Exercise enhancement among Rheumatoid Arthritis patients: Research from the Brigham and Women’s Hospital Rheumatoid Arthritis Sequential Study

Iverson MD, Frits M, von Heideken J, Weinblatt M, Shadick NA.  Physical activity and correlates of physical activity participation over three years in adults with rheumatoid arthritis.  Arthritis Care Res (Hoboken) 2017;69(10):1535-1545. PMCID:PMC5436948

The Brigham and Women’s Hospital Rheumatoid Arthritis Sequential Study (BRASS) was founded 14 years ago by Drs. Nancy A. Shadick and Michael Weinblatt to study genetic and clinical predictors of disease activity, biomarkers of disease response, and the natural history of patients with rheumatoid arthritis (RA) treated in the biologic DMARD era. Over 1,400 patients with either new onset or established RA disease have been recruited from the practices of Brigham and Women’s Hospital rheumatologists.  At annual visits, information is collected on multiple variables, including demographics, disease activity score (DAS), medication use, co-morbidities, and functional status. More than 1,200 clinical variables are collected at each six month timepoint, which allows for the generation of extensive phenotyping and clinical analyses.

One avenue of inquiry in the BRASS Registry has concerned the patterns of exercise among patients with RA, their attitudes toward such activity, and the predictors of participation in physical activity. Drs. Shadick and Maura Iversen recently published a study can add the citation and link it to the paper? see below for citation the effects of moderate to vigorous physical activity and RA disease activity. They investigated the clinical, demographic and psychosocial correlates of successfully meeting the physical activity recommendations from the CDC Office of Disease Prevention and Health Promotion, which suggest at least 150 minutes of moderate physical activity or 75 minutes of vigorous activity each week.

This study found that among patients in BRASS with relatively well controlled disease (average DAS score of 3.1), 36% were physically inactive and only 29% met the recommendations for moderate to vigorous physical activity, mostly in the moderate category. Caucasian subjects were more likely than other races to achieve the recommended levels of activity. Older adults, those with worse mental health, poorer physical function, higher BMI, and those who perceived their disease to be more severe were less likely to be physically active.  The overall results demonstrated that higher DAS scores were associated with being less physically active

The study highlights an undertreated aspect of the management of the patient with RA, and emphasizes the importance of formulating exercise recommendations that would meet minimal guidelines for physical activity. Rheumatologists have focused on careful management of RA through pharmacologic means, but physical activity prescriptions are likely critical for improving long-term function and reducing cardiovascular risk.  We are now working on what those prescriptions should be for patients with RA and how those will translate into changes in physical activity.