In a recent study led by Dr. Brian J. Andonian from Duke University, researchers found that a combination of remote, supervised aerobic training, resistance training, and a hypocaloric diet led to significant improvements in cardiovascular risk factors for adults with rheumatoid arthritis (RA) who also had overweight or obesity.
Methodology:
The study involved 24 adults aged 60-80 years with RA and met criteria for overweight or obesity. Participants were randomly assigned to either a Supervised Weight Loss and Exercise Training (SWET) program or a Counseling Health as Treatment (CHAT) program, lasting for 16 weeks. The SWET intervention included remote supervision of 150 minutes/week of moderate-to-vigorous intensity aerobic training, two days per week of resistance training, and a hypocaloric diet aiming for a 7% body weight loss. The CHAT group, serving as controls, underwent two lifestyle counseling sessions followed by monthly check-ins.
Primary Outcome:
The primary outcome measured the change in a composite cardiovascular risk based on the metabolic syndrome z-score (MSSc), a continuous weighted score considering five metabolic syndrome components: waist circumference, mean arterial blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol.
Key Findings:
Both groups exhibited improvement in the primary outcome of MSSc, with absolute changes from baseline of -1.67 for the SWET group and -1.34 for the CHAT group (P < .01 for both).
SWET participants showed significantly greater improvements in secondary outcome measures, including body weight, fat mass, disease activity score in 28 joints based on C-reactive protein (DAS28-CRP), patient-reported physical and mental health, physical function, and fatigue.
CHAT group also showed significant improvement compared to their baseline, although not as pronounced as the SWET group.
Specific effects of the intervention components were noted, such as aerobic training on physical function and fatigue, resistance training on DAS28-CRP, and weight loss on MSSc.
Neither group experienced significant changes in lean mass, absolute peak V02, unilateral isometric knee extension, or bilateral grip strength.
Implications for Practice:
The researchers highlighted that integrating even 2 hours of healthy lifestyle counseling may improve RA management. The comprehensive, remotely supervised lifestyle intervention demonstrated substantial impacts on various aspects of health.
Source and Limitations:
The study, published online on December 21, 2023, in ACR Open Rheumatology, was supported by the US National Institute of Arthritis and Musculoskeletal and Skin Diseases and the Claude D. Pepper Older Americans Independence Center of the US National Institute on Aging. The study acknowledged limitations, including a small sample size and the lack of blinding. The high level of motivation in the CHAT group also influenced outcomes, and the study was conducted during the COVID-19 pandemic, potentially impacting participants’ physical and mental health.
Disclosures:
The study received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases and the Claude D. Pepper Older Americans Independence Center of the US National Institute on Aging.