ACR: Any consistent exercise ‘advised over no exercise’ for rheumatoid arthritis
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Patients being treated for rheumatoid arthritis are strongly advised to engage in physical exercise when possible, according to new recommendations from the American College of Rheumatology.
“Together with pharmacologic treatment options, exercise, rehabilitation, diet and additional integrative interventions are considered as potential adjunctive treatments for RA,” Benjamin J. Smith, DMSc, PA-C, DFAAPA, interim program director and associate dean at the Florida State University College of Medicine, and co-principal investigator of the guideline, said in an ACR press release summarizing the new recommendations. “Recognizing the need to support patients and clinicians when considering treatments to complement their pharmacologic regimen, the ACR developed this guideline.”
The new recommendations, entitled “Guideline for Exercise, Rehabilitation, Diet and Additional Integrative Interventions for Rheumatoid Arthritis,” were approved by the ACR board of directors on Oct. 31. A manuscript detailing the guidelines has been submitted for publication in Arthritis & Rheumatology and Arthritis Care & Research. The full guidance is expected to be published in spring 2023.
According to a summary released by the ACR, the new document includes 28 recommendations for rheumatologists who are initiating integrative care for their patients with RA. In total, there is one strong recommendation and 27 conditional recommendations dealing with exercise, diet, rehabilitation and other integrative interventions.
The single strong recommendation states that “consistent engagement in exercise is advised over no exercise.” No type, frequency or intensity is prescribed, but regular movement is highlighted, according to the release. In addition, to have the greatest impact, each patient should be advised according to their own capabilities and needs.
The new guideline also recommends that patients follow a Mediterranean diet. Additional conditional recommendations advise in favor of aerobic, aquatic, resistance and mind-body exercises. Regarding rehabilitation, there are conditional recommendations for comprehensive occupational and physical therapy, hand therapy exercises, splinting bracing or taping, joint protection, the use of assistive devices and vocational rehabilitation.
Other measures that received conditional approval include self-management programs, cognitive behavioral therapy, acupuncture, massage therapy and thermal modalities.
The recommendations conditionally recommend against electrotherapy and chiropractic therapy.
“Being able to include the diverse integrative interventions in the management of persons with RA throughout their disease course, as an interdisciplinary team, is essential,” Smith said in the release. “This guideline highlights the vital role expert members of interprofessional health care teams serve in providing optimal care to people with RA.”
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