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21-02-2020 | Rheumatoid arthritis | News

RA patients respond well to personalized physical exercise programs

Hannah Kitt

medwireNews: People with rheumatoid arthritis (RA) benefit from individually-tailored physical exercise programs, with improvements seen after 3 months across a range of variables including cognitive function, cardiovascular fitness, muscle strength, and body composition, researchers report.

“Many of these variables correlate directly with mortality, and all are associated with significant morbidity in RA populations,” say Maha Azeez (St James’s Hospital, Dublin, Ireland) and colleagues, who propose that “[a] structured exercise programme should be an integral part of chronic disease management protocols for patients with RA.”

The randomized controlled trial included 45 individuals, 24 of whom were enrolled in a personalized 3-month exercise program, individually created in response to their baseline cardiovascular fitness, strength, and perceived ability. The remaining 21 patients received standard care whereby their physician informed them of the benefits of exercise.

Over 3 months, patients enrolled in the exercise program had a significant improvement in cognitive function. Their Montreal Cognitive Assessment (MoCA) scores increased from a median of 25.5 at baseline, indicative of cognitive impairment, to 28.0 at 3 months, which the investigators say sits “comfortably within the normal range.”

By comparison, patients assigned to standard care saw some improvement in cognition but the increase in MoCA score from 25.0 at baseline to 27.0 at month 3 was not statistically significant.

“Our finding of improved MoCA scores in this RA population is novel,” stresses the team, adding: “No medication has been proven to reduce the risk of dementia or age-related cognitive impairment in RA patients.

“Structured physical exercise appears to be an important non-pharmacological intervention in this domain.”

In addition, after 3 months of following their personalized exercise program, patients’ maximal oxygen consumption, a “strong and independent predictor of cardiovascular disease and overall mortality,” significantly improved from 23.2 mL/kg/min to 27.6 mL/kg/min, the researchers report.

Again, there was no significant change in this variable among those patients receiving standard care.

Positive changes in body composition occurred as a result of the exercise program, with a median 2.6 cm decrease in waist circumference, from 94.0 cm to 91.4 cm, and a 2.5% reduction in truncal fat. The team notes that both of these variables “correlate well with visceral fat,” which carries an increased risk for cardiovascular disease.

Improved muscle strength was also reported, with a significant 1–2 kg increase in left and right handgrip strength. This is noteworthy considering the fact that “handgrip strength and function is a major cause of disability in patients with RA,” highlight the investigators in Clinical Rheumatology.

Fatigue, a common barrier to exercise, was reduced after 3 months among those in the intervention group, as was disease activity, with reductions seen in the global fatigue index and DAS28 scores. Improved quality of life was also reported.

Overall, the researchers conclude that “the completion of a personalized 3-month exercise programme has considerable benefits for RA patients with stable disease and should inform future designs of management and clinical trial protocols.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group

Clin Rheumatol 2020; doi: 10.1007/s10067-020-04937-4

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