Cardiovascular rehabilitation in rheumatoid arthritis: evidence and future directions

Rheumatoid arthritis is a chronic systemic autoimmune disease associated with increased cardiovascular disease risk and mortality. Patients with rheumatoid arthritis have a nearly two-fold higher risk of myocardial infarction, heart failure, and thromboembolic events compared to the general population, driven by systemic inflammation and conventional risk factors. Cardiovascular rehabilitation has emerged as a promising intervention, yet its role in rheumatoid arthritis remains underexplored. This review highlights the interplay between rheumatoid arthritis and cardiovascular risk, the pathophysiological mechanisms linking inflammation and vascular injury, and the potential benefits of structured cardiovascular rehabilitation programs. Evidence demonstrates that exercise training within cardiovascular rehabilitation reduces systemic inflammation, improves endothelial function, and enhances quality of life without worsening rheumatoid arthritis disease activity. Patient selection, timing of initiation, and tailoring modalities such as aerobics, resistance, and flexibility training are essential to ensure safety and efficacy. Despite strong evidence, barriers remain, including misconceptions about exercise safety, patient fatigue, and limited physician referral. eHealth tools and multidisciplinary collaboration between rheumatologists, cardiologists, physiatrists, and allied health professionals offer opportunities to overcome these barriers. Future research should focus on adapting cardiovascular rehabilitation protocols to rheumatoid arthritis-specific needs, clarifying referral criteria, and evaluating long-term outcomes. Integrating cardiovascular rehabilitation into standard rheumatoid arthritis management has the potential to reduce cardiovascular disease burden, improve physical function, and enhance overall patient well-being.