Background/Purpose: Older persons with rheumatoid arthritis (RA) are at increased risk for sarcopenic obesity, physical disability, adverse drug events, and cardiovascular disease; thus, there is a need for novel, non-pharmacologic interventions to improve clinical care in this patient population. Weight loss and exercise training have well-established benefits of improving clinical outcomes in non-RA populations; however, the effects of combined lifestyle interventions for older patients with RA are understudied. In this randomized controlled trial of older patients with RA and overweight/obesity, our goal was to identify the effects of a remotely supervised weight loss and exercise training (SWET) intervention on disease activity and patient reported outcomes.

Methods: Older (age 60-80 years), previously sedentary participants with RA and overweight/obesity (BMI 28-40 kg/m²), who all satisfied 2010 ACR/EULAR RA classification criteria, were randomized to 16 weeks of SWET or a counseling health as treatment (CHAT) control group. The SWET intervention group completed aerobic training (150 minutes/week moderate-to-vigorous exercise), resistance training (2 days/week), and a hypocaloric diet (7% weight loss target). The CHAT control group completed 2 baseline visits of diet and exercise counseling followed by usual care. Baseline and post-intervention assessments included body composition assessment (BOD POD®), minimal waist circumference measurement, muscle strength assessment (isometric knee extension), RA disease activity (DAS-28-CRP) assessment, and Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires. Within group pre- versus post-intervention changes were assessed using Wilcoxon signed rank tests. Between group comparisons of outcome absolute change (post – pre) were assessed using regression modeling controlling for the baseline outcome. Relationships were assessed using Spearman’s correlations. Statistical significance for the primary outcome (between group changes in DAS-28-CRP) was established at p< 0.05.

Results: Compared to the CHAT control group (n=10, 9 female, mean age 65.6±5.4), older RA participants who completed the remotely supervised SWET intervention (n=10, 7 female, mean age 67.7±5.4) significantly improved DAS-28-CRP (p=0.03) (Table 1). SWET group participants also comparatively improved patient reported outcomes, including physical health, physical function, mental health, and fatigue (p< 0.05 for all) (Table 1). Decreases in DAS-28-CRP among all participants (n=20) were associated with decreases in waist circumference (rho=0.48, p=0.03) and increases in leg muscle strength (rho=-0.57, p=0.01).

Conclusion: In older participants with RA and overweight/obesity, when compared to a lifestyle counseling control intervention, a remotely supervised weight loss and exercise training intervention significantly improved RA disease activity and multiple patient-reported assessments of overall health. Results of this randomized control trial support the use of multifaceted lifestyle interventions in the usual clinical care of older patients with RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/remotely-supervised-weight-loss-and-exercise-training-improves-disease-activity-and-patient-reported-outcomes-in-older-patients-with-rheumatoid-arthritis/