High-Intensity Interval Training Demonstrates Sustainable Effects in Inflammatory Arthritis Patients

Introduction: A randomized trial presented at the European Alliance of Associations for Rheumatology (EULAR) 2023 Annual Meeting reveals that high-intensity interval training (HIIT) has sustainable effects on cardiorespiratory fitness (CRF) and cardiovascular disease (CVD) risk factors in patients with inflammatory joint diseases (IJD). The trial, known as the ExeHeart trial, aimed to assess the short- and long-term impacts of supervised HIIT over a 12-week period in patients with IJD. The results indicate that HIIT is a feasible and effective physiotherapeutic intervention that can be implemented in primary care settings without exacerbating IJD symptoms.

Study Details: The ExeHeart trial, a collaborative effort involving patient research partners, focused on evaluating the effects of HIIT on CRF, CVD risk factors, and disease activity in IJD patients. Sixty participants with various types of IJD were randomly assigned to either a standard care group or a group receiving standard care alongside a 12-week supervised HIIT intervention. Assessments were conducted at baseline, 3 months (primary endpoint), and 6 months postbaseline. The median age of the participants was 59 years, with 57% being women, and 82% having a high risk for CVD.

HIIT Intervention and Results: The HIIT group underwent supervised 4×4-minute HIIT sessions twice a week, alternating between 90%-95% peak heart rate and moderate activity at 70%. The control group engaged in unsupervised moderate-intensity exercise sessions. The primary outcome, CRF, measured through peak oxygen uptake (VO2 max), showed a statistically significant improvement favoring the exercise group at both the 3-month and 6-month assessments. However, no significant changes were observed in pain or fatigue levels. A per-protocol analysis at 3 months demonstrated a significant difference in VO2 max between the groups.

Long-Term Implications and Recommendations: The sustainable enhancement in CRF achieved through HIIT holds significant clinical implications. Improved CRF indicates better oxygen delivery to working muscles, leading to overall health improvements and a reduced risk for CVD. However, the study did not provide data on the maintenance of increased CRF beyond 6 months. While moderate and high-intensity workouts are beneficial, Norden recommends at least one high-intensity exercise session per week, alongside lower and moderate-intensity exercises as desired. EULAR emphasizes the importance of physical activity in managing IJD and recommends routine CVD screening for individuals with IJD.

Conclusion: The ExeHeart trial demonstrates that HIIT has sustainable effects on CRF and CVD risk factors in patients with IJD. This physiotherapeutic intervention can be implemented in primary care settings without worsening IJD symptoms. By incorporating HIIT into their routines, IJD patients can improve their overall fitness, reduce CVD risk, and potentially enhance their long-term health outcomes.