Background: Two randomized controlled trials (L-EXTRA and L-EXSPA) evaluating longstanding, personalized, supervised exercise therapy in individuals with severe functional limitations due to rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) were conducted. Both demonstrated that supervised exercise therapy was more effective than usual care after one year [1, 2]. However, whether, and to what extent, the favourable outcomes were maintained in the long term remained unclear.

Objectives: To evaluate the long-term effects of longstanding, personalized, supervised exercise therapy on physical function and quality of life of people with RA and axSpA with severe functional limitations at two years after the start of the intervention.

Methods: Patients in the intervention groups of the studies (International Clinical Trials Registry Platform NL-OMON52885 and NL-OMON52399) received an exercise intervention led by trained primary care physiotherapists (contents: personalized goal setting, active exercises, education and self-management regarding physical activity). During the intervention period, the number of sessions was aimed at 64 (and 14 extra if needed) for the first year and 52 in the second year, whereas the continuation and frequency in the period thereafter was determined by the physiotherapist and patient for the further duration of the study (max. 42 months). Assessments comprised the Patient Specific Complaints activity ranked 1 (PSC1), 6 Minute Walk Test (6MWT), Patient Reported Measurement Information System Physical Function-10 (PROMIS-10), Short Form- 36 Physical and Mental Component Summary Score (SF-36 PCS and MCS), and the Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL, RA only). Mixed linear models were used for within-group analysis over time using outcomes at baseline, 26 (excluding PSC and 6MWT), 52 and 104 weeks. Only data from the intervention group were used, as patients in the usual care group gained access to the intervention after 52 weeks at different timepoints, causing possible time fluctuations in the assessments.

Results: At baseline, the RA and axSpA intervention groups comprised 109 participants (89% female, mean age 59.4 SD12.1 years) and 110 participants (50.9% female, mean age 51.9 SD 11.7 years), respectively. Of the 105 intervention group patients from the RA study who were in the study at 52 weeks, 24 did not reach 104 week assessment due to the planned termination of the study and 4 dropped out. Of the 103 intervention group patients from the axSpA study who were in the study at 52 weeks, 22 did not reach 104 week assessment due to the study end, and 13 patients dropped out. Of the 109 RA patients 99 used the intervention in the first year, for axSpA this were 102 out of the 110 patients. In the second year 73 (72%) and 76 (83%) of the 101 and 92 patients who were part of the study in the second year used it at any time point between 52 and 104 weeks, respectively. At 104 weeks, both in the RA and axSpA groups, statistically significant improvements as compared to baseline were seen for all outcome measures, except for the SF-36 MCS (Table 1). Between 52 and 104 weeks, no significant improvement or deterioration was observed for any of the outcome measures, indicating that effects were sustained (Table 1). The only exception was a significant improvement of the 6MWT between 52 and 104 weeks in the axSpA group.

Conclusion: The 1-year favourable effects of longstanding, personalized, supervised exercise therapy in patients with RA and axSpA with severe functional limitations on physical function and quality of life were sustained two years after starting this treatment. Benefits were preserved despite declining usage in the second year, highlighting the long-term value of personalized, supervised exercise for these particular subgroups of patients.

REFERENCES: [1] Teuwen et al. Ann Rheum Dis. 2024;83(4):437-445.

[2] van Wissen et al. Rheumatology (Oxford). 2024 Jun 8:keae323.

Acknowledgements: EAM Mahler, FA van Gaalen, A.Spoorenberg, A M van Tubergen, AA den Broeder, D van Schaardenburg, WB van den Hout. Financial support: The Netherlands Organization for Health Research and Development (ZonMw, 852004018 and 852004019), Ministry of Health, Welfare and Sport (Ministerie van Volksgezondheid, Welzijn en Sport), the Royal Dutch Society for Physical Therapy (KNGF) and the Dutch Arthritis Society (ReumaNederland).

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.