OP0203-HPR EVALUATION OF A 10-WEEK PROGRESSIVE RESISTANCE TRAINING PROGRAMME FOR PEOPLE WITH INFLAMMATORY ARTHRITIS
Authors: J. Skeates, J. Pearson, S. Derham, S. Palmer
Journal: Annals of the Rheumatic Diseases (2020)

Background: Inflammatory Arthritis [IA] adversely affects well-being, function, fatigue and strength 1 . Guidelines recommend people with IA should exercise to improve strength and cardiovascular fitness 2 . In 2015, our team introduced an evidence-based Progressive Resistance Training Programme [PRTP] for IA 3 . Objectives: To evaluate the effectiveness of a PRTP within a United Kingdom National Health Service setting. Methods: A pre- to post-treatment evaluation was conducted. People with IA attending Rheumatology Physiotherapy were offered a supervised PRTP (1 hour x 10 weeks): 7 exercises at 70-80% 1-repetition maximum (3 x 8-12 repetitions). Treatment outcomes included Health Assessment Questionnaire [HAQ], EQ5D-5L, 30s sit-to-stand [STS], Self-Efficacy (SARAH Trial) [SE], Grip Strength and FACIT-Fatigue [FACIT-F]. Changes in outcomes were analysed using Paired Samples t-tests and standardised mean difference (SMD). Results: 201 patients commenced the programme between May 2015 and April 2019, with 121 participants providing complete pre-post HAQ data. Diagnoses included Rheumatoid Arthritis (n=149), Psoriatic Arthritis (n=42), Juvenile Idiopathic Arthritis (n=5), Enteropathic IA (n=2), Oligoarthritis (n=1), Reactive Arthritis (n=1) and Undifferentiated IA (n=1). Age (mean ± SD) = 56.8 ± 14.8 years; number of sessions attended = 7.7 ± 3.4. There were no differences between those recorded as not completing the PTRP (n=54; 72% women; age 55.0 ± 14.6 years; HAQ 0.99 ± 0.70) versus the others (n=147; 78% women; age 57.5 ± 14.8; HAQ 0.86 ± 0.65). A pragmatic decision was made to analyse all available data for each outcome. Table 1. Analysis of PRTP outcomes * Indicates clinical improvement. Outcome measure Pre- treatment Post- treatment Mean difference (95% CI) p-value Standardised mean difference (95% CI) HAQ max score 3 (n=121) 0.83 ± 0.65 0.70 ± 0.67 -0.13 (-0.07, -0.19) p&lt;0.001 -0.20* (-0.46, 0.07) EQ5D VAS max score 100 (n=119) 70.0 ± 16.3 76.7 ± 15.2 6.7 (9.4, 3.9) p&lt;0.001 0.42* (0.17, 0.68) STS number in 30s (n=118) 13.2 ± 4.9 16.2 ± 5.3 3.0 (3.6, 2.5) p&lt;0.001 0.59* (0.33, 0.85) SE max score 70 (n=117) 52.3 ± 10.4 58.6 ± 8.0 6.3 (8.3, 4.4) p&lt;0.001 0.68* (0.41, 0.94) Grip Strength kg force (n=62) 20.3 ± 9.4 23.6 ± 10.6 3.3 (4.8, 1.7) p&lt;0.001 0.33* (-0.03, 0.68) FACIT-F max score 52 (n=58) 30.9 ± 11.5 35.5 ± 12.0 4.6 (7.2, 2.1) p=0.001 0.39* (0.02, 0.76) Conclusion: All outcome measures demonstrated statistically significant improvements. Notably, minimal clinically important differences were achieved in STS and FACIT-F. STS correlates to lower limb power, balance and endurance, and is a predictor of falls 4 . Fatigue significantly impacts function in people with IA 5 , often limiting confidence and willingness to participate in exercise activities 6 . Effective evidence-based PRTPs for people with IAs can be delivered by Physiotherapists. Improvements in function, wellbeing, self-efficacy, strength and fatigue are achievable, however, exploration of the clinical relevance of these observed changes is recommended. Further research exploring patients’ perspectives of the PRTP and adherence to long-term exercise is needed. References: [1]Cooney et al . (2011) Benefits of Exercise in Rheumatoid Arthritis J. Aging Res. Vol 2011 [2]Rausch Ostoff et al . (2018) 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis Ann Rheum Dis 77(9) [3]Lemmey et al . (2009) Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial Arthritis Rheum 16(12) [4]Beaudart et al . (2019) Assessment of Muscle Function and Physical Performance in Daily Clinical Practice Calcif. Tissue Int. 105(1) [5]Dures et al . (2016) Patient preferences for psychological support in inflammatory arthritis: a multicentre survey Ann Rheum Dis 75(1) [6]Rongen-van Dartel et al . (2015) Effect of Aerobic Exercise Training on Fatigue in Rheumatoid Arthritis: A Meta-Analysis Arth Care Res 67(8) Disclosure of Interests: None declared