Abstract 17793: Remotely Delivered Weight Loss and Exercise Intervention to Improve Cardiovascular Risk in Older Patients With Rheumatoid Arthritis

Persons with rheumatoid arthritis (RA) face two-fold increases in CVD, due to traditional risk factors - e.g., hypertension, dyslipidemia, obesity, and physical inactivity - and RA systemic inflammation. Despite improvements in pharmacologic management of inflammatory disease activity, the increased prevalence of RA CVD persists. Thus, developing innovative, non-pharmacologic interventions to improve clinical care is critical. The goal of the SWET-RA trial was to identify the effects of a 16-wk remotely supervised weight loss and exercise training (SWET) intervention on metabolic syndrome in older persons (60-80 years) with RA and overweight/obesity (BMI 28-40 kg/m ). Participants were randomized to SWET (n =10) or a counseling health as treatment (CHAT) control group (n=10). Using video conference and mobile applications, the SWET group completed aerobic training (150 min/wk moderate-to-vigorous), resistance training (2 days/wk), and a hypocaloric diet (7% weight loss goal). The CHAT group completed two counseling visits for diet and exercise followed by monthly check-ins. Metabolic syndrome -scores (MSSc) were derived from fasting glucose, triglycerides (TG), HDL-cholesterol (HDL-C), waist circumference (WC), and mean arterial pressure. Within groups, Wilcoxon signed rank tests assessed significance of post- minus pre-intervention change scores (p<0.05). Between group comparisons were assessed using regression modeling controlling for baseline. Following the intervention, the SWET group significantly improved TG and WC, yet reduced HDL-C; the CHAT group did not improve individual score components. Both groups significantly improved MSSc, with no between group differences. Results from this trial support the use of a remotely delivered program for older persons with RA and overweight/obesity. Both SWET and CHAT elicited improvements in a composite measure of CVD risk. Although SWET exceeded CHAT for reductions in TG and WC, HDL-C was reduced in SWET - possibly due to the hypocaloric diet - and increased in CHAT, likely accounting for the lack of MSSc group difference. More research is needed to distinguish the specific effects of exercise versus diet and weight loss for improving RA CVD risk.

Duke Scholars

Author Leanna Ross Medicine, Cardiology