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Consequently, biological disease-modifying antirheumatic drugs (bDMARDs) may attenuate that risk. IL-6 is also a myokine, secreted from exercising skeletal muscles, where IL-6 exhibits anti-inflammatory effects that may ameliorate the risk of CVD. In healthy humans treated with IL-6 signalling inhibitors (IL-6i), exercise induced loss of visceral fat mass and cardiac adaptations were abolished. We hypothesise that IL-6 signalling inhibition will impair the cardiac and metabolic adaptions to exercise training compared with TNF inhibition in RA patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and analysis<\/jats:title><jats:p>80 RA patients treated with IL-6i (n=40) or TNF inhibitors (n=40) are included in a 12-week randomised investigator-blinded 4\u00d74\u2009min high-intensity interval training (HIIT) study. Patients are stratified for medical treatment and sex and allocated 1:1 to an exercise or a no exercise control group (four groups). The supervised exercise intervention comprises 3\u2009weekly HIIT sessions on an ergometer bicycle. The primary outcome is the change in left ventricular mass (LVM), and key secondary outcome is change in visceral fat mass. Both outcomes are measured by MRI. Primary statistical analysis will evaluate LVM at follow-up in a regression model. Intention-to-treat and per protocol analyses will be conducted. The latter necessitates a minimum attendance rate of 80%, adherence to bDMARDs treatment of \u226580% and minimum 8\u2009min (50%) of maximal heart rate above 85% per session.<\/jats:p><\/jats:sec><jats:sec><jats:title>Ethics and dissemination<\/jats:title><jats:p>The study has been approved by the Capital Region Ethics Committee (H-21010559 amendments 86424, 87463 and 88044) and the Danish Medicines Agency (2021-b005287-21). The trial will follow ICH-GCP guidelines. Regardless of outcome, results will be published in relevant peer-reviewed journals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration numbers<\/jats:title><jats:p>Eudra-CT: 2021-b005287-21 and<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05215509\">NCT05215509<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2022-068600","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T14:15:14Z","timestamp":1683814514000},"page":"e068600","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Effect of a 12-week high-intensity exercise intervention: a comparison of cardiac exercise adaptations during biological disease-modifying antirheumatic drug treatment (TNF inhibitors vs IL-6 signalling inhibitors) in patients with rheumatoid arthritis \u2013 study protocol for a randomised controlled trial"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct05215509","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6828-9398","authenticated-orcid":false,"given":"Simon","family":"J\u00f8nck","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0394-0722","authenticated-orcid":false,"given":"Malte Lund","family":"Adamsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pil","family":"H\u00f8jgaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iben Elmerdahl","family":"Rasmussen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helga","family":"Ellingsgaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten Asp Vonsild","family":"Lund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter Godsk","family":"J\u00f8rgensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren","family":"Jacobsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"K\u00f8ber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Vejlstrup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lene","family":"Dreyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bente Klarlund","family":"Pedersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5757-9506","authenticated-orcid":false,"given":"Ronan M G","family":"Berg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regitse H\u00f8jgaard","family":"Christensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,5,11]]},"reference":[{"key":"2023051107150623000_13.5.e068600.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)06075-5"},{"key":"2023051107150623000_13.5.e068600.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.07.010"},{"key":"2023051107150623000_13.5.e068600.3","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.143396"},{"key":"2023051107150623000_13.5.e068600.4","doi-asserted-by":"crossref","first-page":"e58","DOI":"10.1016\/S2665-9913(20)30221-6","article-title":"Cardiovascular risk in inflammatory arthritis: rheumatoid arthritis and gout","volume":"3","author":"Hansildaar","year":"2021","journal-title":"Lancet Rheumatol"},{"key":"2023051107150623000_13.5.e068600.5","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1038\/nrrheum.2017.49","article-title":"Immunometabolism in early and late stages of rheumatoid arthritis","volume":"13","author":"Weyand","year":"2017","journal-title":"Nat Rev Rheumatol"},{"key":"2023051107150623000_13.5.e068600.6","doi-asserted-by":"crossref","unstructured":"Guo Q , Wang Y , Xu D , et al . 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