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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 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.
Rheumatoid arthritis (RA) is a disabling disease that affects patients' 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 bod....
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 Zubirán (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.......
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 ± 13.1 years, and their BMI was 26.8 ± 4.6. The average disease duration was 15.5 ± 6.1 years, and the disease activity, measured by Disease Activity Score 28, was classified as low activity with an average of 1.9 ± 1. Regarding disability, the Health Assessment Questionnaire Disability yielded an average score of 0.5 ± 0.3. For the six participant.......
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
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 t....
Name | Company | Catalog Number | Comments |
Alcohol 70% swabs | NA | NA | Any brand can be used |
bicycle ergometer | NA | NA | Any brand can be used |
BIVA tolerance software 2002 | NA | NA | Is a sofware created for academic use, can be download in http://www.renalgate.it/formule_calcolatori/bioimpedenza.htm in "LE FORMULE DEL Prof. Piccoli" section |
BIVA confidence software | NA | NA | Is a sofware created for academic use, can be download in http://www.renalgate.it/formule_calcolatori/bioimpedenza.htm in "LE FORMULE DEL Prof. Piccoli" section |
Chair | NA | NA | Any brand can be used |
Chlorhexidine | NA | NA | Any brand can be used, 0.05% |
Examination table | NA | NA | Any brand can be used |
Leadwires square socket | BodyStat | SQ-WIRES | |
Long Bodystat 0525 electrodes | BodyStat | BS-EL4000 | |
Plastic ball | NA | NA | Any brand can be used, 30 cm |
Pulse oximeter | NA | NA | Any brand can be used |
Quadscan 4000 equipment | BodyStat | BS-4000 | Impedance measuring range: 20 - 1300 Ω ohms Test Current: 620 μA Frequency: 5, 50, 100, 200 kHz Accuracy: Impedance 5 kHz: +/- 2 Ω Impedance 50 kHz: +/- 2 Ω Impedance 100 kHz: +/- 3 Ω Impedance 200 kHz: +/- 3 Ω Resistance 50 kHz: +/- 2 Ω Reactance 50 kHz: +/- 1 Ω Phase Angle 50 kHz: +/- 0.2° Calibration: A resistor is supplied for independent verification from time to time. The impedance value should read between 496 and 503 Ω. |
Resistence bands | NA | NA | Any brand can be used, with resistence of 0.5 kg to 3.2 kg |
Stationary bicycle | NA | NA | Any brand can be used |
Treadmill | NA | NA | Any brand can be used |
Wooden stick | NA | NA | Any brand can be used, 1.5m in large and <1kg |
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