High-intensity interval training improves cardiovascular and physical health in patients with rheumatoid arthritis: a multicentre randomised controlled trial

Bilberg A, Mannerkorpi K, Borjesson M, Svedlund S, Sivertsson J, Klingberg E, Bjersing J

Question

Does supervised HIIT plus strength exercise improve cardiovascular health, physical fitness, and overall health in patients with rheumatoid arthritis without worsening pain or disease activity?

Summary

In 87 adults with well-controlled rheumatoid arthritis, 12 weeks of supervised cycling HIIT plus strength exercise improved VO2max, oxygen pulse, waist circumference, strength, and overall health compared with advice to do moderate activity. Pain and disease activity did not worsen, though some participants needed exercise modifications for symptoms.

Methodology

87 adults with rheumatoid arthritis randomized to HIIT plus strength exercise or active control.
87 participants.
Cycle ergometer and resistance training.
Work intervals: 4 min.
Recovery: 3 min active recovery at 70% HRmax.
Intensity: 90-95% HRmax intervals; strength progressed to 70-80% 1RM.
38 min HIIT plus 20 min strength.
2 supervised sessions/week plus 1 self-administered aerobic session/week.
12 weeks.
Assessor-blinded multicentre randomized controlled trial
VO2max, Strength, Disease activity, and Overall health were tracked.

Outcomes

VO2max

Intervention improved VO2max versus control.

Between-group change 3.71 mL/kg/min, 95% CI 2.16 to 5.25, p<0.0001.

Improved

Strength

Grip strength and sit-to-stand favored intervention.

Grip +28.5 N, p=0.021; 1-minute STS +5.0 reps, p<0.001.

Improved

Disease activity

Pain and disease activity did not worsen compared with control.

DAS28 difference -0.25, 95% CI -0.60 to 0.10; pain -4.0, 95% CI -13.07 to 5.06.

No clear change

Adverse events

Some symptom events required modifications, but participants generally tolerated the program.

One irregular heart-rate event; four temporary musculoskeletal pain cases; one persistent pain case completed without strength exercise.

Mixed

Insights

Clinical HIIT protocols need explicit screening, symptom thresholds, and modification pathways.
4 x 4 cycling HIIT can be feasible in well-controlled RA when supervised.
Strength training contributed to benefits, so the result should not be attributed to HIIT alone.

Limitations

Mostly female sample and few men.
Well-controlled RA only.
Control group activity was not objectively reported.
Combined HIIT plus strength intervention.
Hospital supervision limits direct consumer translation.

Safety

One intervention participant experienced irregular heart rate during supervised HIIT and completed at moderate intensity after cardiology evaluation.
Four participants had temporarily increased musculoskeletal pain during strength exercise.
One participant completed the intervention without strength exercise after persistent musculoskeletal pain.
Temporary workload modification was used for pain >5/10 or pain lasting >24 hours.