Does Exercise and Lifestyle Modification Improve RA? Save
Does exercise or lifestyle modifications reduce the risk of getting rheumatoid arthritis (RA) or change those with early RA?. A current review and meta-analysis found no studies addressing benfit in pre-clinical RA, but found evidence that exercise improves few selected aspects of early RA.
They found not studies addressing exercise interventions in at-risk or pre-clinical RA. But they examined 15 studies involving 1154 participants wherein early RA was studied. There was a moderate-to-high risk of bias and they found significant benefits for strength, hand function, functional capacity, pain, and morning stiffness in early RA. No significant beneficial effect was seen for exercise on disease activity, morning stiffness or quality of life.
Major evidence gaps remain for cardiovascular fitness, fatigue, mental health, inflammation, and the pre-clinical population. Well-designed preventive and early-phase trials are needed.
What About Pre-Clinical RA?
I posed this question to Openevidence.com and found No randomized controlled trials of lifestyle interventions in pre-clinical RA (clinically suspect arthralgia / ACPA-positive at-risk individuals), as far as altering the progression to clinical RA.
But there exists potentially valuable information:
- "Plants for Joints" RCT protocol has been proposed and published - but to RCT results are available. This interventional 16 week trial will be a observer-blind, 2 arm RCT enrolling ACPA-positive (32 patients) individuals with arthralgia who wil be treated wtih a multidisciplinary lifestyle program combines a whole-food plant-based diet, exercise, and stress management. The primary outcome being change in an RA-risk score.
- VITAL trial - provides indirect evidence. VITAL trial (n=25,871) showed that vitamin D (2000 IU/day) ± omega-3 fatty acids (1 g/day) reduced the overall incidence of autoimmune diseases, including RA (a secondary endpoint).
- Nurses Health Study - found that women adhering to ≥4 of 5 healthy lifestyle factors (non-smoking, healthy BMI, physical activity, moderate alcohol, healthy diet) had a 58% lower RA risk (HR 0.42)
More research is needed on this subject.
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