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Molecular effects of exercise in patients with inflammatory rheumatic disease

Nature Clinical Practice Rheumatology volume 4, pages 597–604 (2008)Cite this article

Abstract

Exercise is now known to be beneficial for patients with inflammatory rheumatic disease. In patients with rheumatoid arthritis, exercise can improve physical performance, cardiorespiratory fitness and muscle strength, and reduce disease activity and systemic inflammation, as evidenced by reductions in erythrocyte sedimentation rate and other systemic markers of inflammation. Similar effects on physical performance and cardiorespiratory fitness have been observed in patients with polymyositis and dermatomyositis. Improved muscle performance in these patients is associated with an increased ratio of type I : type II muscle fibers and increased cross-sectional area of type II muscle fibers, suggesting that myositis-affected muscle retains the ability to respond to exercise. In addition, resistance exercise training can reduce the expression of genes involved in inflammation and fibrosis in patients with myositis, and in vitro mechanical loading of chondrocytes can suppress the expression of proinflammatory cytokines, indicating that exercise can also reduce inflammation in the local tissue environment. Further studies of the systemic and local responses underlying exercise-associated improvement in muscle performance, soft tissue integrity and health outcomes are warranted.

Key Points

  • Impaired muscle performance and muscle atrophy are common features in patients with chronic rheumatic disorders

  • Exercise training can improve performance without exacerbation of disease progress

  • Exercise training can reduce systemic inflammation

  • Exercise training might have beneficial effects on certain molecular processes in muscle tissue and cartilage that reduce inflammation and fibrosis and promote tissue repair

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Figure 1: Photomicrographs depicting cellular and pathological changes in skeletal muscle of (A) a healthy individual, (B) a patient with myositis, showing characteristic immune cell infiltrates, endomysial fibrosis and fiber size variation, and (C) a patient with rheumatoid arthritis showing small angled atrophic fibers (asterisks).
Figure 2: From inflammation to disability: a vicious cycle.

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Acknowledgements

The authors apologize to those colleagues whose important work could not be cited due to space restrictions.

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Authors and Affiliations

  1. Department of Medicine at Karolinska University Hospital, IE Lundberg is Professor of Rheumatology in the Rheumatology Unit, Solna,

    Ingrid E Lundberg

  2. GA Nader is an Assistant Professor in the Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,

    Gustavo A Nader

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Correspondence to Ingrid E Lundberg.

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Lundberg, I., Nader, G. Molecular effects of exercise in patients with inflammatory rheumatic disease. Nat Rev Rheumatol 4, 597–604 (2008). https://doi.org/10.1038/ncprheum0929

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