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Rheumatoid Arthritis & the Importance of Staying Active

March 2016

Rheumatoid arthritis (RA) is an autoimmune disorder characterized by chronic joint pain, particularly in smaller joints such as those in the hands and feet.[1] RA causes painful swelling at the joints that can lead to bone erosion and joint deformity. This autoimmune disorder can also attack other tissues, such as the eyes, skin, lungs, and blood vessels.

People with RA are at an increased risk for cardiovascular disease for several reasons. Joint pain can make it very difficult to exercise and perform other types of physical activity. Therefore, people with RA often get less physical activity than the average person, which can put them at risk for a variety of ailments associated with a sedentary lifestyle. RA also causes inflammation of the blood vessels, which can lead to scarring and atherosclerosis, two conditions that increase the likelihood of a cardiovascular event.

The average VO2max for adults is approximately 40 ml/kg/min.[2] In a study using 150 adults with RA, the mean VO2max was 20.9 ml/kg/min.[3] This represents an extremely low level of fitness and indicates a very weak cardiovascular system. Even small variations in VO2max translated to significant differences in other risk factors. Comparing the bottom tertile (18.4 ml/kg/min and lower) to the upper tertile (22.4 ml/kg/min), there were significant differences in blood pressure, HDL count, insulin resistance, body fat, and white blood cell count.

Low impact exercises such as cycling, elliptical machines, and swimming can help RA sufferers stay active and maintain range of motion while minimizing joint pain. Stretching is also important to help reduce joint stiffness. When joints are stiff and sore, they tend to be used less, which can lead shorter ranges of motion over time. A pilot study used RA patients that were on stable treatment plans and had them participate in high-intense, low-impact aerobic, and resistance training exercises.[4] Measurements in large joints were assessed pre- and post-exercise and showed no acute or chronic changes that were detrimental, while positive effects on physical fitness and function were observed.

It’s important for individuals with RA to perform both aerobic and strength training exercises to help control compounding factors that affect their health. Physical activity can help maintain functionality, improve quality of life, and decrease the chances of a cardiovascular event.


Pineapple

The pineapple is a tropical fruit made from many flowers, whose individual fruitlets come together around a central core.[5] Indigenous to South America, pineapples were cultivated by the Aztecs and Mayans and were eventually introduced to Spain by Christopher Columbus. New World explorers named this fruit ‘pineapple’ for its resemblance to pine cones.[6]

Pineapples are an excellent source of vitamin C and manganese. Vitamin C is a well-known antioxidant that supports a number processes in the body, including protection against free radicals and the production of serotonin and collagen. Manganese is important cofactor in many enzymes that are responsible for energy production and antioxidant defenses. Pineapple is also a good source of vitamin B1, vitamin B6, dietary fiber, folate, and pantothenic acid. Pineapples also contain a compound called bromelain that is currently being studied for its anti-inflammatory properties. When bromelain is taken on its own, studies show that it may reduce inflammation, decrease excessive coagulation, and decrease certain types of tumor growth. More research is needed to determine if the same results can be achieved by increasing pineapple in the diet.


Grilled Salmon and Pineapple with Avocado Dressing

2 tablespoons extra-virgin olive oil
1 1/2 tsp chopped fresh basil, plus some sprigs, for garnish
1 1/2 tsp chopped fresh chives
1 tsp chopped fresh tarragon, plus some sprigs, for garnish
1/2 tsp kosher salt
1/2 tsp freshly ground black pepper
Four 4-ounce skinless salmon fillets, each about 1 inch thick
Four 1/2-inch-thick round slices (rings) of pineapple, preferably fresh
Avocado Dressing (recipe follows)

Avocado Dressing:
1/4 cup fresh lemon juice (from 1 large lemon)
2 Tbsp chopped fresh basil
1 Tbsp finely chopped fresh chives
1 Tbsp extra-virgin olive oil
1 1/2 tsp finely chopped fresh tarragon
1/8 tsp anchovy paste, optional
1/8 tsp kosher salt
1/8 tsp freshly ground black pepper
1 small clove garlic, smashed
1/2 avocado, diced

Directions:
Place a grill pan over medium-high heat or preheat a gas or charcoal grill. Whisk the oil, chopped basil, chives, chopped tarragon, salt and pepper in a small bowl to blend. Brush the salmon and pineapple slices with the herb mixture. Cook the salmon until barely cooked through and still pink inside, about 4 minutes per side. Cook the pineapple until slightly charred, 3 to 4 minutes per side. Transfer 1 pineapple slice to each plate and arrange a piece of salmon slightly overlapping it. Spoon 2 tablespoons of the Avocado Dressing over each piece of fish. Garnish with basil and tarragon sprigs and serve.

To make the avocado dressing, combine the lemon juice, basil, chives, olive oil, tarragon, anchovy paste, salt, pepper, garlic and avocado in a food processor. Add 2 tablespoons of water and process until smooth. Cover the dressing and let stand for at least 15 minutes and up to 1 hour for the flavors to blend.

If using canned pineapple, make sure to blot it dry very well before grilling it.

Recipe from http://www.foodnetwork.com/recipes/giada-de-laurentiis/grilled-salmon-and-pineapple-with-avocado-dressing.html


Abdominal Fat

There is a common misconception that performing a lot of crunches and other abdominal exercises will result in a flat stomach or 6-pack abs. A study investigated whether the addition of only abdominal exercises would change any abdominal measurements. The abdominal exercise group performed 14 sets of ab exercises 5 days a week, for 6 weeks, while the control group did not change any behaviors.[8] Compared to the control group, there were no differences in body weight, body fat percentage, abdominal fat percentage, abdominal circumference, or skinfold measurements. The exercise group was able to perform a greater number of curl-up repetitions.

In order to decrease fat mass, calorie output must be greater than calories consumed. To demonstrate, two groups of women performed aerobic activity 5 days a week.[9] One group exercised for 60 minutes each bout and the other group exercised for 30 minutes each bout. Both groups were asked to not change their usual diet. After 12 months, both groups had favorable changes in body composition, but the 60 minute group had significantly greater changes in total fat loss and subcutaneous abdominal fat loss. As subcutaneous abdominal fat decreases, the abdominal muscles can become more visible. Aerobic exercise is much more effective at decreasing body and abdominal fat when compared to ab exercises alone.


Health Matters is written by Lindsey Guthrie, MS, RD, LD/N and Tyler Guthrie, MS, CSCS.

References:

  1. Mayo Clinic. Rheumatoid arthritis. http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/basics/definition/con-20014868
  2. Wang, CY, Haskell WL, Farrell SW, et al. Cardiorespiratory Fitness Levels Among US Adults 20–49 Years of Age: Findings From the 1999–2004 National Health and Nutrition Examination Survey. American Journal of Epidemiology. 2010; 171(4): 426.
  3. Metsios GS, Koutedakis Y, Veldhuijzen van Zanten JJ, et al. Cardiorespiratory fitness levels and their association with cardiovascular profile in patients with rheumatoid arthritis: a cross-sectional study. Rheumatology. 2015; Nov 13.
  4. Law RJ, Saynor ZL, Gabbitas J, et al. The Effects of Aerobic and Resistance Exercise on Markers of Large Joint Health in Stable Rheumatoid Arthritis Patients: A Pilot Study. Musculoskeletal Care. 2015; 13(4): 222.
  5. The George Mateljan Foundation. Pineapple. http://www.whfoods.com/genpage.php?tname=foodspice&dbid=34#descr
  6. Wikipedia. Pineapple. https://en.wikipedia.org/wiki/Pineapple#History
  7. The Dallas Morning News. Texas A&M joins research into water-saving pineapple that may help feed the world. http://www.dallasnews.com/news/metro/20151127-texas-am-joins-research-into-water-saving-pineapple-that-may-help-feed-the-world.ece
  8. Vispute SS, Smith JD, LeCheminant JD, Hurley KS. The effect of abdominal exercise on abdominal fat. Journal of Strength and Conditioning Research. 2011; 25(9): 2559.
  9. Fridenreich CM, Neilson HK, O’Reilly R, et al. Effects of a High vs Moderate Volume of Aerobic Exercise on Adiposity Outcomes in Postmenopausal Women. Journal of the American Medical Association – Oncology. 2015; 1(6): 766.