The authors would like to thank professors Piccoli and Pastori of the Department of Medical and Surgical Sciences, University of Padova, Italy, for providing the BIVA software. Also, to Dr. Luis Llorente and Dra. Andrea Hinojosa-Azaola from the Department of Immunology and Rheumatology at the INCMNSZ for rheumatological assessment of patients. This work was supported by the CONACyT which sponsored the scholarship CVU 777701 for Mariel Lozada Mellado during his Ph.D. course study and through the Research Project Grant 000000000261652. The sponsor did not have any role in the study design or in the collection, analysis, or interpretation of data, nor in the writing of the report and in the decision to submit the paper for publication.

The present protocol was approved by and followed the Human Research and Ethics Committee guidelines of the National Institute of Medical Sciences and Nutrition Salvador Zubir&#225;n (Ref.: 1347). Informed consent was obtained from the human participants before participation in this study. Only patients in functional class I to III without total or partial arthroplasties18,19 and who were not candidates for prostheses were included in this study. Exclusion criter...

The video discusses research on using vector impedance analysis to assess hydration changes in body cell mass in rheumatoid arthritis patients. It highlights the increased infection risk associated with low body cell mass and emphasizes the benefits of physical exercise in improving strength, quality of life, and inflammation in these patients.

Developing an Exercise Program for Rheumatoid Arthritis Patients

<ol>
	<li>Aletaha, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rheumatoid+arthritis+classification+criteria:+An+American+College+of+Rheumatology/European+League+Against+Rheumatism+collaborative+initiative.">Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative.</a> Annals of the Rheumatic Diseases. 62 (9), 1580-1588 (2010).</li><li>Gamal, R. M., Mahran, S. A., Abo El Fetoh, N., Janbi, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quality+of+life+assessment+in+Egyptian+rheumatoid+arthritis+patients:+Relation+to+clinical+features+and+disease+activity.">Quality of life assessment in Egyptian rheumatoid arthritis patients: Relation to clinical features and disease activity.</a> Egyptian Rheumatologist. 38 (2), 65-70 (2016).</li><li>Rall, L. C., Roubenoff, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rheumatoid+cachexia:+metabolic+abnormalities,+mechanisms,+and+interventions.">Rheumatoid cachexia: metabolic abnormalities, mechanisms, and interventions.</a> Rheumatology. 43 (10), 1219-1223 (2004).</li><li>Summers, G. D., Deighton, C. M., Rennie, M. J., Booth, A. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rheumatoid+cachexia:+A+clinical+perspective.">Rheumatoid cachexia: A clinical perspective.</a> Rheumatology. 47 (8), 1124-1131 (2008).</li><li>Elkan, A. C., Engvall, I. L., Cederholm, T., Hafstr&#246;m, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rheumatoid+cachexia,+central+obesity+and+malnutrition+in+patients+with+low-active+rheumatoid+arthritis:+Feasibility+of+anthropometry,+Mini+Nutritional+Assessment,+and+body+composition+techniques.">Rheumatoid cachexia, central obesity and malnutrition in patients with low-active rheumatoid arthritis: Feasibility of anthropometry, Mini Nutritional Assessment, and body composition techniques.</a> European Journal of Nutrition. 48 (5), 315-322 (2009).</li><li>Engvall, I. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cachexia+in+rheumatoid+arthritis+is+associated+with+inflammatory+activity,+physical+disability,+and+low+bioavailable+insulin-like+growth+factor.">Cachexia in rheumatoid arthritis is associated with inflammatory activity, physical disability, and low bioavailable insulin-like growth factor.</a> Scandinavian Journal of Rheumatology. 37 (5), 321-328 (2008).</li><li>Jacobs, D. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioelectrical+Impedance+Analysis:+Implications+for+Clinical+Practice.">Bioelectrical Impedance Analysis: Implications for Clinical Practice.</a> Nutrition in Clinical Practice. 12 (5), 204-210 (1997).</li><li>Santill&#225;n-D&#237;az, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+rheumatoid+cachexia+assessed+by+bioelectrical+impedance+vector+analysis+and+its+relation+with+physical+function.">Prevalence of rheumatoid cachexia assessed by bioelectrical impedance vector analysis and its relation with physical function.</a> Clinical Rheumatology. 37 (3), 607-614 (2018).</li><li>Piccoli, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bivariate+normal+values+of+the+bioelectrical+impedance+vector+in+adult+and+elderly+populations.">Bivariate normal values of the bioelectrical impedance vector in adult and elderly populations.</a> The American Journal of Clinical Nutrition. 61 (2), 269-270 (1995).</li><li>Espinosa-Cuevas, M. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Vectores+de+impedancia+bioel&#233;ctrica+para+la+composici&#243;n+corporal+en+poblaci&#243;n+mexicana+[Bioelectrical+impedance+vectors+for+body+composition+in+Mexican+population].">Vectores de impedancia bioel&#233;ctrica para la composici&#243;n corporal en poblaci&#243;n mexicana [Bioelectrical impedance vectors for body composition in Mexican population].</a> Revista de investigaci&#243;n cl&#237;nica [Clinical research journal]. 59 (1), 15-24 (2007).</li><li>Piccoli, A., Pillon, L., Dumler, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impedance+vector+distribution+by+sex,+race,+body+mass+index,+and+age+in+the+United+States:+standard+reference+intervals+as+bivariate+Z+scores.">Impedance vector distribution by sex, race, body mass index, and age in the United States: standard reference intervals as bivariate Z scores.</a> Nutrition. 18 (2), 153-167 (2002).</li><li>Maese, J., Garc&#237;a De Y&#233;benes, M. J., Carmona, L., Hern&#225;ndez-Garc&#237;a, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Estudio+sobre+el+manejo+de+la+artritis+reumatoide+en+Espa&#241;a+(emAR+II)+[Study+on+the+management+of+rheumatoid+arthritis+in+Spain+(emAR+II)].+Caracter&#237;sticas+cl&#237;nicas+de+los+pacientes+[Clinical+characteristic+of+patients].">Estudio sobre el manejo de la artritis reumatoide en Espa&#241;a (emAR II) [Study on the management of rheumatoid arthritis in Spain (emAR II)]. Caracter&#237;sticas cl&#237;nicas de los pacientes [Clinical characteristic of patients].</a> Reumatolog&#237;a Clinica. 8 (5), 236-242 (2012).</li><li>Hurkmans, E., Van der Giesen, F. J., Vlieland, T. P. M. V., Schoones, J., Van den Ende, E. C. H. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dynamic+exercise+programs+(aerobic+capacity+and/or+muscle+strength+training)+in+patients+with+rheumatoid+arthritis.">Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis.</a> Cochrane Database of Systematic Reviews. 4, CD006853 (2009).</li><li>Baillet, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+cardiorespiratory+aerobic+exercise+in+rheumatoid+arthritis:+Meta-analysis+of+randomized+controlled+trials.">Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: Meta-analysis of randomized controlled trials.</a> Arthritis Care &amp; Research. 62 (7), 984-992 (2010).</li><li>De Jong, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+follow-up+of+a+high-intensity+exercise+program+in+patients+with+rheumatoid+arthritis.">Long-term follow-up of a high-intensity exercise program in patients with rheumatoid arthritis.</a> Clinical Rheumatology. 28 (6), 663-671 (2009).</li><li>Garc&#237;a-Morales, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+a+dynamic+exercise+program+in+combination+with+Mediterranean+diet+on+quality+of+life+in+women+with+rheumatoid+arthritis.">Effect of a dynamic exercise program in combination with Mediterranean diet on quality of life in women with rheumatoid arthritis.</a> Journal of Clinical Rheumatology. 26 (2), S116-S122 (2019).</li><li>Munneke, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+a+high-intensity+weight-bearing+exercise+program+on+radiologic+damage+progression+of+the+large+joints+in+subgroups+of+patients+with+rheumatoid+arthritis.">Effect of a high-intensity weight-bearing exercise program on radiologic damage progression of the large joints in subgroups of patients with rheumatoid arthritis.</a> Arthritis &amp; Rheumatism. 53, 410-417 (2005).</li><li>Hochberg, M., Chang, R., Dwosh, I., Lyndsey, S., Pincus, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+American+College+of+Rheumatology+1991+Revised+Criteria+for+the+Classification+of+Global+Functional+Status+in+Rheumatoid+Arthritis.">The American College of Rheumatology 1991 Revised Criteria for the Classification of Global Functional Status in Rheumatoid Arthritis.</a> Arthritis &amp; Rheumatism. 35, 498-502 (1991).</li><li>Nikiphorou, E., Konan, S., MacGregor, A. J., Haddad, F. S., Young, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+surgical+treatment+of+rheumatoid+arthritis.">The surgical treatment of rheumatoid arthritis.</a> Bone Joint Journal. 96 (10), 1287-1289 (2014).</li><li>Jacqueline, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rheumatoid+Arthritis:+A+Brief+Overview+of+the+Treatment.">Rheumatoid Arthritis: A Brief Overview of the Treatment.</a> Medical Principles and Practice. 27 (6), 501-507 (2019).</li><li>Piccoli, A., Rossi, B., Pillon, L., Bucciante, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+method+for+monitoring+body+fluid+variation+by+bioimpedance+analysis:+the+RXc+graph.">A new method for monitoring body fluid variation by bioimpedance analysis: the RXc graph.</a> Kidney International. 46 (2), 534-539 (1994).</li><li>Benatti, F. B., Pedersen, B. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Exercise+as+an+anti-inflammatory+therapy+for+rheumatic+diseases+-+Myokine+regulation.">Exercise as an anti-inflammatory therapy for rheumatic diseases - Myokine regulation.</a> Nature Reviews Rheumatology. 11 (2), 86-97 (2015).</li><li>Cooney, J. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Benefits+of+Exercise+in+Rheumatoid+Arthritis.">Benefits of Exercise in Rheumatoid Arthritis.</a> Journal of Aging Research. 6, 297-310 (2011).</li><li>Barbosa-Silva, M. C. G., Barros, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioelectrical+impedance+analysis+in+clinical+practice:+a+new+perspective+on+its+use+beyond+body+composition+equations.+Current+Opinion.">Bioelectrical impedance analysis in clinical practice: a new perspective on its use beyond body composition equations. Current Opinion.</a> Clinical Nutrition and Metabolic Care. 8 (3), 311-317 (2005).</li><li>Mulasi, U., Kuchnia, A. J., Cole, A. J., Earthman, C. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioimpedance+at+the+bedside:+current+applications,limitations,+and+opportunities.">Bioimpedance at the bedside: current applications,limitations, and opportunities.</a> Nutrition in Clinical Practice. 30 (2), 180-193 (2015).</li><li>Steihaug, O. M., Bogen, B., Kristoffersen, M., Ranhoff, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bones,+blood+and+steel:+How+bioelectrical+impedance+analysis+is+affected+by+a+hip+fracture+and+surgical+implants.">Bones, blood and steel: How bioelectrical impedance analysis is affected by a hip fracture and surgical implants.</a> Journal of Electrical Bioimpedance. 8, 54-59 (2017).</li><li>Nwosu, A. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioelectrical+impedance+vector+analysis+(BIVA)+is+a+method+to+compare+body+composition+differences+according+to+cancer+stage+and+type.">Bioelectrical impedance vector analysis (BIVA) is a method to compare body composition differences according to cancer stage and type.</a> Clinical nutrition ESPEN. 30, 59-66 (2019).</li><li>Martins, P. C., Gobbo, L. A., Silva, D. A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioelectrical+impedance+vector+analysis+(BIVA)+in+university+athletes.">Bioelectrical impedance vector analysis (BIVA) in university athletes.</a> Journal of the International Society of Sports Nutrition. 18 (7), 1-8 (2021).</li><li>Norman, K., Pirlich, M., Sorensen, J., Christensen, P., Kemps, M., Sch&#252;tz, T., Lochs, H., Kondrup, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioimpedance+vector+analysis+as+a+measure+of+muscle+function.">Bioimpedance vector analysis as a measure of muscle function.</a> Clinical Nutrition. 28 (1), 78-82 (2009).</li><li>Stagi, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Usability+of+classic+and+specific+bioelectrical+impedance+vector+analysis+in+measuring+body+composition+of+children.">Usability of classic and specific bioelectrical impedance vector analysis in measuring body composition of children.</a> Clinical nutrition. 41 (3), 673-679 (2022).</li><li>Garber, C. 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The authors have nothing to disclose.

In rheumatoid arthritis, the vicious circle of the disease has been described, which refers to the structural changes in joints caused by inflammation mechanisms; these changes, together with the chronic inflammatory state, lead to patients going through stages of great pain and inflammation, with structural changes in joints and as a consequence functional disability, that increase the risk of developing metabolic and cardiovascular diseases and alterations in body composition such as rheumatoid cachexia<sup class='xref...

Rheumatoid arthritis (RA) is a disabling disease that affects patients&#39; functionality and independence due to acute joint pain, reduced muscle strength, and impaired physical function, all of which are associated with the inflammatory process inherent to the disease1,2. In advanced stages, persistent inflammation causes structural alterations leading to deformity, joint dysfunction, and rheumatoid cachexia, which is a poor prognostic factor for these patients3,4.
Rheumatoid cachexia is characterized by alterations in body composition, such as muscle loss with stable weight and increased fat mass, which can significantly impact the quality of life for these patients3,5,6. Various techniques are available to assess body composition, with the most widely used being bioelectrical impedance analysis (BIA). However, when conventional BIA analysis is used in subjects with altered body compositions, the estimations may be limited as they are based on prediction equations formulated for a healthy or normally hydrated population7,8.
A different approach, called bioelectrical impedance vector analysis (BIVA), utilizes the impedance vector based on graphical RXc. It utilizes impedance, resistance (R), and reactance (Xc) data corrected for height, resulting in a vector that provides information about the hydration state and integrity of the cell mass. BIVA is capable of classifying patients into categories such as dehydration, overhydration, normal, athlete, lean, cachectic, and obese, making it a valuable tool for RA patients8,9,10. Vectors located above or below the main axis (the left or right halves of the ellipses) have been associated with higher and lower cell mass&#160;in soft tissues, respectively. Forward and backward displacements of vectors parallel to the major axis are linked to dehydration and fluid overload. Athletes are defined as individuals with higher cell mass, potentially accompanied by dehydration. The lean classification refers to those with lower cell mass, potentially accompanied by dehydration, and the obese classification applies to individuals with higher cell mass, which may be accompanied by fluid overload. The classification of cachexia by BIVA is determined by high resistance and low reactance values, represented by the movement of the vector to the right of the graph, indicating a decrease in cell mass, potentially accompanied by an alteration in hydration status11 (Figure 1).
Conventional pharmacological treatments for RA primarily focus on reducing pain, inflammation, and joint damage progression, with limited attention given to alterations in body composition12. Among the non-pharmacological therapies commonly used in this population, exercise-based interventions have shown positive outcomes in improving functionality, fatigue, pain, joint mobility, aerobic capacity, muscle strength, endurance, flexibility, and psychological well-being. Importantly, these interventions have been shown to achieve these benefits without exacerbating symptoms or causing joint damage in patients without extensive pre-existing damage13,14,15,16,17. However, there is limited knowledge on implementing and evaluating changes in hydration and body cell mass status following exercise interventions in this population. These patients often experience pain, inflammation, and structural joint changes, limiting the types of activities they can engage in and further complicating body composition assessments using traditional approaches. This protocol aims to demonstrate how to evaluate changes in hydration and body cell mass status using bioelectrical impedance vectorial analysis after implementing a dynamic exercise program for patients with rheumatoid arthritis. Additionally, the protocol provides details of the dynamic exercise program, including cardiovascular capacity, strength, and coordination components, as well as the steps, instruments, limitations, and general considerations.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Alcohol 70% swabs</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used</td>
		</tr>
		<tr>
			<td>bicycle ergometer</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used</td>
		</tr>
		<tr>
			<td>BIVA&#160; tolerance software 2002</td>
			<td>NA</td>
			<td>NA</td>
			<td>Is a sofware created for academic use, can be download in http://www.renalgate.it/formule_calcolatori/bioimpedenza.htm in &#34;LE FORMULE DEL Prof. Piccoli&#34; section</td>
		</tr>
		<tr>
			<td>BIVA confidence software</td>
			<td>NA</td>
			<td>NA</td>
			<td>Is a sofware created for academic use, can be download in http://www.renalgate.it/formule_calcolatori/bioimpedenza.htm in &#34;LE FORMULE DEL Prof. Piccoli&#34; section</td>
		</tr>
		<tr>
			<td>Chair</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used</td>
		</tr>
		<tr>
			<td>Chlorhexidine</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used, 0.05%</td>
		</tr>
		<tr>
			<td>Examination table</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used</td>
		</tr>
		<tr>
			<td>Leadwires square socket</td>
			<td>BodyStat</td>
			<td>SQ-WIRES</td>
			<td></td>
		</tr>
		<tr>
			<td>Long Bodystat 0525 electrodes</td>
			<td>BodyStat</td>
			<td>BS-EL4000</td>
			<td></td>
		</tr>
		<tr>
			<td>Plastic ball</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used, 30 cm</td>
		</tr>
		<tr>
			<td>Pulse oximeter</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used</td>
		</tr>
		<tr>
			<td>Quadscan 4000&#160; equipment</td>
			<td>BodyStat</td>
			<td>BS-4000</td>
			<td>Impedance measuring range: 20 - 1300 &#937; ohms 
			Test Current: 620 &#956;A 
			Frequency: 5, 50, 100, 200 kHz 
			Accuracy: Impedance 5 kHz: +/- 2 &#937; 
			Impedance 50 kHz: +/- 2 &#937; 
			Impedance 100 kHz: +/- 3 &#937; 
			Impedance 200 kHz: +/- 3 &#937; 
			Resistance 50 kHz: +/- 2 &#937; 
			Reactance 50 kHz: +/- 1 &#937; 
			Phase Angle 50 kHz: +/- 0.2&#176; 
			Calibration: A resistor is supplied for independent verification from time to time. The impedance value should read between 496 and 503 &#937;.</td>
		</tr>
		<tr>
			<td>Resistence bands</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used, with resistence of 0.5 kg to 3.2 kg</td>
		</tr>
		<tr>
			<td>Stationary bicycle</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used</td>
		</tr>
		<tr>
			<td>Treadmill</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used</td>
		</tr>
		<tr>
			<td>Wooden stick</td>
			<td>NA</td>
			<td>NA</td>
			<td>Any brand can be used, 1.5m in large and &#60;1kg</td>
		</tr>
	</tbody>
</table>

evaluation of changes in hydration and body cell mass with bioelectrical impedance analysis after exercise program for rheumatoid arthritis patients

Rheumatoid arthritis (RA) is a debilitating disease that can result in complications such as rheumatoid cachexia. While physical exercise has shown benefits for RA patients, its impact on hydration and body cell mass remains uncertain. The presence of pain, inflammation, and joint changes often restrict activity and make traditional body composition assessments unreliable due to altered hydration levels. Bioelectrical impedance is a commonly used method for estimating body composition, but it has limitations since it was primarily developed for the general population and does not consider changes in body composition. On the other hand, bioelectrical impedance vectorial analysis (BIVA) offers a more comprehensive approach. BIVA involves graphically interpreting resistance (R) and reactance (Xc), adjusted for height, to provide valuable information about hydration status and the integrity of the cell mass.
Twelve women with RA were included in this study. At the beginning of the study, hydration and body cell mass measurements were obtained using the BIVA method. Subsequently, the patients participated in a six-month dynamic exercise program encompassing cardiovascular capacity, strength, and coordination training. To evaluate changes in hydration and body cell mass, the differences in the R and Xc parameters, adjusted for height, were compared using BIVA confidence software. The results showed notable changes: resistance decreased after the exercise program, while reactance increased. BIVA, as a classification method, can effectively categorize patients into dehydration, overhydration, normal, athlete, thin, cachectic, and obese categories. This makes it a valuable tool for assessing RA patients, as it provides information independent of body weight or prediction equations. Overall, the implementation of BIVA in this study shed light on the effects of the exercise program on hydration and body cell mass in RA patients. Its advantages lie in its ability to provide comprehensive information and overcome the limitations of traditional body composition assessment methods.

Author Spotlight: Implementation of BIVA for Analyzing Disease Risk Factors in Patients with Low Body Cell Mass 

Evaluation of Changes in Hydration and Body Cell Mass with Bioelectrical Impedance Analysis after Exercise Program for Rheumatoid Arthritis Patients

The research aims to demonstrate the utility of the vector impedance analysis for assessing change in hydration in body cell mass in patients with rheumatoid arthritis, and to investigate the benefits of physical exercise for this population. Recent research has shown that patients classified with low body cell mass, using bioelectrical impedance vector analysis, have an increased risk of infections and service predictors for cardiovascular diseases. This findings indicate that patients with lower cellular mass as determined by vectorial bioelectrical impedance analysis have a high risk of infections.Additionally, we have observed that physical exercise improves strength and quality of life and reduces inflammation in patient with rheumatoid arthritis. Assessing body composition through vectorial analysis of bioelectrical impedance will enable informed decision in pharmacological treatment. Additionally, integrating physical exercise as part of the treatment aims to prevent or improve a specific alteration associated with changes in body composition.It is crucial to evaluate the long-term effects of body composition alterations in patients with rheumatoid arthritis and demonstrate the effectiveness of physical exercise in increasing cellular mass, which is the most metabolically active human body compartment, which provides a greater functional reserve associated with better prognosis.

Results are presented for six female patients with RA who participated in a 48 session dynamic exercise program. The mean age of the patients was 52.7 &#177; 13.1 years, and their BMI was 26.8 &#177; 4.6. The average disease duration was 15.5 &#177; 6.1 years, and the disease activity, measured by Disease Activity Score 28, was classified as low activity with an average of 1.9 &#177; 1. Regarding disability, the Health Assessment Questionnaire Disability yielded an average score of 0.5 &#177; 0.3. For the six participant...

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This protocol assesses alterations in hydration and body cell mass status using bioelectrical impedance vectorial analysis following a dynamic exercise program designed for patients with rheumatoid arthritis. The dynamic exercise program itself is detailed, highlighting its components focused on cardiovascular capacity, strength, and coordination. The protocol details steps, instruments, and limitations.

Rheumatoid arthritis (RA) is a debilitating disease that can result in complications such as rheumatoid cachexia. While physical exercise has shown ...

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Research

JoVE Journal

Medicine

Pre-Test and Bioelectrical Impedance Analysis Measurement for Participant Classification in Cachexia Study

To begin, ask the patient to remove both shoes, the right sock, and any metal objects that are in contact with their skin position. The patient's supine for five minutes with extended arms and legs. Clean the back of the hand and the right foot with 70%alcohol.To classify cachexia by BIVA, download the BIVA tolerance Rxc Graph software, and open it. Go to the second worksheet titled Reference Populations and choose a row that corresponds to the reference population. Then copy and paste it into the second row highlighted in yellow.Next, go to the fifth worksheet titled Subjects:and in column A, enter the patient's ID;And in column B, enter the number one. In column E, using M for men and F for women, enter the patient's sex. In columns F and G, input the previously noted resistance and reactance values at 50 kilohertz.Then enter height in centimeters and weight in kilograms in the next two columns. In column J, enter the number corresponding to the reference population chosen in the second worksheet. Following this, in column K, input a number between one and 10 for the point graph sheet.Enter the patient's age in the next column. From the options bar at the top of the software, click on the compliments, then select the calculate option and click it. Next, navigate to sheet three Point graph to observe a BIVA graph according to the chosen reference population.Upon seeing a dialogue box, select the group code entered in column K, then click OK.A BIVA graph is displayed with the patient's vector drawn as a geometric figure. Next, observe the tolerance ellipses of 50, 75, and 95%in the quadrants I, II, III, and IV in the BIVA graph.

Dynamic Exercise Program for Evaluation of Joint Health in Rheumatoid Arthritis Patients

Before beginning the exercise session, ask the patients to describe any pain or discomfort felt in their joints. Next, for the upper extremity warmup, instruct the patient to reach a range of motion with no discomfort for each joint movement. For the lower extremity, guide the patient to perform warmup exercises in a standing position with both feet grounded on a stable surface.Then instruct the patient to reach a non-painful movement. Speed through the range of motion for each joint while sitting on the chair in the setup phase. Instruct the patient to perform functional movement patterns with more than two joints per segment.Initiate the work phase by setting a comfortable walking speed for the patient on the treadmill. After five minutes, adjust the speed while concurrently measuring the heart rate. With a pulse oximeter, increase the speed until reaching a heart rate zone between 55 and 75%of the maximum heart rate.After 10 minutes, assess the patient using a perceived effort rating scale for the final five minutes. Lower the treadmill speed to a comfortable pace for the patient. Next, perform upper extremity mobility resistance exercises while handling a wooden stick with both hands.After teaching the patient combined exercises encompassing the range of motion for more than two joints. Instruct the patient to place one end of the resistance band on the floor and step on it with their foot. Then perform elbow flexion against the band's resistance.For lower extremity exercises, have the patient sit in a stable chair with 90 degree hip and knee flexion. Then perform hip flexions for each leg up to 20 to 30 degrees above the starting position. Then ask the patient to perform a slight hip flection above 10 degrees from the base position, followed by a hip abduction.Lastly, lead the patient to return at a slow tempo to the base position. Next, make a soccer goal by placing two chairs approximately 1.3 meters apart. Direct the patient to kick a 30 centimeter plastic at a three meter spot in front of the soccer goal.Finally, gently perform a global stretch for cooling without putting stress on the joints. Participants who did not undertake the exercise program had a similar disease activity, but a slightly higher average age and BMI. No changes were made to any patient's pharmacological treatment during the intervention period.Before the exercise, all patients were classified as cachexia and had an average resistance of 630 and a reactance of 46. After exercise, the patients were reclassified as normal with an average resistance of 577 and reactants of 57. The patients who did not participate in the exercise program showed a shift in BIVA classification toward cachexia.Over six months, implementing the dynamic exercise program resulted in a decrease in resistance per height and an increase in reactance per height. No statistically significant changes were observed in the group that did not undergo the exercise program.

774 Views.  National Autonomous University of Mexico.  This protocol assesses alterations in hydration and body cell mass status using bioelectrical impedance vectorial analysis following a dynamic exercise program designed for patients with rheumatoid arthritis. The dynamic exercise program itself is detailed, highlighting its components focused on cardiovascular capacity, strength, and coordination. The protocol details steps, instruments, and limitations.

Developing an Exercise Program for Rheumatoid Arthritis Patients

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