EULAR: ‘Never too late’ for patients with rheumatic disease to start exercising

• Updated on: 2024-05-15
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Patients with rheumatic and musculoskeletal diseases should engage in both aerobic and strengthening exercises, aiming for at least moderate intensity, according to new EULAR recommendations.

The recommendations, which cover lifestyle behaviors and work participation to prevent rheumatic and musculoskeletal disease progression, also state that patients should be counseled that “it is never too late to start exercising.”

“In general, there is a lack of consensus regarding which lifestyle modifications can meaningfully modify [rheumatic and musculoskeletal disease (RMD)]-specific progression (including both modifiable (eg, pain, fatigue) and irreversible (eg, joint damage) outcomes),” James M. Gwinnutt, PhD, of the Center for Epidemiology Versus Arthritis at the University of Manchester, in the United Kingdom, and co-authors wrote in the Annals of the Rheumatic Diseases. “Nevertheless, people with RMDs frequently ask about this topic, and thus it is a priority.”

To develop recommendations on lifestyle behaviors for rheumatic and musculoskeletal diseases, EULAR convened a task force of 19 experts, including rheumatologists, geriatricians, epidemiologists, public health experts and patients. The task force’s work began in 2018 as members defined strategies to assess the association between six lifestyle exposures — exercise, diet, weight, alcohol, smoking and work participation — and seven diseases of interest.

In all, the diseases of interest included osteoarthritis, rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, systemic lupus erythematosus, systemic sclerosis and gout.

The task force reviewed original research on each of the six exposures, with the results presented to the entire task force in May 2019. Members drafted preliminary recommendations and overarching principles and, in a 2020 survey, rated their levels of agreement with the recommendations.

The task force ultimately approved five overarching principles and 18 recommendations. According to the recommendations, patients with rheumatic and musculoskeletal diseases should exercise regularly according to their ability and avoid physical inactivity. In addition, EULAR recommends that patients engage in both aerobic and strengthening exercises, aiming for at least moderate intensity, and that they be counseled that “it is never too late to start exercising.” Patients with OA or axial SpA in particular should be encouraged to exercise, as it is especially beneficial for outcomes in these diseases, according to EULAR.

Regarding diet, the recommendations state that patients with rheumatic and musculoskeletal diseases should be informed that eating specific food types is unlikely to result in any “large benefits” for outcomes.

On the subject of weight, EULAR states that patients who are overweight or obese should work with professionals to achieve “controlled and intentional weight loss” via healthy diet and increased exercise, as this may be beneficial for disease outcomes.

In addition, although low-level alcohol consumption is unlikely to negatively impact rheumatic and musculoskeletal disease outcomes, patients with RA or gout should understand that consuming moderate amounts of alcohol can increase the risk for flare, according to EULAR. It is recommended that patients discuss alcohol consumption with their health professionals, especially when starting new treatments.

The new EULAR recommendations also encourage smoking cessation, noting that patients with RA should understand that smoking may impact disease modifying anti-rheumatic drug treatment response.

Lastly, the recommendations state that work participation may be beneficial to health outcomes, and should therefore “receive attention” during consultations.

“These recommendations represent the consensus views of a wide spectrum of health professionals, scientists and people with RMDs and, due to the wide geographic representation of the [task force (TF)] members, should be appropriate for all individuals with RMDs across Europe,” Gwinnutt and colleagues wrote. “Defining recommendations based on evidence is the first step towards improving the lifestyles, and ultimately the disease outcomes, of people with RMDs.”