Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by synovitis and arthritis. The arthritis in RA can be erosive and destructive leading to pain, disability, and deformity. The prevalence of RA among individuals over the age of 60 years is approximately 2% and highest among those 70 years of age and older. Older individuals with RA have more muscle weakness, less muscle mass, and more fat mass than age- matched individuals without RA due to a combination of chronic inflammatory disease and inactivity. With the established pattern of low physical activity and high fat mass among older RA patients, additional caloric supplementation is not routinely recommended alone, but the combination of exercise and nutritional interventions have been suggested as important treatments for rheumatoid cachexia and older frail individuals in general. Resistance exercise is a safe and effective intervention to improve strength, muscle mass, and function in younger individuals with RA. However, it has not been tested in older RA patients who have considerably more muscle weakness and disability. Many resistance exercise protocols cannot be applied to an older population because of joint limitations from RA damage. Protein supplementation, particularly in the post-exercise period, may significantly influence the impact of resistance exercise on muscle strength in the elderly. Further, older individuals with RA may have higher daily protein requirements due to the hypercatabolic state of their inflammatory disease. The combination of these two important interventions, resistance exercise and protein supplementation, to combat the body composition changes, weakness, and disability associated with RA has never been evaluated in older individuals. This study proposes a randomized controlled cross-over trial to evaluate a tailored 16-week resistance exercise program, in combination with protein supplementation, for older (?70 years of age) individuals with RA. The exercise protocol in this study is distinctive because it combines dynamic and isometric (static) resistance exercise performed on specialized equipment that can accommodate the range of motion limitations frequently encountered in the older RA population. This study will also begin to evaluate if additional benefit can be achieved with daily protein supplementation. As the population ages, we are likely to see an increase in the prevalence of inflammatory rheumatic disease and its concomitant detrimental effects on muscle, strength, and fatigue in the elderly. This project proposes to test an important adjuvant approach to treatment, resistance exercise and protein supplementation, which is safe, inexpensive, and potentially highly beneficial.

Public Health Relevance

Rheumatoid arthritis (RA) is a common form of inflammatory arthritis and can lead to muscle loss and weakness in older individuals. This study will test if a resistance exercise program in combination with protein shakes will increase strength, muscle, and quality of life in older people who have RA. The findings will help us learn whether these lifestyle interventions help older patients with RA, and will also contribute to our understanding of the effects of aging on inflammatory diseases such as RA.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Small Research Grants (R03)
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Special Emphasis Panel (ZAG1-ZIJ-9 (M1))
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Joseph, Lyndon
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Johns Hopkins University
Internal Medicine/Medicine
Schools of Medicine
United States
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Timlin, H; Lee, S M; Manno, R L et al. (2015) Rituximab for remission induction in elderly patients with ANCA-associated vasculitis. Semin Arthritis Rheum 45:67-9
Chen, Teresa K; Murakami, Christine; Manno, Rebecca L et al. (2014) Hematuria duration does not predict kidney function at 1 year in ANCA-associated glomerulonephritis. Semin Arthritis Rheum 44:198-201