Exercise strongly backed in rheumatoid arthritis

The new guideline outlines an integrative approach to the condition and covers non-pharmacological interventions.

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Consistent engagement in exercise is the lone “strong recommendation” in the American College of Rheumatology’s first guideline on exercise, rehabilitation, diet and other integrative interventions for rheumatoid arthritis.

The new document is designed to complement – not replace – the ACR’s 2021 Guideline for the Treatment of RA, which recommends pharmacological therapies to manage the disease.

Recommendations were evaluated and voted on by a 20-person strong interdisciplinary panel, which included people with expertise on exercise physiology, nutrition and social work, as well as three people with lived experience of rheumatoid arthritis.

All up, there are 28 recommendations, almost half of which pertain to rehabilitation.

While regular exercise was the only strong recommendation to come out of the guideline, there was no further information on what that may look like in terms of form, frequency, intensity and duration.

Separately, aerobic, aquatic, resistance and mind-body exercise all received conditional recommendations.

There’s also a conditional recommendation for patients to follow a Mediterranean-style diet, which consists of vegetables, whole grains, fresh fruits and nuts and avoids red meat, processed meat, refined carbohydrates and sweets.

The voting panel conditionally recommended against every formally defined diet other than the Mediterranean diet.

They also recommended against dietary supplements, electrotherapy and chiropractic therapy.

Acupuncture, massage therapy, thermal modalities and cognitive behavioural therapy all scored recommendations in the “additional therapies” section of the guideline.

According to the summary document, which only listed seven of the 13 conditional rehabilitation recommendations, both comprehensive occupational and physical therapy is recommended, as well as hand therapy.

So is splinting, compression and joint protection techniques, as well as adaptive equipment.

The full manuscript has been submitted for publication in both Arthritis & Rheumatology and Arthritis Care and Research.