From Intention to Maintenance: A Two-Year Examination of Clinical and Lifestyle Changes in Rheumatoid Arthritis.

OBJECTIVE: To evaluate the long-term impacts of a 16-week remotely supervised exercise and weight loss intervention for rheumatoid arthritis (Supervised Weight Loss and Exercise Training in Rheumatoid Arthritis [SWET-RA]). METHODS: In total, 21 older adults with RA completed the SWET-RA parent trial; 17 of 21 completed an exit survey. Approximately two years after study completion, 14 of 19 eligible participants (mean age 68.9 years) returned for the SWET-RA Reunion. Reunion participants completed surveys on sustained health behaviors and barriers to maintenance. Clinical assessments were evaluated relative to pre-intervention values and included anthropometrics, RA disease activity (Disease Activity Score in 28 joints [DAS-28]), blood biomarkers, and patient-reported outcomes. RESULTS: At study completion, most participants reported improvements in RA (n = 15) and intended to maintain health behaviors (n = 17). At the two-year Reunion, 50% engaged in aerobic activity regularly, whereas resistance training (21.4%) and dietary self-monitoring (14.3%) were less maintained. Barriers included lack of self-motivation and illness. In total, 10 of 14 participants experienced sustained improvements in RA disease activity without increasing medication. Among the 12 not increasing RA medication, DAS-28 C-reactive protein significantly improved (Δ = -1.0 ± SD 0.9, P = 0.002). Cardiometabolic risk, assessed via metabolic syndrome Z score, improved significantly for participants not increasing related medications (Δ = -1.6 ± SD 2.4, P = 0.05). CONCLUSION: Two years post-intervention, only half of the older adults with RA maintained aerobic exercise, with fewer sustaining resistance exercise and self-monitoring dietary intake. Nonetheless, compared to pre-intervention, long-term improvements in RA disease activity and cardiometabolic risk were present. These findings support the inclusion of lifestyle programs in comprehensive RA management.

Duke Scholars

Author Katherine Collins-Bennett Population Health Sciences

Author William Erle Kraus Medicine, Cardiology

Author Leanna Ross Medicine, Cardiology

Author Kim Marie Huffman Medicine, Rheumatology and Immunology

Author Connie Watkins Bales Medicine, Geriatrics and Palliative Care

Author Ilene C. Siegler Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...

Author Brian Andonian Medicine, Rheumatology and Immunology