Abstract P442: An Innovative, Remotely Delivered Weight Loss and Exercise Intervention to Improve Rheumatoid Arthritis Cardiovascular Risk
Authors: Ross Leanna M , Zidek Alyssa M , Kraus William E , Bales Connie W , Porter Starr Kathryn N , Andonian Brian J , Huffman Kim M 
Published: March 2023

Introduction:
Despite improvements in pharmacologic management of rheumatoid arthritis (RA), patients with RA continue to have an increased risk for CVD - the leading cause of death in this population. RA CVD results from a combination of traditional risk factors - such as hypertension, dyslipidemia, physical inactivity, and obesity - and RA-related systemic inflammation. Although weight loss and physical activity are promising means for improving both traditional and inflammatory risk factors, evidence is lacking for lifestyle interventions targeting these health behaviors in RA.

Hypothesis:
In the SWET-RA trial, we hypothesized that, as compared to standard of care, a 16-week remotely delivered weight loss and exercise intervention would improve CVD risk factors in older persons with RA and obesity.

Methods:
Twenty-four patients (age 60-80 years; BMI 28-40 kg/m
2
) were randomized to one of two groups: 1) supervised weight loss and exercise training (SWET); or 2) counseling health as treatment (CHAT). The SWET intervention - delivered via video conference, the study YouTube channel, and mobile applications - consists of a) dietitian-led caloric restriction diet (7% weight loss goal) with weekly weigh-ins and group support sessions; and b) exercise physiologist-led aerobic (150 min moderate-to-vigorous exercise) and resistance training (twice weekly). CHAT provides initial clinical counseling on healthy diets and physical activity followed by monthly check-ins. Outcomes include body mass; body composition via Air Displacement Plethysmography; peak oxygen consumption [VO
2
(mL/kg/min)] via maximal cardiopulmonary exercise testing; and mean arterial blood pressure (MAP). Within-groups, paired t-tests assessed whether post- minus pre-intervention change scores (mean ± standard deviation) were significant (p<0.05).

Results:
To date, 13 patients (61.5% White; 84.6% female) have completed the study; 8 additional patients are expected to complete the study by February 2023. Following the intervention, the CHAT group (n=5) had mean changes in body mass, fat mass, and lean mass of -2.4 ± 4.0%, -3.3 ± 4.3 kg, and 1.0 ± 1.0 kg (all p>0.05). Those randomized to SWET (n=8) had significant improvements in body mass (-5.0 ± 2.9%; p=0.002) and fat mass (-4.3 ± 2.8 kg; p=0.004), and no change in lean mass (0.4 ± 1.2 kg; p=0.36). The CHAT group had a 1.1 ± 6.7% change in peak VO
2
(p=0.81), while the SWET group exhibited a 10.6 ± 16.7% change (p=0.13). There were minimal changes in MAP for both groups (CHAT: -1.0 ± 1.0 mmHg; SWET: -0.4 ± 1.2 mmHg).

Conclusions:
Preliminary findings indicate that, as compared to CHAT, the SWET intervention elicits beneficial changes in body mass, fat mass, and cardiorespiratory fitness. As the SWET-RA trial is pioneering a remotely delivered program, results from this study will help guide lifestyle intervention implementation to improve CVD risk in larger groups of patients with RA.