Background/Purpose:
Increased morbidity and mortality are recognized consequences of rheumatoid arthritis (RA). In addition to chronic inflammation, reduced physical activity may contribute to adverse outcomes in these patients. This study was undertaken to assess the impact of a targeted, exercise intervention on health outcomes in RA.
Methods:
Patients with established, well-controlled RA were recruited. Baseline assessments relating to cardiovascular risk factors, body composition, disability, sleep quality and physical activity were ascertained using standardized measures. Exercise was then prescribed in order to a) target individual functional limitations as identified by the Health Assessment Questionnaire (HAQ) and b) increase each patients’ physical activity according to the American College of Sports Medicine recommendations.
Patients were assessed every 3 weeks for 12 weeks by a rheumatologist and physical therapist. Compliance was aided by the provision of an exercise diary and a pedometer. All parameters were re-measured at the completion of the 12 week program. Ethical approval was obtained from the St James’s Hospital Ethics Committee. Statistical analysis was undertaken using SPSS 18.
Results:
Results
Forty patients with RA (mean age 46 years) (SD8.0) and mean disease duration of 15.6 years (SD 10.9) were included. Thirty (75%) were seropositive and 38 (95%) had evidence of erosive disease. All fulfilled the ACR diagnostic criteria for RA. Twenty nine (72.5%) were current/ex-smokers. All (100%) were taking disease-modifying treatment; 10 (25%) were on biologic agents. Mean body mass index was 27.1 (SD 5.2). At baseline, only 2 (5%) were involved in any form of exercise.
|
|
Pre-intervention |
Post intervention |
Significance |
|
HAQ |
0.81 (SD 0.38) |
0.53 (SD 0.54) |
0.000 |
|
Grip (lbs pressure) (R) |
28.87 (SD 18.29) |
33.87 (SD 18.19) |
0.000 |
|
Grip (lbs pressure) (L) |
25.15 (SD 15.83) |
28.23 (SD 19.54) |
0.000 |
|
Pain (VAS) |
28.66 (SD 21.79) |
20.83 (SD18.03) |
0.000 |
|
Stiffness (VAS) |
31.71 (SD 22.77) |
23.83 (SD 23.82) |
0.000 |
|
EBBS (range 43-172) |
125.9 (SD 5.5) |
131.5 (SD 9.4) |
0.000 |
|
PSQI (range 0-21) |
7.21 (SD 4.45) |
6.22 (SD 3.58) |
0.000 |
|
FSS (range 1-81) |
37.89 (SD 25.58) |
26.64 (SD 21.88) |
0.000 |
|
FFM (kg) |
44.76 (SD 9.38) |
45.40 (SD 9.22) |
0.005 |
|
BMI (kg/m2) |
27.15 (SD 5.23) |
26.97 (SD 4.93) |
0.316 |
|
Total cholesterol(mmol/L) |
4.86 (SD 0.83) |
4.72 (SD 0.68) |
0.018 |
|
LDL- cholesterol (mmol/L) |
2.78 (SD 0.72) |
2.65 (SD 0.59) |
0.018 |
|
HDL- cholesterol (mmol/L) |
1.44 (SD 0.33) |
1.42 (SD 0.34) |
0.571 |
EBBS: Exercise barriers and benefits scale, PSQI: Pittsburgh Sleep Quality Index, FFS: Fatigue Severity Scale, FFM: Fat Free Mass
Conclusion:
A 12 week targeted exercise program yielded significant improvements in strength, pain, joint stiffness, sleep, fatigue and lipid profile, impacting on both health and quality of life in patients with RA. Although fat free mass measurements improved significantly, there was no major change in BMI suggesting that dietary adjustments may be a necessary accompaniment to a sustained exercise program in order to effect weight loss in overweight patients with RA.
Disclosure:
L. J. Durcan,
None;
F. Wilson,
None;
F. D. O’Shea,
None;
G. Cunnane,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-targeted-exercise-intervention-on-health-outcomes-in-rheumatoid-arthritis/