Exercise-based and mind-body rehabilitation strategies to improve cardiovascular autonomic control in rheumatologic diseases
14 affiliations
- 14Health Lab: Physiology, Research & Innovation for Precision Health, Department of Physiology and Pharmacology, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
- 2Section of Rehabilitation, Department of Neuroscience-DNS, University of Padova, Padova, Italy
- 3University of Poitiers, Laboratory « Mobilité, Vieillissement, Exercice » (MOVE)-UR 20296, Faculty of Sports Sciences, Poitiers, France
- 4Department of Applied Sciences and Mechatronics, University of Applied Science Munich, München, Germany
- 5Klinikum Bad Gastein, Bad Gastein, Austria
- 6Department of Medical Psychology, Psychosomatics and Psychotherapy, Medical University of Graz, Graz, Austria
- 7Center of Rehabilitation, Physical and Sport Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- 8Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- 9Department of Psychology, Luther College, Decorah, IA, United States
- 100Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- 111Institute of Biomedical Electronics, Vienna University of Technology (TU Wien), Vienna, Austria
- 122Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
- 133Institut für Physikalische Medizin und Rehabilitation, Landeskrankenhaus-Universitätsklinikum, Innsbruck, Austria
- 144Klinikum am Kurpark, Baden, Austria
Abstract
Rheumatologic diseases (RDs) are chronic autoimmune and inflammatory conditions associated with increased cardiovascular risk and autonomic nervous system dysfunction, typically characterized by sympathetic predominance, reduced vagal tone, and persistent inflammation. This narrative review synthesizes current evidence on exercise-based and mind-body rehabilitation strategies aimed at improving cardiovascular autonomic control in RDs, including rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, systemic sclerosis, and fibromyalgia. We examine the physiological mechanisms linking these interventions to autonomic regulation and inflammatory modulation, drawing upon the inflammatory reflex framework. Aerobic exercise training demonstrates consistent benefits for cardiovascular autonomic control, including enhanced heart rate variability, improved heart rate recovery, and reduced inflammation, though effects are reversible upon cessation. Resistance training improves pain and physical function but shows equivocal effects on autonomic outcomes. Balneotherapy and aquatic exercise may enhance parasympathetic activity, though responses are temperature-dependent and highly individualized. Mind-body interventions, including yoga, mindfulness, and breathing exercises, show promise for improving symptom burden and cardiac vagal modulation, with slow-paced breathing demonstrating particularly consistent acute and chronic autonomic benefits. Emerging evidence supports transcutaneous auricular vagus nerve stimulation as a non-invasive modality capable of modulating inflammation and reducing pain, though effects on cardiac autonomic control remain inconsistent across RDs populations. Key challenges include high inter-individual variability in treatment responses, poor long-term adherence, and frequent dissociation between subjective clinical improvement and objective autonomic measures. This review identifies critical knowledge gaps and proposes future research directions to optimize rehabilitation protocols for cardiovascular protection in RDs.
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BibTeX
@article{rodrigues2026exercisebased,
title = {{Exercise-based and mind-body rehabilitation strategies to improve cardiovascular autonomic control in rheumatologic diseases}},
author = {Gabriel Dias Rodrigues and Maria Chiara Maccarone and Benoit Dugué and Chirstian Hanshans and Renata Cop and Sabrina Mörkl and Goda Camille Mickeviciute and Konstantinos Triantafyllias and Loren Toussaint and Jameson Hirsch and Eugenijus Kaniusas and Richard Crevenna and Erich Mur and Christian Wiederer and Martin Offenbächer and Martin Offenbächer},
journal = {Frontiers in Medicine},
year = {2026},
month = nov,
doi = {10.3389/fmed.2026.1846075},
url = {https://doi.org/10.3389/fmed.2026.1846075},
note = {CC BY},
}
RIS
TY - JOUR
TI - Exercise-based and mind-body rehabilitation strategies to improve cardiovascular autonomic control in rheumatologic diseases
AU - Gabriel Dias Rodrigues
AU - Maria Chiara Maccarone
AU - Benoit Dugué
AU - Chirstian Hanshans
AU - Renata Cop
AU - Sabrina Mörkl
AU - Goda Camille Mickeviciute
AU - Konstantinos Triantafyllias
AU - Loren Toussaint
AU - Jameson Hirsch
AU - Eugenijus Kaniusas
AU - Richard Crevenna
AU - Erich Mur
AU - Christian Wiederer
AU - Martin Offenbächer
AU - Martin Offenbächer
PY - 2026
DA - 2026/11/04
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1846075
UR - https://doi.org/10.3389/fmed.2026.1846075
AB - Rheumatologic diseases (RDs) are chronic autoimmune and inflammatory conditions associated with increased cardiovascular risk and autonomic nervous system dysfunction, typically characterized by sympathetic predominance, reduced vagal tone, and persistent inflammation. This narrative review synthesizes current evidence on exercise-based and mind-body rehabilitation strategies aimed at improving cardiovascular autonomic control in RDs, including rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, systemic sclerosis, and fibromyalgia. We examine the physiological mechanisms linking these interventions to autonomic regulation and inflammatory modulation, drawing upon the inflammatory reflex framework. Aerobic exercise training demonstrates consistent benefits for cardiovascular autonomic control, including enhanced heart rate variability, improved heart rate recovery, and reduced inflammation, though effects are reversible upon cessation. Resistance training improves pain and physical function but shows equivocal effects on autonomic outcomes. Balneotherapy and aquatic exercise may enhance parasympathetic activity, though responses are temperature-dependent and highly individualized. Mind-body interventions, including yoga, mindfulness, and breathing exercises, show promise for improving symptom burden and cardiac vagal modulation, with slow-paced breathing demonstrating particularly consistent acute and chronic autonomic benefits. Emerging evidence supports transcutaneous auricular vagus nerve stimulation as a non-invasive modality capable of modulating inflammation and reducing pain, though effects on cardiac autonomic control remain inconsistent across RDs populations. Key challenges include high inter-individual variability in treatment responses, poor long-term adherence, and frequent dissociation between subjective clinical improvement and objective autonomic measures. This review identifies critical knowledge gaps and proposes future research directions to optimize rehabilitation protocols for cardiovascular protection in RDs.
SN - 2296-858X
ER -