targeted remotely-delivered anti-inflammatory interventions with exercise for rheumatoid arthritis

Conditions: Rheumatoid Arthritis

Summary: the primary objective of this study is to assess the feasibility of an intensive, remotely-delivered, combined aerobic and resistance training exercise program for patients with rheumatoid arthritis (ra) and to collect data to support power calculations for a larger research study.

the primary aim of this study is to assess the feasibility of an intensive, remotely-delivered, combined aerobic and resistance training exercise intervention program for patients with rheumatoid arthritis (ra) and to collect data to inform the design of a larger research study. this protocol will build upon a recent project, gathering additional data to support future grant applications. the findings will provide critical information for determining the design and appropriate sample size and ensuring sufficient statistical power for a larger study. additionally, this pilot will evaluate the practicality of implementing a remotely supervised exercise training intervention in early and active ra patients, helping to establish its potential for broader clinical use.

Eligibility criteria:
inclusion criteria: * persons with early ra - defined as duration of diagnosis equal to or less than 6 months, and prior to starting biologic disease modifying anti rheumatic drug (dmard) therapy * seropositive (positive rheumatoid factor or anti-citrullinated protein antibody) or erosions typical of ra on radiographs * history of fulfilling 2010 acr/eular classification criteria for ra * active ra, not in clinical disease remission (clinical disease activity index for ra (cdai) \> 2.8) * stable doses (for ≥ 1 month) of all ra and cardiovascular risk-related medications (including statins, metformin, sglt2 inhibitors, glp1ra) except for glucocorticoids exclusion criteria: * pregnant or intending to become pregnant during the intervention period * current treatment with exogenous insulin * other inflammatory arthropathy or myopathy, paget's disease, pigmented villonodular synovitis, joint infection, ochronosis, neuropathic arthropathy, osteochondromatosis, acromegaly, hemochromatosis, or wilson's disease * current malignancy other than minimally invasive carcinomas routinely treated topically or with minor surgical treatment * absolute contraindications to exercise testing: ongoing unstable angina; uncontrolled cardiac arrhythmia with hemodynamic compromise; active endocarditis; symptomatic severe aortic stenosis; decompensated heart failure; acute pulmonary embolism, pulmonary infarction, or deep vein thrombosis; acute myocarditis or pericarditis; acute aortic dissection; physical disability that precludes safe and adequate testing * relative contraindications to exercise testing: known obstructive left main coronary artery stenosis; moderate to severe aortic stenosis with uncertain relation to symptoms; tachyarrhythmias with uncontrolled ventricular rates; acquired advanced or complete heart block; hypertrophic obstructive cardiomyopathy with severe resting gradient; recent stroke or transient ischemic attack; mental impairment with limited ability to cooperate; uncorrected medical conditions, such as hypertension (see below), significant anemia, important electrolyte imbalance, and hyperthyroidism * modified contraindications to exercise testing: acute myocardial infarction (mi) within six months; resting hypertension with systolic or diastolic blood pressures \>160/90 mm hg * lack of internet access

Keywords: exercise training