ABSTRACT
OBJECTIVE: To compare a remotely supervised weight loss and exercise intervention to lifestyle counseling for effects on cardiovascular disease risk, disease activity, and patient-reported outcomes in older patients with rheumatoid arthritis (RA) and overweight/obesity. METHODS: Twenty older (60-80 years), previously sedentary participants with seropositive RA and overweight/obesity were randomized to 16 weeks of either Supervised Weight loss and Exercise Training (SWET) or Counseling Health As Treatment (CHAT). The SWET group completed aerobic training (150 minutes/week moderate-to-vigorous intensity), resistance training (two days/week), and a hypocaloric diet (7% weight loss goal). The CHAT control group completed two lifestyle counseling sessions followed by monthly check-ins. The primary outcome was a composite metabolic syndrome z-score (MSSc) derived from fasting glucose, triglycerides, high density lipoprotein-cholesterol, minimal waist circumference, and mean arterial pressure. Secondary outcomes included RA disease activity and patient-reported outcomes. RESULTS: Both groups improved MSSc (absolute change -1.67 ± 0.64 in SWET; -1.34 ± 1.30 in CHAT; P < 0.01 for both groups) with no between-group difference. Compared with CHAT, SWET significantly improved body weight, fat mass, Disease Activity Score-28 C-reactive protein, and patient-reported physical health, physical function, mental health, and fatigue (P < 0.04 for all between-group comparisons). Based on canonical correlations for fat mass, cardiorespiratory fitness, and leg strength, component-specific effects were strongest for (1) weight loss improving MSSc, physical health, and mental health; (2) aerobic training improving physical function and fatigue; and (3) resistance training improving Disease Activity Score-28 C-reactive protein. CONCLUSION: In older patients with RA and overweight/obesity, 16 weeks of remotely supervised weight loss, aerobic training, and resistance training improve cardiometabolic health, patient-reported outcomes, and disease activity. Less intensive lifestyle counseling similarly improves cardiovascular disease risk profiles, suggesting an important role for integrative interventions in the routine clinical care of this at-risk RA population.
ABSTRACT
BACKGROUND AND AIMS: Pandemics have previously resulted in increased cardiovascular morbidity and mortality. It is unclear if the effects of the COVID-19 pandemic will be amplified in individuals at high risk for cardiovascular disease, such as military populations, resulting in augmented cardiovascular events in Veterans. The purpose of this study was to determine if traditional behavioral risk factors for cardiovascular disease are amplified due to the COVID-19 pandemic and if risk factors are more prevalent in Veterans compared to non-Veterans. METHODS AND RESULTS: Thirty-two student Veterans and 46 non-Veteran students between the ages of 18 and 35 completed a Qualtrics self-report questionnaire assessing health behaviors, physical activity, and mental health both before and during COVID-19. Veterans displayed worse pre-COVID cardiovascular health behaviors such as poor sleep habits, greater use of tobacco, alcohol, and energy drinks, and lower values of social engagement compared to non-Veterans. Many health behaviors remained unchanged in student Veterans during the pandemic. The non-Veteran group exhibited augmentation of cardiovascular health behaviors during COVID-19, shown through the worsening sleep habits, increased anxiety, and reduced physical activity. CONCLUSION: Student Veterans demonstrate heightened risk for cardiovascular disease based on the pre-COVID elevation of behavioral risk factors. These behavioral factors continued to remain elevated during the COVID-19 pandemic. Non-Veteran students displayed amplification of behavioral risk factors for cardiovascular disease due to the COVID-19 pandemic. These results highlight the need for resources and interventions for our student veterans and suggest long-term cardiovascular consequences for all students who suffered through the COVID-19 pandemic.
