Rheumatoid arthritis (RA) is an inflammatory disease characterized by accelerated atherosclerosis and increased cardiovascular risk (1). Recent data indicate that physical activity (PA) is associated with reduced cardiovascular risk in RA (2); however, it is still unclear which factors underlie the cardioprotective role of PA in this population. The aim of this study was to investigate the associations between objectively-measured PA and cardiovascular risk factors (i.e. blood pressure [BP], fasting glucose and lipids and C-reactive protein) and vascular remodeling (i.e., carotid intima-media thickness [cIMT]) in RA. Thirty six post-menopausal women with RA (64±8 years, 28.6±7.7 kg.m-2) took part in this cross-sectional study. This study followed the principles of the Declaration of Helsinki and was approved by the local Institutional Ethics Committee. PA levels were assessed by means of a triaxial accelerometer. Time spent in sedentary, light-intensity and moderate-to-vigorous (MVPA) activities was determined using Freedson cutpoints (3). Blood samples following a 12-h fasting were taken to determine plasma glucose, lipid profile, and C-reactive protein. BP was assessed for 24 h using an ambulatory blood pressure monitor. Systolic and diastolic BP (SBP/DBP) mean levels and SBP/DBP load (% of values above normative values) were determined for 24-h, awake and asleep periods (4). cIMT was assessed using a high-resolution ultrasound (Logiq E, General Electric, USA). Patients remained in the supine position with their head slightly extended, while the transducer (3.0-10.0 MHz) was positioned perpendicularly to the orientation of the common carotid artery (CCA), 1-2 cm below the bifurcation, in the longitudinal plane (5). Measurements were performed in the far wall of the right CCA and were analyzed by the Cardiovascular Suite software (QUIPU, Italy). Pearson’s correlation coefficients were calculated to test the association between PA levels and BP, traditional cardiovascular risk factors and cIMT. Significance level was set at p≤0.05. Weekly MVPA (min/week) was negatively associated with mean cIMT (r=-0.49, p=0.02) and SBP load during sleep (r=-0.43, p=0.04). Daily steps were negatively associated with 24h-SBP (r=-0.43, p=0.04), asleep-SBP (r=-0.47, p=0.02), and SBP load during 24-h (r=-0.41, p=0.05), awake (r=-0.41, p=0.05) and asleep (r=-0.52, p=0.01) periods. Sedentary time and light-intensity PA were not associated with any cardiovascular parameter. In conclusion, higher MVPA levels associate with reduced ambulatory SBP and with improved vascular health in post-menopausal women with RA. This latter emerges a potential new mechanism by which PA may play a cardioprotective role in RA, a hypothesis that requires further validation in a prospective fashion.