Effect of high-intensity interval training in physiotherapy primary care for patients with inflammatory arthritis: the ExeHeart randomised controlled trial

Kristine Røren Nordén; Anne Grete Semb; Hanne Dagfinrud; Jonny Hisdal; Joseph Sexton; Camilla Fongen; Emilie Bakke; Sigrid Ødegård; Jon Skandsen; Thalita Blanck; George S Metsios; Anne Therese Tveter

doi:10.1136/rmdopen-2023-003440

Effect of high-intensity interval training in physiotherapy primary care for patients with inflammatory arthritis: the ExeHeart randomised controlled trial

RMD Open. 2024 Jan 18;10(1):e003440. doi: 10.1136/rmdopen-2023-003440.

Authors

Kristine Røren Nordén^{1

2}, Anne Grete Semb³, Hanne Dagfinrud^{4

2}, Jonny Hisdal^{5

6}, Joseph Sexton³, Camilla Fongen², Emilie Bakke², Sigrid Ødegård⁷, Jon Skandsen³, Thalita Blanck³, George S Metsios⁸, Anne Therese Tveter^{2

9}

Affiliations

¹ Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway kristineroren.norden@diakonsyk.no.
² Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway.
³ Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
⁴ Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁵ Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway.
⁶ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁷ Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, Diakonhjemmet Hospital, Oslo, Norway.
⁸ Department of Nutrition and Dietetics, University of Thessaly, Volos, Greece.
⁹ Faculty of Health Sciences, Institute of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Akershus, Norway.

Abstract

Objectives: To assess the effect of high-intensity interval training (HIIT) delivered in physiotherapy primary care on the primary outcome of cardiorespiratory fitness (CRF) in patients with inflammatory arthritis (IA). Additionally, to explore the effects of HIIT on secondary outcomes, including cardiovascular disease (CVD) risk factors and disease activity.

Methods: Single-blinded randomised controlled trial with 60 patients randomly assigned to either a control group receiving usual care or an exercise group receiving usual care and 12 weeks of individualised HIIT at 90%-95% peak heart rate. Outcomes were assessed at baseline, 3 months and 6 months post baseline and included CRF measured as peak oxygen uptake (VO_2peak), classic CVD risk factors, disease activity, anthropometry and patient-reported physical activity, pain, fatigue, disease impact and exercise beliefs and self-efficacy.

Results: Intention-to-treat analysis demonstrated a significant between-group difference in VO_2peak at 3 months (2.5 mL/kg/min, 95% CI 0.9 to 4.0) and 6 months (2.6 mL/kg/min, 95% CI 0.8 to 4.3) in favour of the exercise group. A beneficial change in self-reported physical activity in favour of the exercise group was observed at 3 and 6 months. The HIIT intervention was well-tolerated with minimal adverse events and no apparent impact on disease activity. Differences in secondary outcomes related to CVD risk factors, disease impact, pain, fatigue and exercise beliefs and self-efficacy were generally small and non-significant.

Conclusion: After 12 weeks of supervised HIIT delivered in physiotherapy primary care, patients with IA demonstrated a favourable improvement in CRF, with sustained effects at 6-month follow-up.

Trial registration number: NCT04922840.

Keywords: Arthritis, Psoriatic; Arthritis, Rheumatoid; Cardiovascular Diseases; Physical Therapy Modalities; Spondylitis, Ankylosing.

Publication types

Randomized Controlled Trial

MeSH terms

Arthritis* / therapy
Cardiovascular Diseases* / complications
Cardiovascular Diseases* / prevention & control
Fatigue / etiology
High-Intensity Interval Training*
Humans
Pain
Physical Therapy Modalities / adverse effects
Primary Health Care

Associated data

ClinicalTrials.gov/NCT04922840