FRI0682 Exercise may decrease syncope secondary to postural change in females with rheumatoid arthritis: pilot study

• Published in: Annals of the rheumatic diseases Vol. 77; no. Suppl 2; p. 860
• Main Authors: Janse Van Rensburg, D. C., Ker, J. A., Grant, C. C., Fletcher, L.
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2018
• Subjects: Autonomic nervous system; Balance; Blood pressure; Heart rate; Influence; Parasympathetic nervous system; Physical training; Posture; Rheumatoid arthritis; Syncope; Vagus nerve
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2018-eular.6261

Background:The autonomic nervous system (ANS) regulates the heart rate via sympathetic and parasympathetic influences. Literature has shown that rheumatoid arthritis (RA) patients suffer from autonomic dysfunction. This may consequently lead to syncope with possible falls after posture change i.e. rising from supine to the standing position. Previous research has shown general improvement of the ANS after exercise, but not in specific relation with posture change.Objectives:To determine the effect of exercise on posture change (supine to standing position) in females with RA as measured by short-term heart rate variability (ANS function).Methods:Patients with confirmed RA were randomly selected to a control group (RAC) or an exercise group (RAE). The RAE group (n=19) trained two to three times per week under supervision. The RAC group (n=18) continued with their current sedentary lifestyle. The medium intensity exercise programme lasted for 12 weeks. No change in medication was allowed during this time. ANS function and balance were determined by quantification of the variability of the inter-beat interval detected with the Polar 810i heart rate monitor system. Frequency domain analyses were used for quantification, including LF (ms²) – indicating mainly sympathetic influence, HF (ms²) – indicating parasympathetic influence, and LF/HF – indicator of autonomic balance.Results:The two groups matched regarding baseline demographic data (age, sex, disease activity, disease duration). Due to small sample sizes and variables not following a normal distribution, non-parametric Mann Whitney U analyses were performed on the heart rate variability parameters. Comparing posture change (i.e. standing value minus supine value) from pre- to post intervention, all frequency domain parameters changed as anticipated (i.e. vagal withdrawal and increased sympathetic influence) for the RAE group. For the RAC group the measurements deteriorated.LF (ms²): RAE -1.03 to 22.03 (stronger sympathetic influence); RAC 43.45 to -31.21 (weaker sympathetic influence)HF (ms²): RAE -24.03 to -33.34 (better vagal withdrawal); RAC -191.7 to -114.1 (less vagal withdrawal)LF/HF:RAE 10.57 to 15.04; RAC 2.9 to 7.6Conclusions:From these preliminary results it appear that exercise may indeed improve autonomic function in RA patients, in such a way that posture change will not be an added burden for falls in an already otherwise compromised population.Disclosure of Interest:None declared