The effects of aerobic exercise on sleep quality, fatique, quality of life, depression, serum bdnf and irisin levels in rheumatoi̇d arthri̇ti̇s patients

Objective: In this study, we aimed to investigate the effects of aerobic exercise on sleep quality, fatigue, quality of life, depression, serum BDNF and irisin levels in RA patients. Materials and Methods: 73 patients diagnosed with rheumatoid arthritis according to the 2010 ACR/EULAR diagnostic criteria were included to our study. Patients were between 20-60 years of age and had DAS 28 (Disease Activity Score) ≤3.2 (low disease activity or remission). In addition, 78 age- and sex-matched healthy adults were included. The patients were randomly divided into two different groups. The first group, which included 40 patients, was given a home exercise program including ROM exercises and strengthening exercises for large muscle groups. In the second group, which included 33 patients, in addition to the home exercise program, an aerobic exercise program was applied on the bicycle ergometry device in the Opticare software for 4 weeks, 5 days a week, for a total of 20 sessions. The exercise intensity of the patients was of moderate intensity and was determined by the Karvonen formula calculated according to the maximum heart rate (220-years) and resting heart rate. Before the program, the maximum load that could be given to the patients was calculated using 6 MWT. Between 60-80% of the calculated Wmax was applied throughout the exercise. The patients were evaluated by the same physician twice, at the beginning of the treatment and at the end of the treatment (4th week). Demographic data, disease duration, medical treatment and autoantibody level (anti-CCP, RF) of the patients were recorded. Disease activity was evaluated by DAS 28, sleep quality by PSQI, fatigue level by FSS, depression by BDI, quality of life by SF-36 and exercise capacity by 6 MWT. As a biomarker; serum Irisin and BDNF levels were evaluated with the ELISA kit and the results were recorded as ng/dl. Only one blood sample was taken from the healthy adult group, demographic and clinical parameters were questioned. Statistical analysis was done with Statistical Package for the Social Sciences (SPSS) 25 developed for Windows. p <0.05 was considered statistically significant. Results: In the first evaluation, it was determined that sleep quality and quality of life were significantly lower in RA patients compared to healthy individuals, and fatigue and depression were more common. Although there was a significant decrease in depression scores in both RA groups after exercise therapy, there was no significant difference between the groups. In addition, in the group receiving aerobic exercise, DAS 28 scores decreased, PUKI total and subjective sleep quality, sleep latency, sleep disorder parameters decreased, Fatigue severity scale scores decreased, physical function, vitality, mental health, pain, general health subscales in SF-36 parameters improved and a significant increase in the 6-minute walking test distance were detected (p<0.05). When the percentage changes in serum irisin and BDNF levels before and after treatment were compared, no statistical significance was observed between the groups (p>0.05). BDNF and irisin levels were positively correlated with each other (r>0.50). Moreover, irisin level showed a weak positive correlation with age, disease activity, and disease duration (r<0.50). Conclusion: Aerobic exercise is very effective in delaying disease exacerbation, reducing fatigue and depression, increasing quality of life, exercise capacity and sleep quality in RA patients, and appears to be a supportive therapy for medical treatment. Physical activity and exercise should be part of routine treatment in RA patients. On the other hand, studies with a larger number of patients and longer follow-up periods are needed in order to more clearly evaluate the relationship of biomarkers with exercise and sleep in RA patients in the future. This is the first study to examine the effects of aerobic exercise on sleep quality, fatigue, quality of life, depression, serum BDNF and irisin levels in RA patients. Key words: Rheumatoid arthritis, Sleep quality, Aerobic exercise, Irisin, BDNF