ObjectiveTo determine the effect of a multidisciplinary lifestyle program in patients with RA with low–moderate disease activity.MethodsIn the ‘Plants for Joints’ (PFJ) parallel-arm, assessor-blind randomized controlled trial, patients with RA and 28-joint DAS (DAS28) ≥2.6 and ≤5.1 were randomized to the PFJ or control group. The PFJ group followed a 16-week lifestyle program based on a whole-food plant-based diet, physical activity and stress management. The control group received usual care. Medication was kept stable 3 months before and during the trial whenever possible. We hypothesized that PFJ would lower disease activity (DAS28). Secondary outcomes included anthropometric, metabolic and patient-reported measures. An intention-to-treat analysis with a linear mixed model adjusted for baseline values was used to analyse between-group differences.ResultsOf the 83 people randomized, 77 completed the study. Participants were 92% female with mean (S.D.) age of 55 (12) years, BMI of 26 (4) kg/m2 and mean DAS28 of 3.8 (0.7). After 16 weeks the PFJ group had a mean 0.9-point greater improvement of DAS28 vs the control group (95% CI 0.4, 1.3; P < 0.0001). The PFJ intervention led to greater decreases in body weight (difference –3.9 kg), fat mass (–2.8 kg), waist circumference (–3 cm), HbA1c (–1.3 mmol/mol) and low-density lipoprotein (–0.32 mmol/l), whereas patient-reported outcome measures, blood pressure, glucose and other lipids did not change.ConclusionThe 16-week PFJ multidisciplinary lifestyle program substantially decreased disease activity and improved metabolic status in people with RA with low–moderate disease activity.Trial RegistrationInternational Clinical Trials Registry Platform; https://www.who.int/clinical-trials-registry-platform; NL7800.
With growing environmental concerns, upcycling has become an important theme in literature and practice. Upcycling can help slow and close resource cycles through product life-extension. Cities offer opportunities for upcycling initiatives and seek to tackle challenges in urban solid waste management by encouraging entrepreneurs to create value from local waste streams in urban resource centres and circular crafts centres. However, little is known about what drives urban upcycling and which barriers and drivers occur. This study explores urban upcycling in the context of the Dutch furniture industry, since The Netherlands positions itself as a ‘circular economy hotspot’ and furniture offers promising opportunities and best practices for upcycling. The analysis of 29 semi-structured interviews with experts engaged in urban upcycling reveals personal motives, drivers and barriers. Personal motives include (1) a personal purpose to ‘do good’, (2) an urge to challenge the status quo and (3) learning and inspiring by doing. Key drivers entail opportunities to (1) engage in collaborative experimentation, (2) participate in cross-sectoral local networks, (3) develop resource-based adaptive competences, (4) respond to increasing demand for upcycled products and (5) make social business activities financially viable. Key barriers perceived by upcycling experts include (1) limitations in resource availability, (2) increasing capacity requirements, (3) negative public quality perception, (4) limited marketing competences and (5) an unequal playing field. This study contributes with a comprehensive definition of urban upcycling and a structured overview of key factors that drive and constrain urban upcycling.
