RA Track
GRIP
Graduated Resistance for Improved Performance
Duration
24 weeks · 3 progressive phases
Structure
Progressive, 3 phases over 6 months
Delivery
Virtual
About this protocol
GRIP targets the three domains pharmacotherapy cannot fully address in rheumatoid arthritis: cardiovascular mortality, rheumatoid cachexia, and functional capacity. Three integrated pillars run over six months: joint mobility and hand exercise targeting MCPs, PIPs, wrists, shoulders, knees and MTPs (informed by the SARAH trial); graduated walking-based HIIT addressing the 50–68% excess cardiovascular mortality documented in RA; and progressive resistance training targeting rheumatoid cachexia (affecting up to 67% of patients and not reversed by DMARDs or TNF inhibitors). Built on the RAPIT trial safety legacy.
Clinical authors
- Angelo Papachristos, PT, ACPAC
- Sameer Chunara, PT, ACPAC
Evidence base
GRIP is derived from systematic review and randomized controlled trial evidence in Rheumatoid Arthritis (RA). Protocol parameters — phase structure, load progression, and outcome measures — align with EULAR, ACR, and ASAS exercise-therapy recommendations. Outcome tracking favours open-access PROMIS instruments where validated equivalents exist.
View the evidence library →Outcome measures
- DAS28-CRP (TJC28, SJC28, CRP, patient global)
- PROMIS Physical Function Short Form 10aPROMIS
- Grip Strength (Jamar dynamometer, kg)
- PROMIS Upper Extremity Short Form 7aPROMIS
- 6-Minute Walk Test
- PROMIS Fatigue Short Form 7aPROMIS
- Body Composition (DXA) — lean mass, fat mass, ALMI
- Peak HR + RPE (every session)
PROMIS short forms are free, NIH-developed measures used in place of paid legacy instruments.
What's included
- Virtual assessment with a certified exercise therapist
- Personalised programme plan
- Live-virtual group or individual sessions
- Asynchronous guided home programme
- Regular ePRO check-ins with adaptive progression
- Care coordinator support
- Programme completion report
Interested in this protocol?
Speak to us about adding GRIP to your PSP or benefits plan.
Request a pilotFor patients