Session Type: Abstract Submissions (ACR)
Rheumatoid Arthritis (RA) patients have lower levels of physical activity compared to their non-RA counterparts. Large proportions of patients with RA are overweight or obese, and exhibit poor cardio-respiratory fitness and reduced muscle strength. These factors have been associated with poor function and increased mortality. A less well studied but important co-morbidity that affects RA patients is cognitive impairment, which can have a negative impact on patients’ ability to manage their disease. We aimed to investigate the effects of a specifically designed exercise programme on body composition, aerobic capacity, muscle strength and cognition in RA patients.
Sixty-six patients with RA were randomised on a 1:1, case:control ratio. Assessments included body composition (waist circumference), fitness (VO2max), muscle strength (hand-grip) and cognitive testing (Montreal Cognitive Assessment), in addition to disease related measures. Patients in the intervention group were enrolled for a three-month exercise programme. The control group received standard care.
Twenty-eight cases and 24 controls attended for baseline testing. Seven patients were subsequently lost to follow up (4 cases and 3 controls). There were significant improvements in several measured outcomes in the intervention group compared to controls after three months. Median waist circumference was significantly reduced in cases, with median value 94.0 cm (range 67.3-124.5) at 0 months, compared to 91.4 cm (range 66.0-124.5) at 3 months, (2.8% reduction, p<0.0001). Aerobic capacity, as measured by VO2max, for cases was 23.2 ml/kg/min at 0 months compared to 27.6 ml/kg/min at 3 months (19% increase, p=0.002). Median right grip strength was 12kg (0-23) at 0 months, compared to 13kg (0-30) at 3 months (8.3% increase, p=0.025). For left grip strength, the median value was 8kg (0-20) at 0 months, compared to 10kg (0-32) at 3 months (25% increase, p=0.005). There was a significant improvement in cognitive function for cases, with median Montreal Cognitive Assessment value 25.5 (20-30) at 0 months compared to 28.0 (22-30) at 3 months (10% increase, p=0.001). There was also a significant reduction in C-reactive protein (median 2.8, range 1.0-27.4 at 0 months compared to 1.9, 1.0-18.4, at 3 months, equating to a reduction of 32.1%, p=0.025). Fatigue scores, measured by Global Fatigue Index were reduced from median 13.2 (range 6.4-34.1) at 0 months, to 10.9 (6.5-37.5) at 3 months (p=0.047). There was a significant reduction in trunk fat at 3 months (median 37.3, range 16.3-56.9) compared to 36.2, range 16.3-56.5 (p=0.004). For all above measures, there was no significant difference in median control values at 3 months.
There are significant benefits associated with physical activity for both general health and RA-related parameters, as evidence by the current data. This study has demonstrated for the first time that exercise has a significant impact on cognitive function in RA. We can conclude that physical activity is safe and effective in RA patients and should be a vital component of management protocols.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-exercise-on-body-composition-cardiovascular-fitness-muscle-strength-and-cognition-in-patients-with-rheumatoid-arthritis-a-randomised-controlled-trial-of-a-patient-specific-exercise-prog/