, elderly RA patients and low levels of education. The inactivity correlated with health issues such as overweight, comorbidities, low functional status, higher disease activity, pain and fatigue – so the further analysis.
Worrying about the harmful effects of exercise is certainly a factor in the inactivity of RA patients. Others, according to Sewerin, are pain and uncontrolled disease activity, a long-standing RA and, ultimately, the fact that the topic has played a rather minor role in the doctor's discussion so far. And this despite the fact that there is now sufficient evidence for a positive effect of adequate physical activity on the disease activity.
As Severin has said, sport makes endorphins not only happy, but also self-confident and powerful through serotonin and dehydroepiandrosterone.
Myokines are released
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Much more important, however, is that it has a positive effect on the cytokines released by the muscles during physical activity, so-called myokines. These peptide hormones lead to the release of anti-inflammatory cytokines in macrophages, support bone metabolism, improve the glucose metabolism via effects on the pancreas, the liver and the intestine, stimulate fat metabolism in adipose tissue and increase the endothelial function in the blood vessels.
In addition, myokines also improve cognitive abilities, as demonstrated by the protagonists of myokin research, Fabiana Benatti from Sao Paulo and Bente Pedersen from Copenhagen (Nat Rev Rheumatol 2015; 11: 86-97).
In contrast, inactivity favors an inflammatory synovium and the accumulation of visceral fat, which in turn leads to macrophage infiltration and ultimately chronic-systemic inflammation.
Important pillar in RA management
Regular training and physical activity should therefore be regarded as a necessary and important pillar in the management of RA patients and more space in the doctor-patient interview.
At the same time, the image should no longer be defined by senior women in water aerobics, but rather by athletic role models for young rheumatism patients.
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