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Physical Activity in Rheumatoid Arthritis: A Systematic Review
Abstract
Physical activity is associated with improved health outcomes in many populations. It is assumed that physical activity levels in the rheumatoid arthritis (RA) population may be reduced as a result of symptoms of the disease. The objective of this review is to establish the current evidence base for levels of physical activity in the RA population.
A systematic review was performed of 7 databases (Emabase, MEDLINE, AMED, Biomedical Reference Collection Expanded, CINAHL, Nursing and Allied Health Collection, and SportsDiscus) up to February 2011 to examine the evidence in the area.
One hundred and thirty-six studies were identified through electronic searching. One hundred and six were excluded based on title and/or abstract analysis and a further 14 were excluded based on full text analysis. Sixteen studies meeting the criteria were deemed suitable for inclusion. The results of the included studies indicate that the level of physical activity may be lower among individuals with RA when compared with healthy controls or normative data.
There are a number of methodological considerations at play within the studies reviewed which prohibits definitive conclusion on the physical activity levels of this population group. Given the known health benefits of physical activity, further research in this area appears indicated.
... According to previous studies (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), factors associated with arthritis include sociodemographic factors, health risk behaviors, poor mental health, and chronic conditions. Sociodemographic factors associated with arthritis include older age (7)(8)(9)(10)(11), female sex (7)(8)(9)(10)(11), higher economic status (9) and lower education (10,12). ...
... Sociodemographic factors associated with arthritis include older age (7)(8)(9)(10)(11), female sex (7)(8)(9)(10)(11), higher economic status (9) and lower education (10,12). Specific health risk behaviors, such as smoking (13), low physical activity or sedentary behavior (12,(14)(15)(16), non-alcohol use (17) and obesity (5,8,14,18) have shown to increase the risk of arthritis. Moreover, poor mental health (5,19,20), including sleep problems (19) and depressive symptoms (10,18,21), increased the odds of arthritis. ...
... Obesity may 'exhibit a chronic subclinical inflammatory state' increasing the risk of rheumatoid arthritis (42). Some studies found an association between physical inactivity and arthritis (12,14,15,23,43), while this study did not find this association. The non-significant association between physical inactivity and SRA in this study may be related to how physical activity was measured, it only included exercise and no other physical activity. ...
Background
The study aimed to assess the prevalence and associated factors of cross-sectional and incident arthritis or rheumatism among a national community sample of middle-aged and older adults in Thailand.
Methods
We analyzed cross-sectional and longitudinal data from two consecutive waves (2015 and 2017) of the Health, Aging, and Retirement in Thailand (HART) study. Arthritis or rheumatism (SRA) was assessed by self-reported health care provider diagnosis.
Results
The cross-sectional (baseline) sample included 5,616 participants (≥45 years, median age 66 years, interquartile range 57 to 76 years) and the incident (follow-up) sample included 3,545 participants. The prevalence of SRA in the cross-sectional sample (baseline) was 4.0% and in the incident (follow-up) sample 5.3%. In the cross-sectional multivariable model, obesity class I (aOR: 1.78, 95% CI: 1.19 to 2.67), obesity class II (aOR: 1.82, 95% CI: 1.02 to 3.25), hypertension (aOR: 1.90, 95% CI: 1.35 to 2.66), brain disease and/or psychiatric problems (aOR: 4.79, 95% CI: 2.27 to 10.62), sleep problem (aOR: 1.45, 95% CI: 1.01 to 2.07) and prescription drug use (aOR: 1.63, 95% CI: 1.14 to 2.33) were positively associated, and not in the labor force (aOR: 0.53, 95% CI: 0.34 to 0.84), and employed (aOR: 0.63, 95% CI: 0.41 to 0.99) were negatively associated with SRA. In the incident multivariable model, obesity class I (aOR: 1.78, 95% CI: 1.17 to 3.61), obesity class II (aOR: 2.01, 95% CI: 1.12 to 3.61), poor mental health (aOR: 1.69, 95% CI: 1.19 to 2.41), and functional disability (aOR: 2.04, 95% CI: 1.01 to 4.13) were positively associated, and current alcohol use (aOR: 0.50, 95% CI: 0.25 to 0.99) was negatively associated with SRA.
Conclusion
The middle and older Thai adults had a low prevalence and incidence of SRA, and several physical and mental risk factors for cross-sectional and/or incident SRA were identified.
... Although this paradox is still not well understood, it appears that this works in a Stat3-dependent manner. Stat3 signaling is often increased in skeletal muscle wasting, especially under conditions of high circulating IL-6 (65,66). Moreover, IL-6-induced cardiac hypertrophy is regulated by Stat3 (53). ...
... In humans, physical inactivity is associated with greater RA disease activity (54), poorer immune function (55,56), CVD (57)(58)(59)(60), and skeletal muscle pathology (61)(62)(63)(64)(65)(66). Here, in K/BxN animals, regular wheel exercise reduced paw swelling and inflammation in concert with remarkable improvements in cardiac and skeletal muscle phenotypes. ...
... In an adjuvant induced model of RA (AIA), eccentric exercise prevents weakness associated with skeletal muscle inflammation (44). However, in CAIA mice, voluntary running conversely promotes arthritis onset and slowed the resolution of inflammation (66). In this CAIA mouse model of arthritis, mechanical strain is implicated in the localization of joint inflammation and erosions (5). ...
Rheumatoid arthritis (RA) is a systemic inflammatory arthritis impacting joints as well as cardiac and skeletal muscle. RA's distinct impact on cardiac and skeletal muscle tissue is suggested by studies showing that new RA pharmacologic agents strongly improve joint inflammation, but have little impact on RA associated mortality, cardiovascular disease and sarcopenia. Thus, the objective is to understand the distinct effects of RA on cardiac and skeletal muscle, and to therapeutically target these tissues through endurance-based exercise as a way to improve RA mortality and morbidity. Methods We utilize the well characterized RA mouse model, the K/BxN mouse to investigate cardiac and skeletal muscle pathologies, including the use of wheel running exercise to mitigate these pathologies. Results Strikingly, we found that K/BxN mice, like human RA patients, also exhibit both cardiac and skeletal muscle myopathies that were correlated with circulating IL-6 levels. Three months of wheel running exercise significantly improved K/BxN joint swelling and reduced systemic IL-6 concentrations. Importantly, there were morphologic, gene expression and functional improvements in both the skeletal muscle and cardiac myopathies with exercise. Conclusion The K/BxN mouse model of RA recapitulated important RA clinical comorbidities, including altered joint, cardiac and skeletal muscle function. These morphological, molecular and functional alterations were mitigated with regular exercise, thus suggesting exercise as a potential therapeutic intervention to lessen disease activity in the joint and the peripheral tissues, including the heart and skeletal muscle.
... However, available data indicate that people with RA typically do not engage in sufficient levels of physical activity to yield positive health outcomes, and spend long periods of the day sedentary. 32,33 Until recently, our understanding of the levels and health consequences of sedentary behaviour and physical activity in RA has largely been based on studies employing self-report methods to quantify engagement in these behaviours. The selection of self-report instruments introduces issues around measurement validity and reliability, such as social desirability bias and errors in participant recall, 32,[34][35][36] limiting the accuracy of such measures in sedentary behaviour and physical activity research. ...
... Further, to ensure progress in this field, it is essential that the validity of these accelerometer cut-points for the measurement of free-living behaviour is established. Despite several advantages relative to self-report, accelerometers are still limited in their ability to measure posture -an important facet of the characterisation of 127 32,33 Until recently, our understanding of the levels and health consequences of sedentary behaviour and physical activity in RA has largely been based on studies employing self-report methods to quantify engagement in these behaviours. The selection of self-report instruments introduces issues around measurement validity and reliability, such as social desirability bias and errors in participant recall, 32,[34][35][36] limiting the accuracy of such measures in sedentary behaviour and physical activity research. ...
... However, available data indicate that people with RA typically do not engage in sufficient levels of physical activity to yield positive health outcomes, and spend long periods of the day sedentary. 32,33 Until recently, our understanding of the levels and health consequences of sedentary behaviour and physical activity in RA has largely been based on studies employing self-report methods to quantify engagement in these behaviours. The selection of self-report instruments introduces issues around measurement validity and reliability, such as social desirability bias and errors in participant recall, 32,34-36 limiting the accuracy of such measures in sedentary behaviour and physical activity research. ...
Background:
The accurate measurement of sedentary time and physical activity in Rheumatoid Arthritis (RA) is critical to identify important health consequences and determinants of these behaviours in this patient group. However, objective methods have not been well-validated for measurement of sedentary time and physical activity in RA.
Aims:
Specific objectives are to: 1) validate the ActiGraph GT3X+ accelerometer and activPAL3μTM against indirect calorimetry and direct observation respectively, and define RA-specific accelerometer cut-points, for measurement of sedentary time and physical activity in RA; 2) validate the RA-specific sedentary time accelerometer cut-points against the activPAL3μTM; 3) compare sedentary time and physical activity estimates in RA, using RA-specific vs. widely-used non-RA accelerometer cut-points.
Methods:
Objective 1: People with RA will wear an ActiGraph GT3X+, activPAL3μTM, heart rate monitor and indirect calorimeter, whilst being video-recorded undertaking 11 activities representative of sedentary behaviour, and light and moderate intensity physical activity. Objectives 2 and 3: People with RA will wear an ActiGraph GT3X+ and activPAL3μTM for 7 days to measure free-living sedentary time and physical activity.
Discussion:
This will be the first study to define RA-specific accelerometer cut-points, and represents the first validation of the ActiGraph accelerometer and activPALTM, for measurement of sedentary time and physical activity in RA. Findings will inform future RA studies employing these devices, ensuring more valid assessment of sedentary time and physical activity in this patient group.
... There is a wealth of evidence supporting the beneficial effects of physical activity (PA) in improving joint health, physical function, and mental well-being, as well as reducing cachexia and fatigue in patients with RA [14,15]. Additionally, it was shown that physical activity is a protective factor in the etiology of RA. ...
... In addition, it is recommended that resistance training should be performed twice a week [17]. Even though RA patients commonly report that they are aware of the positive effects of physical activity [18,19], systematic reviews have shown that physical activity is lower in RA patients than in healthy controls [14,20]. In a cross-sectional study of 21 countries, only 13.8% of patients with RA reported regular physical activity [21]. ...
Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease, which is associated with low levels of physical activity (PA). However, the factors related to low physical activity levels have rarely been studied. Methods: In this cross-sectional study, 70 seropositive RA patients were included. Physical activity was objectively assessed with an ActiGraph GT3X+ accelerometer. In addition, body mass index, smoking status, work ability, and clinical parameters (functional disabilities, disease activity, disease duration, pain, and inflammation parameters) were measured. Results: RA patients performed a mean of 215.2 (SD: 136.6) min a week of moderate physical activity and 9.1 (SD: 26.3) min of vigorous physical activity. The total amount of moderate and vigorous physical activity (MVPA) was associated with BMI, and functional disabilities. In addition, non-smokers and patients with better work ability did more MVPA. No association could be seen with disease activity, disease duration, pain, and inflammatory markers. After mutual adjusting of all the variables, only BMI showed a significant relationship with MVPA. Conclusions: RA patients perform de facto no physical activity with vigorous intensity. Factors related to low physical activity are BMI, functional disabilities, workability and smoking status, whereas due to the study design no causal and temporal link could be made.
... This is somewhat concerning given that research has repeatedly shown the positive effects of exercise for adults with arthritis, including not only aerobic and resistance exercise [35], but also yoga [36] and to some extent, Pilates [37]. While individuals with arthritis may benefit from exercise, they generally are less active [38], with international data showing that more than two thirds of patients with arthritis are physically inactive [39]. ...
... Our analysis identified a number of significant factors associated with overall CAM use in adults with SRDD arthritis. These factors were consistent with those reported in previous research, including studies reporting on gender and racial/ethnic differences between users and non-users of CAM in patients with arthritis [36,37], and among persons with musculoskeletal pain and complaints using specific types of CAM therapies, such as chiropractic and massage [38,39]. ...
Background
The use of complementary and alternative medicine (CAM) therapies have been reported for the management of arthritis. However, little is known about CAM use among adults with self‐reported doctor‐diagnosed (SRDD) arthritis since 2012.
Objectives: To determine: 1) the prevalence and type of CAM use, 2) the difference in characteristics between CAM users and non‐CAM users, and 3) the factors related to CAM use, among US adults with SRDD arthritis.
Design
Secondary analysis of the 2012 National Interview Health Survey (NHIS) data.
Setting
The NHIS is a cross‐sectional survey that gathers health‐related data on the civilian, non‐institutionalized U.S. population.
Participants
The NHIS 2012 uses a complex, multi‐stage sampling design and oversamples minorities to achieve population representation, and included 34,525 adults, with 7,179 adults having SRDD arthritis.
Methods
Data were analyzed using Stata 15.1 survey syntax. The potential factors related to CAM use included socio‐demographics and health related characteristics.
Main Outcome Measurements
CAM modalities were categorized into six groups: natural products, manipulative therapies, mind‐body therapies, special diets, movement therapies, and other practitioner‐based CAM modalities.
Results
Of the adults with SRDD arthritis, 2,428 (weighted estimate of 36.2% of US adult population) had used CAM within the last year. Adults with SRDD arthritis reported greater use of CAM than those without, particularly the use of natural products, manipulative therapies and other practitioner‐based CAM modalities. Factors associated with higher CAM use included being female, residing in regions other than the U.S. South, having a college degree or higher, reporting very good/excellent self‐rated health status and having current symptoms of joint stiffness/pain.
Conclusion
As more than one‐third of US adults with SRDD arthritis seek CAM therapies, open and non‐judgmental conversations between conventional medicine providers, CAM providers and patients should be encouraged to ensure patient health care needs are being met.
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... Poor sleep has been identified as a major concern for people with RA, with disturbed sleep and fatigue known to affect up to 70% in this population [2][3][4]. This consequently influences their health-related quality of life (HQoL), in addition to their mental and physical health, and may lead to people with RA not being as physically active compared to their more healthier counterparts [5,6]. Sleep is an important aspect in maintaining the body's circadian rhythm and is an important factor that influences mood, physical, and cognitive performance, and daytime sleepiness [7]. ...
... While pharmacologic interventions have improved the management of RA, with PA and exercise remaining an important part of overall treatment [39], with health professionals playing a crucial role in promoting same [40,41]. Despite PA having significant health benefits, the current PA levels are reported as sub-optimal in this population [6,42,43]. While participants in this study can be considered physically active by meeting the relevant PA duration guidelines of 30+ min, 5 days per week, the volume of lying down time (LDT) and SBD is concerning. ...
Regular physical activity (PA) is important for people with rheumatoid arthritis (RA). Poor sleep is a common complaint among people with RA, which may have an influence on their PA levels. There is a lack of objective information regarding total sleep time (TST) and PA duration in this population. A cross-sectional study design was used. SenseWear Pro3 Armband(R)TM is used to measure TST and total PA duration. Four valid days, with 95% wear time necessary for inclusion in final results. Disease activity and function were measured using the DAS-28, HAQ and VAS. Data analysis carried out using SPSS v22. Seventy-five (75) participants completed monitoring period, with 51 (68%) meeting modified PA duration guidelines. Data with 95% wear time over a minimum of 4 days were available for 32 recorded participants, with a mean TST of 5.7 (SD_1.11) hours per night and a median 1.25 (IQR_1.88) hours of daily PA. TST had a positive significant relationship with PA (p = 0.018); PA demonstrated a negative significant relationship with functional limitations (p = 0.009) and correlated with lower CRP levels; CRP levels had in turn a significant relationship to global health (p = 0.034). Total sleep time was low for people with RA. People with RA who are more physically active have longer TST. These findings provide an objective profile of TST and PA duration in people with RA and suggest a relationship between increased PA duration and longer TST. Further research is needed to confirm these novel findings.
... Healthy behaviours such as achieving sufficient PA is a challenge for most people but may be even more challenging for people with inflammatory joint diseases (IJDs), as IJDs are characterised by functional limitations, pain and fatigue. 1 2 PA defined as 'any bodily movement produced by skeletal muscles that result in energy expenditure' 3 is safe and can improve disease activity, pain, fatigue, quality of life and sleep in people with IJDs. 4 5 Despite these beneficial health outcomes, people with IJDs have lower PA levels than their healthier counterparts and many do not meet the required PA recommendations. [6][7][8][9][10] Self-monitoring of PA has the potential to contribute to successful behaviour change in PA interventions in different populations, including people with IJDs. [11][12][13][14] PA can be monitored in different ways, although ...
Objectives
Self-monitoring of physical activity (PA) has the potential to contribute to successful behaviour change in PA interventions in different populations, including people with inflammatory joint diseases (IJDs). The objectives of this study were to describe the use and knowledge of self-report-based and device-based PA measures in people with IJDs in four European countries, and to explore if the use of such devices, sociodemographic or disease-related variables were associated with adherence to the recommendations of at least 150 min of moderate to vigorous PA per week.
Setting
Cross-sectional survey, performed in 2015–2016.
Participants
People with IJDs in Belgium, Denmark, Ireland and Sweden.
Primary and secondary outcome measures
Use of self-report and device-based PA measures, receipt of instructions how to use PA measures, confidence in using them, adherence to PA recommendations and associated factors for adherence to PA recommendations.
Results
Of the 1305 respondents answering questions on PA measures, 600 (46%) reported use of any kind of self-report or device-based measures to self-monitor PA. Between country differences of 34%–58% was observed. Six per cent and four per cent received instructions from health professionals on how to use simple and complex devices, respectively. Independent associated factors of fulfilment of recommendations of PA were living in Ireland (OR=84.89, p<0.001) and Sweden (OR=1.68, p=0.017) compared with living in Denmark, not perceiving activity limitations in moderate activities (OR=1.92, p<0.001) and using a device to measure PA (OR=1.56, p<0.001). Those living in Belgium (OR=0.21, p<0.001) were less likely to fulfil recommendations of PA.
Conclusions
Almost half of the participants with IJDs used self-report-based or deviced-based PA measures, although few used wearable devices regularly. The results indicate that participants meeting public PA health guidelines were engaged in self-monitoring of PA.
... Furthermore, foot symptoms associated with RA can cause biomechanical alterations, as well as a lack of joint proprioception. The level of physical activity may also be lower among individuals with RA when compared with healthy controls [10,12,13]. Consequently, patients with RA present a higher risk of falls, showing decreased postural stability and difficulty maintaining postural control during everyday activities [11]. ...
The main objective of the present study was to determine the relationship between kinesiophobia and pain (general and foot pain), foot function, and disease activity in patients with rheumatoid arthritis (RA). A total of 124 interviews were carried out with participants with RA. Participants were recruited from the Hospital Universitario Virgen de las Nieves de Granada in Spain. Interviews took place in January 2021. Participants completed the following questionnaires during an appointment with their rheumatologist: Foot Function Index (FFI), Tampa Scale for Kinesiophobia (TSK-11), and the Visual Analogue Scale Pain foot (VAS Pain). Furthermore, the Simplified Disease Activity Index (SDAI) was used to measure disease activity. Of the 124 participants, 73% were women, and their mean age was 59.44 years (SD 11.26 years). In the statistical analysis, positive linear correlations (p < 0.001) were obtained between the variables TSK-11 and VAS (related to general pain or foot pain) and FFI (in its three subscales). Additionally, a negative correlation between the TSK-11 and the educational background was shown. This study provided information about the relationship between foot function and pain with different levels of kinesiophobia in patients with RA. Additionally, the educational background of the patient was considered a predictor of whether or not a patient suffered from kinesiophobia.
... 18,19 Furthermore, different BMI cut-offs have been suggested for patients with RA, reduced by 2 kg/m 2 for each weight status tier, to better depict the changes in body composition due to RC. 20 RC appears to be the result of several synergistic mechanisms, including an excessive production of inflammatory cytokines and hypermetabolism. 21 Hypermetabolism in particular is the result of increased protein degradation and decreased muscle mass, 13,21 which, in the presence of low physical activity levels and sedentary lifestyle, result to an increased accumulation of FM, [22][23][24] further propelling inflammation. 25 Moreover, the underlying testosterone deficiency and hypogonadism, paired with the observed decrease in the production of insulin and the intake of GC medication, pave the way for the development of RC. 21,22,[26][27][28] The limited available studies on the effect of pharmacotherapy on RC suggest that the intake of corticosteroids (CG) and tumour necrosis factor α (TNF-α) inhibitors tend to increase FM accumulation, whereas the use of tocilizumab (TCZ) might induce a gain in lean body mass (LBM). ...
Cachexia is an early result of rheumatoid arthritis (RA) (rheumatoid cachexia, RC), characterised mainly by involuntary loss of fat-free mass. RC is apparent in 1-67% of patients with RA, depending on the diagnostic criteria applied and the method used for the assessment of body composition. RC is associated with increased inflammation and disability, lower health perception, and greater mortality risk. These changes in body composition are driven by the inflammation process, the low levels of physical activity, the underlying testosterone deficiency and hypogonadism, and the pharmacotherapy required for RA. Chronic inflammation enhances resting energy expenditure as a response to stress, inducing an energy deficit, further propelling protein turnover. The use of corticosteroids and tumour necrosis factor α (TNF-α) inhibitors tend to increase fat accumulation, whereas other disease-modifying antirheumatic drugs (DMARDs) appear to induce increments in fat-free mass. The present review presents all information regarding the prevalence of RC, diagnostic criteria, and comorbidities, as well as the effects of pharmacotherapy and medical nutrition therapy on body composition of patients with RA.
... 9,[16][17][18] Despite this, people with RA are less physically active than the general population. 19,20 Fear of acute post-exercise pain and disease aggravation (i.e., a flare-up) may partially explain this. 10,21 Therefore, their concerns regarding pain and disease activity post-exercise need to be addressed. ...
Background
Exercise is advocated in the treatment of rheumatoid arthritis (RA). However, uncertainty around the acute effects of exercise on pain and inflammation may be stopping people with RA from exercising more regularly.
Objectives
To determine the acute effects of exercise on pain symptoms, clinical inflammatory markers, and inflammatory cytokines in RA.
Design
A systematic review of the literature.
Data sources and methods
Five databases were searched (PubMed, Cochrane Library, CINAHL, Scopus and SPORTDiscus); inclusion criteria were studies with acute exercise, a definite diagnosis of RA and disease characteristics assessed by clinical function (i.e., disease activity score, health assessment questionnaire and self-reported pain), clinical markers associated with inflammation (i.e., c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)), and inflammatory cytokines (i.e., interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α)).
Results
From a total of 1544 articles, initial screening and full text assessment left 11 studies meeting the inclusion criteria. A total of 274 people were included in the studies (RA = 186; control = 88). Acute bouts of aerobic, resistance, and combined aerobic and resistance exercise did not appear to exacerbate pain symptoms in people with RA.
Conclusion
Post-exercise responses for pain, clinical inflammatory markers and inflammatory cytokines were not different between people with or without RA. Exercise prescription was variable between studies, which limited between-study comparisons. Therefore, future investigations in people with RA are warranted, which combine different exercise modes and intensities to examine acute effects on pain symptoms and inflammatory markers.
Registration
The PROSPERO international prospective register of systematic reviews – CRD42018091155.
... For adults aged 65 years and older, multicomponent PA focusing on strength training and functional balance is also recommended. Despite the recommendations, those with SpA and RA have been shown to be more sedentary and less physically active than their healthy counterparts [16,17]. ...
Physical activity (PA) is a primary non-pharmacological treatment option for those living with rheumatoid arthritis (RA) and spondyloarthritis (SpA). The aim of this systematic literature review was to summarize and present an updated synthesis of the factors associated with PA in the RA and SpA populations. A tailored search of PubMed (inc. Medline), Web of Science, Embase, APA PsycNET, and Scopus was conducted for research published between 2004 and June 2019. Methodological quality was assessed using The National Institutes of Health (NIH) Quality Assessment Tools for Observational Cohort and Cross-sectional Studies, Case–Control Studies, and Controlled Intervention Studies. Forty RA and eleven SpA articles met the inclusion criteria. Methodological quality was generally fair to good, with two RA studies rated as poor. Correlates are discussed in the sociodemographic, physical, psychological, social, and environmental categories. Environmental factors were not measured in any RA study. In individuals living with RA, consistent positive associations were found between PA and high-density lipoprotein, self-efficacy, and motivation. Consistent negative associations were found for functional disability and fatigue. In individuals with SpA, consistent positive associations were found between PA and quality of life, and consistent negative associations with functional disability. Physical and psychological factors are most consistently related with PA parameters in those living with RA and SpA. Many variables were inconsistently studied and showed indeterminant associations. Studies with prospective designs are needed to further understand the factors associated with PA in these populations, especially in those living with SpA.
... Whether the patients had difficulty performing a certain activity or problems with the duration or intensity of the activity could unfortunately not be determined by our assessments. The effect of inflammatory arthritis on PA has been reported in previous studies on children and adolescents with JIA as well as in adults with rheumatoid arthritis (RA), [32][33][34][35] supporting the findings of our study. We found an association between older age, pain interference, and morning stiffness and nomination of PA. ...
Objective:
To explore quality of life (QOL) using the individualized Patient Generated Index (PGI) in young adults who were diagnosed with JIA in childhood, and examine associations between PGI ratings and standardized health-related outcome measures.
Methods:
Patients (N=79, mean 25.1 ±4.2 yrs, 72% female) completed the PGI and the standardized measures: Health Assessment Questionnaire Disability Index, Medical Outcome Study 12-item Short-Form (SF-12; physical and mental health-related QOL), Brief Pain Inventory Short-Form (pain severity and interference), Hopkins Symptom Checklist-5 and visual analogue scale for fatigue. Information on morning-stiffness, medications, and demographics was also collected. Patients were compared to 79 matched controls.
Results:
The most frequently nominated areas of importance for patients' personally-generated QOL (assessed by PGI) were physical activity (n=38, 48%), work/school (n=31, 39%), fatigue (n=29, 37%) and self-image (n=26, 33%). Nomination of physical activity was associated with older age, more pain interference and morning-stiffness. Nomination of fatigue was associated with current use of disease-modifying antirheumatic drugs, while nomination of self-image was associated with polyarticular course JIA and pain interference. Nomination of work/school was not associated with other factors. Higher PGI scores (indicating better QOL) correlated positively with all SF- 12 subscales except role-emotional and negatively with disability, pain severity, pain interference and morning-stiffness. Compared to controls, patients had more pain, poorer physical health-related QOL and less participation in full-time work or school.
Conclusion:
Physical activity, work/school, fatigue and self-image were frequently nominated areas affecting QOL in young adults with JIA. The PGI included aspects of QOL not covered in standardized measures.
... 5 Studies among persons with RA, however, have typically found lower levels of physical activity than is recommended by existing guidelines. [6][7][8] The use of wearables to self-monitor physical activity may be a promising approach to support people with RA to reach evidenceinformed physical activity recommendations. 9 A wearable is a worn device that tracks movement through sensors or companion smartphone or computer applications. ...
Introduction:
Using wearables to self-monitor physical activity is a promising approach to support arthritis self-management. Little is known, however, about the context in which ethical issues may be experienced when using a wearable in self-management. We used a relational ethics lens to better understand how persons with rheumatoid arthritis (RA) experience their use of a wearable as part of a physical activity counselling intervention study involving a physiotherapist (PT).
Methods:
Constructivist grounded theory and a relational ethics lens guided the study design. This conceptual framework drew attention to benefits, downsides and tensions experienced in a context of relational settings (micro and macro) in which participants live. Fourteen initial and eleven follow-up interviews took place with persons with RA in British Columbia, Canada, following participation in a wearable-enabled intervention study.
Results:
We created three main categories, exploring how experiences of benefits, downsides and tensions when using the intervention intertwined with shared moral values placed on self-control, trustworthiness, independence and productivity: (1) For some, using a wearable helped to 'do something right' by taking more control over reaching physical activity goals. Some, however, felt ambivalent, believing both there was nothing more they could do and that they had not done enough to reach their goal; (2) Some participants described how sharing wearable data supported and challenged mutual trustworthiness in their relationship with the PT; (3) For some, using a wearable affirmed or challenged their sense of self-respect as an independent and productive person.
Conclusion:
Participants in this study reported that using a wearable could support and challenge their arthritis self-management. Constructing moral identity, with qualities of self-control, trustworthiness, independence and productivity, within the relational settings in which participants live, was integral to ethical issues encountered. This study is a key step to advance understanding of ethical issues of using a wearable as an adjunct for engaging in physical activity from a patient's perspective.
Patient or public contribution:
Perspectives of persons with arthritis (mostly members of Arthritis Research Canada's Arthritis Patient Advisory Board) were sought to shape the research question and interpretations throughout data analysis.
... MF, GAP y JM: redacción y edición del manuscrito, aprobación teórica. Se han publicado estudios en los cuales se ha constatado que los pacientes con AR realizan menor AF que los controles 1, 36 . Se presume que este hallazgo estaría en relación con varios factores como el temor a presentar daño articular, aumentar la actividad inflamatoria de la enfermedad así como la falta de información sobre los beneficios de la realización de AF regular 18,26,37 . ...
Introducción: La actividad física (AF) ha recibido un interés creciente como terapia adyuvante para los pacientes con enfermedades reumatológicas. Sin embargo, existe escasa información sobre la AF realizada por los pacientes con artritis reumatoide (AR) de Paraguay.
Objetivo: Analizar la AF de los pacientes con diagnóstico de AR y los factores asociados a la realización de la misma.
Metodología: El estudio fue transversal y los pacientes con AR fueron incluidos de forma consecutiva al momento de su control habitual con su reumatólogo tratante. La AF fue calculada con el GPAQ (Global Physical Activity Questionnaire) y se registraron variables sociodemográficas y clínicas para analizar su relación con la realización de AF.
Resultados: Se incluyó a 187 pacientes, de los cuales el 45,5% no fueron suficientemente activos considerando las recomendaciones de la Organización Mundial de la Salud (OMS). La edad, el sexo y el hipotiroidismo fueron las variables asociadas a la AF.
Conclusión: En nuestro estudio se observó que una proporción importante de pacientes con AR no realizó suficiente AF según las recomendaciones de la OMS. Esto resalta la importancia de analizar los factores implicados en este resultado para lograr superarlos y encontrar estrategias que favorezcan la realización de AF regular.
... A positive association was found between CRF with step count and MVPA time and, a negative association was found between CRF with sedentary time. These associations are also reported by studies on people who have RA without CVD risks [1,7,8,[33][34][35][36]. ...
Lower cardiorespiratory fitness (CRF) and physical activity (PA) associate with higher cardiovascular disease (CVD) risk, but the relationship between CRF and PA in people who have rheumatoid arthritis (RA) at an increased CVD risk (CVD-RA) is not known. The objectives of this study were to determine the levels of CRF and PA in people who have CVD-RA and to investigate the association of CRF with PA in people who have CVD-RA. A total of 24 consecutive patients (19 women) with CVD-RA (> 4% for 10-year risk of fatal CVD development as calculated using the Systematic Coronary Risk Evaluation)—were included in the study. CRF was assessed with a graded maximal exercise test determining maximal oxygen uptake (VO2max). PA was assessed with an accelerometer to determine the amount of step count, sedentary, light and moderate-to-vigorous physical activity (MVPA) minutes per day. Mean age of patients was 65.3 ± 8.3 years. CRF mean values were 16.3 ± 1.2 ml·kg−1 min−1, mean step count per day was 6033 ± 2256, and the mean MVPA time was 16.7 min per day. Significant positive associations were found for CRF with step count (B = 0.001, P = 0.01) and MVPA time (B = 0.15, P = 0.02); a negative association was found for CRF with sedentary time (B = − 0.02, P = 0.03). CRF is low and is associated with step count, sedentary time and MVPA time in people who have RA at an increased CVD risk.
... Mesure de l'activité de course (spontaneous wheel running) L'action de courir dans une roue est un comportement naturel pour un rongeur [90]. La réduction de l'activité de course en condition de douleur chronique (inflammatoire, neuropathique, migraineuse [88,[91][92][93][94][95][96][97]) s'apparenterait à une réduction d'activité qui peut apparaître chez le patient [98,99] et donc être le reflet d'une altération de la qualité de vie. Les difficultés principales de ce test résident dans la difficulté d'obtenir une activité de base stable (il faut en général plusieurs semaines de tests pour l'obtenir), compte tenu de la variabilité entre les rongeurs et de l'effet propre de l'exercice prolongé sur la douleur [100][101][102]. ...
... INTRODUCTION Good-quality evidence has accumulated over the past two decades on the effectiveness of aerobic and muscle-strengthening physical activity (PA) to reduce disease-related symptoms and comorbidity risk in people with rheumatoid arthritis (RA). [1][2][3] Since PA is effective and safe, it is recommended to be included in the standard care of patients with RA. 4 Nevertheless, PA levels remain low in people with RA [5][6][7] and a number of factors challenge the participation in and maintenance of regular PA. Such factors include, for example, time and cost, pain, fatigue and activity limitation, poor selfregulation skills and low autonomous motivation, as well as a lack of knowledge and reluctance on the part of health professionals (HPs) to implement evidence-based PA guidelines. ...
Background
Physical activity (PA) in rheumatoid arthritis (RA) is considered a cornerstone in the treatment. To highlight aspects involved in supporting a positive PA behaviour, it is important to understand the patients’ perceptions of the phenomenon.
Objective
The aim of this qualitative meta-synthesis was to explore and synthesise patient perceptions of PA in RA.
Methods
A purposeful search was conducted across three online databases (PubMed, CINAHL and Web of Science). The methodological quality of the included studies was appraised, and data were extracted and analysed using an interpretive inductive thematic synthesis.
Results
Fifteen studies met the inclusion criteria and were included. PA was identified as an agile lifelong behaviour, with one main theme: The disease as a persistent catalyst for or against PA illustrating how the constant presence of the disease itself underlies the entire process of a life with or without regular PA. Seven subthemes: ‘considering aggravated symptoms’, ‘acknowledging the impact on health’, ‘becoming empowered and taking action’, ‘keeping informed to increase awareness’, ‘creating body awareness’, ‘dealing with social support’ and ‘feeling satisfied with circumstances and achievements’ were interpreted as facilitators and/or challenges.
Conclusion
This synthesis has identified PA as an agile lifelong behaviour in which the disease pervades all aspects of an individuals’ perception of PA. Placed in a theoretical context, our findings outline a model for tailoring PA support to the drivers and determinants of a certain individual, which will improve clinical practice for the benefit of both health professionals and patients with RA.
... people with airways disease) [28] or in cohorts with impaired mobility (i.e. elderly individuals +/-those with underlying musculoskeletal disorders) [29]. ...
Purpose:
The aim of this pilot validation study was to determine the accuracy of a smartphone (iPhone®) pedometer in adults with and without asthma.
Methods
: Ten adults with asthma and ten healthy controls underwent clinical assessment prior to completing two separate trials.
Phase 1.
standardised treadmill and self-paced walking tests. Total steps were recorded via: (i) Yamax Digiwalker™ SW800 pedometer positioned on the waistband, (ii) iPhone® pedometer positioned on the upper body, (iii) iPhone® pedometer positioned on the lower body and evaluated against a video-verified manual step-count.
Phase 2.
step-count was evaluated over seven-days during habitual free-living conditions via Yamax Digiwalker™ SW800 and iPhone® pedometers.
Results:
During treadmill walking, the iPhone® positioned on the lower body correlated strongly (r = 0.96) and produced the highest level of agreement (mean bias: -11 steps, LOA: -43 to 21 steps) in comparison to video-verified manual step-count. During self-paced walking, all devices provided an excellent step-count estimate. During free-living conditions, no difference was observed between the Yamax Digiwalker™ SW800 pedometer and iPhone® (P = 0.10) and a strong correlation (r = 0.94) and acceptable agreement (mean bias: -343, LOA: -1963 to 1276 steps) was observed.
Conclusion:
Our findings indicate that an in-built iPhone® pedometer offers a practical approach to physical activity assessment in adults with and without asthma. Future research is now required to further validate the precision of this approach and evaluate the efficacy and effectiveness of smartphone pedometers to monitor and promote physical activity when employed during medical consultation and/or clinical research trials.
... With sleep being identified as a major concern for people with RA, and disturbed sleep and fatigue known to affect up to 70% in this population [8], health professionals (HPs) should be concerned with the effect low TST and poor sleep quality has on HRQoL. Low TST and poor sleep quality, in addition to their effect on mental and physical health [9,10], may lead to people with RA being less active [11]. Therefore, aiming to increase TST and improving sleep quality through exercise, may be a health promotion strategy that is feasible and safe for this population. ...
Current rheumatology guidelines recommend exercise as a key component in the management of people with RA, however, what is lacking is evidence on its impact on sleep. Objective is to assess the feasibility of a walking-based intervention on TST, sleep quality, and sleep disturbance and to generate potential effect size estimates for a main trial. Participants were recruited at weekly rheumatology clinics and through social media. Patients with RA were randomized to a walking-based intervention consisting of 28 sessions, spread over 8 weeks (2–5 times/week), with 1 per week being supervised by a physiotherapist, or to a control group who received verbal and written advice on the benefits of exercise. Primary outcomes were recruitment, retention, protocol adherence and participant experience. The study protocol was published and registered in ClinicalTrials.gov NCT03140995. One hundred and one (101) people were identified through clinics, 36 through social media. Of these, 24 met the eligibility criteria, with 20 randomized (18% recruitment; 100% female; mean age 57 (SD 7.3 years). Ten intervention participants (100%) and eight control participants (80%) completed final assessments, with both groups equivalent for all variables at baseline. Participants in the intervention group completed 87.5% of supervised sessions and 93% of unsupervised sessions. No serious adverse events were related to the intervention. Pittsburgh Sleep Quality Index global score showed a significant mean improvement between the exercise group-6.6 (SD 3.3) compared to the control group-0.25 (SD 1.1) (p = 0.012); Intervention was feasible, safe and highly acceptable to study participants, with those participants in the exercise group reporting improvements in sleep duration and sleep quality compared to the control group. Based on these findings, a fully powered randomized trial is recommended. Trial registration number: ClinicalTrials.gov Identifier: NCT03140995 (April 25th, 2017)
... These are all different examples on how the current pandemic can encourage less physical activity and more sedentary behaviour in RA, a population that is already characterised by lower levels of physical activity and higher levels of sedentary behaviour. 17,18,32 Since the start of the pandemic, there has been a plethora of advice and recommendations readily available in the news and online, suggesting ways in which people can stay physically active during the pandemic and imposed "lockdown" restrictions. For example, social media has seen an exponential growth in recommendations and suggestions for home-based exercise, which can be carried out during the lockdown. ...
In response to the COVID-19 pandemic, many countries have adopted community containment to manage COVID-19. These measures to reduce human contact, such as social distancing, are deemed necessary to contain the spread of the virus and protect those at increased risk of developing complications following infection with COVID-19. People with rheumatoid arthritis (RA) are advised to adhere to even more stringent restrictions compared to the general population, and avoid any social contact with people outside their household. This social isolation combined with the anxiety and stress associated with the pandemic, is likely to particularly have an impact on mental health and psychological wellbeing in people with RA. Increasing physical activity and reducing sedentary behaviour can improve mental health and psychological wellbeing in RA. However, COVID-19 restrictions make it more difficult for people with RA to be physically active and facilitate a more sedentary lifestyle. Therefore, guidance is necessary for people with RA to adopt a healthy lifestyle within the constraints of COVID-19 restrictions to support their mental health and psychological wellbeing during and after the COVID-19 pandemic.
... Physical activity reduces the risk of these comorbidities in the general population [7], and there is some evidence that it might also be an effective treatment for patients with RA [8,9]. It is well known that a large number of patients with RA have a sedentary lifestyle and are less active than their healthy counterparts [10]. Large population-based studies have found a prevalence of health-enhancing physical activity ranging from 20 to 70% in people with chronic inflammatory arthritis [11][12][13], depending on the methodology used and the country investigated. ...
Background
A large number of patients with RA do not adhere to the recommended levels of physical activity to enhance health. According to EULAR recommendations, physical activity should be part of standard care in people with rheumatic diseases. There have been few larger studies on maintenance of physical activity over longer periods of time. The aim was to study self-reported physical activity levels over 7 years in patients with established rheumatoid arthritis (RA). In addition, to determine variables associated with maintenance or change of physical activity behavior.
Methods
Questionnaires were sent to the BARFOT cohort in 2010 ( n = 1525) and in 2017 ( n = 1046), and 950 patients responded to both questionnaires. Patients were dichotomized according to meeting MVPA recommendations (physically active at a moderate level ≥ 150 min/week or at an intense level ≥ 75 min/week) or not. Body mass index, smoking habits, tender joint count (TJC), swollen joint count (SJC), Patient Global Assessment (PatGA), pain intensity and distribution, fatigue, physical function (HAQ), health-related quality of life (EQ. 5D), comorbidities, and medical treatment were assessed. We used logistic regression analysis to study variables associated with maintenance and/or change of MVPA behavior.
Results
Forty-one per cent ( n = 389) of the patients met MVPA recommendations on both occasions. Patients who met MVPA recommendations over 7 years were younger and a higher proportion were never-smokers. There was a negative association with being overweight or obese, having cardiovascular or pulmonary diseases, pain, fatigue, and physical function, whereas there was a positive association between QoL and maintaining MVPA recommendations. Similar factors were positively associated with a deterioration in physical activity level over time.
Conclusions
Maintenance of physical activity over a long period of time is challenging for patients with established RA. Reports of high quality of life supported maintenance of physical activity while disease related and unhealthy lifestyle factors had a negative effect. Health professionals should consider the patient’s standpoint when encouraging maintenance of physical activity, preferably using coordinated lifestyle interventions.
... 1 Despite the strong evidence for PA, most people with chronic disability do not reach and/or maintain recommended PA levels. [2][3][4][5][6] Supporting not only the adoption of healthy PA behaviors but also their maintenance among patients with chronic disability is an important, yet challenging, task for physical therapists. 7,8 A few intervention studies to support PA maintenance in people with rheumatoid arthritis (RA) have been reported. ...
Objective:
A few studies with a qualitative design have addressed physical activity (PA) maintenance in people with rheumatoid arthritis (RA), but none of them focused specifically on maintenance of PA according to public health recommendations. The purpose of this study was to describe perceptions of PA maintenance during the second year of an outsourced 2-year support program among people with RA.
Methods:
For this descriptive design with a qualitative inductive approach, semistructured interviews were conducted with 18 participants with RA (3 men and 15 women). Variation in age, disease duration, activity limitation, pain, levels of PA, and PA maintenance was targeted through strategic sampling. Qualitative content analysis was used, and a pattern of theme, subthemes, and categories was constructed based on the participants' perceptions of PA maintenance.
Results:
A main overarching theme, "A necessary investment in future health"-with 3 subthemes of dedication, awareness, and affinity-were identified as participants' perceptions of PA maintenance. Eight categories further described are a changed mindset, habits, commitments, monitoring, insights in PA, health gains, social support, and PA context.
Conclusions:
PA according to public health recommendations was perceived as a true investment in future health and wellness requiring dedication, awareness, and affinity. To promote PA maintenance, physical therapists working with people with chronic conditions should consider strengthening these prerequisites by targeting patients' negative attitudes to PA, supporting their creation of PA habits to incorporate in daily routines, introducing monitoring of PA intensity, supporting development of PA self-regulation skills, and providing suitable gym facilities with the possibility of peer support.
... In their study, Margiotta et al. investigated the physical activity level in 93 SLE patients and reported that 60 % of them didn't meet the WHO recommendations for physical activity [22]. ...
Background Patients with rheumatic disease are assumed to have low muscle performance, but few studies have been performed to prove this.
Objective To investigate and compare muscle performance in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients and detect its correlation with disease activity, physical function level and quality of life.
Patients and Methods Fifty RA patients, 50 SLE patients and 50 healthy controls were recruited for this observational, cross-sectional study. Muscle performance tests for the upper and lower limbs and the fatigue severity score were recorded. Assessments of the physical activity level using the frequency intensity time index and quality of life using the SF36 questionnaire were performed. The study was conducted over 4 months from January to April 2019.
Results SLE patients showed better results of muscle performance than RA patients; however, both had lower results as compared to control. Disease activity was correlated to muscle performance tests in both diseases, except for the 30-second chair stand test in SLE (p=0.247). All domains of SF36 had a significant correlation with the performance tests in SLE (p≤0.05); however, only domains of physical function correlated with the tests in the RA group.
Conclusion RA patients tend to have a lower muscle performance and physical activity level as compared to SLE patients and control.
... It has been demonstrated that aerobic and muscle strengthening exercise increases physical function and decreases pain, fatigue, disease activity and disability [15,[17][18][19][20]. Therefore, it has been proposed that exercise should be included in the routine management of RA [21][22][23][24]. However, the amount of exercise performed among patients with RA is lower than the level recommended by international guidelines [25,26]. This reduced level of physical activity among RA patients is often due to the misconception that exercise may further damage the joints [18,[27][28][29]. ...
Objectives:
RA patients often present with low muscle mass and decreased strength. Quantitative MRI offers a non-invasive measurement of muscle status. This study assessed whether MRI-based measurements of T2, fat fraction, diffusion tensor imaging and muscle volume can detect differences between the thigh muscles of RA patients and healthy controls, and assessed the muscle phenotype of different disease stages.
Methods:
Thirty-nine RA patients (13 'new RA'-newly diagnosed, treatment naïve, 13 'active RA'-persistent DAS28 >3.2 for >1 year, 13 'remission RA'-persistent DAS28 <2.6 for >1 year) and 13 age and gender directly matched healthy controls had an MRI scan of their dominant thigh. All participants had knee extension and flexion torque and grip strength measured.
Results:
MRI T2 and fat fraction were higher in the three groups of RA patients compared with healthy controls in the thigh muscles. There were no clinically meaningful differences in the mean diffusivity. The muscle volume, handgrip strength, knee extension and flexion were lower in all three groups of RA patients compared with healthy controls.
Conclusion:
Quantitative MRI and muscle strength measurements can potentially detect differences within the muscles between RA patients and healthy controls. These differences may be seen in RA patients who are yet to start treatment, those with persistent active disease, and those who were in clinical remission. This suggests that the muscles in RA patients are affected in the early stages of the disease and that signs of muscle pathology and muscle weakness are still observed in clinical remission.
... people with airways disease) (28) or in cohorts with impaired mobility (i.e. elderly individuals and/or those with underlying musculoskeletal disorders) (29). ...
Introduction: Regular physical activity and structured exercise are often reported to be associated with improved asthma control - however the majority of published evidence is limited by short-term studies employing subjective measures of assessment (i.e. self-report / questionnaires). Modern smartphones typically include built-in activity sensors (i.e. possess the capability to monitor daily step-count) and thus may offer a cost-effective and pragmatic solution to the assessment of physical activity in clinical practice and/or research trials. The primary aim of this proof-of-concept study was therefore to evaluate the validity of the iPhone® (Apple Inc, USA) step-counter in adults with asthma and healthy controls.
Methods: The study was conducted as a cross-sectional laboratory based-trial. Ten healthy adults with no prior history of respiratory disease and ten adults with a prior physician diagnosis of asthma were enrolled. All completed baseline clinical assessment followed by a standardised walking treadmill challenge consisting of 3 x 3-minute stages at pre-determined speeds: 2.5kph, 5.0kph and 7.5kph. Steps were recorded using the following devices: (i) Yamax Digiwalker™ SW-200 Pedometer (Yamax, UK), (ii) iPhone® step-counter (upper body arm-band), (iii) iPhone® step-counter (lower body trouser pocket) - and evaluated against a video-verified manual step-count (i.e. gold-standard comparator) conducted by the investigator (CR).
Results: No difference was observed in manual total step-count between individuals with asthma (1018 steps) and healthy controls (1038 steps) (P=0.44). The iPhone® step-counter (both upper and lower body) provided close agreement with video-verified manual step-count, and importantly, outperformed the Yamax Digiwalker® SW-200 Pedometer across the majority of test stages. Specifically, the iPhone® (lower body) correlated strongly (r = 0.96; P<0.006) and produced the highest level of agreement with video-verified total step-count (mean bias: -11; limits of agreement: -43 to 21) (Table 1).
Conclusion: Our findings indicate that the iPhone® provides an accurate estimate of step-count in adults with asthma and healthy controls completing a standardised laboratory-based treadmill test. Prior to implementation, further research is required to determine the validity and reliability of this approach during daily active / free living conditions.
... Both prospective and experimental studies indicate higher levels of PA engagement to lead to improvements in inflammatory disease activity, physical function, CVD risk, and psychological health [4][5][6][7]. However, research suggests that people living with RA participate in very low levels of PA, especially at the intensity required to accrue health benefits-that is, moderateto-vigorous PA (MVPA; ≥3 metabolic equivalents) [8,9]. Common barriers to PA reported by RA patients are pain, fatigue, and fear of causing further joint damage [10], despite conclusive evidence that Testing a self-determination theory-based process model of physical activity behavior change in rheumatoid arthritis: results of a randomized controlled trial Sally A. M. Fenton, 1,2, Jet JCS Veldhuijzen van Zanten, 1,2 George S. Metsios, 2,3 Peter C. Rouse,4 Chen-an Yu, 1 Nikos Ntoumanis, 5 George D. Kitas, 1,2 Joan L. Duda 1 PA is safe in this population [11]. ...
Physical inactivity is prevalent in rheumatoid arthritis (RA) patients, increasing the risk of poor physical health and compromised well-being. Interventions are therefore required to support physical activity (PA) behavior change in this population. This study examined whether a self-determination theory (SDT) based exercise intervention for people with RA, increased autonomous motivation for PA and in turn, moderate-to-vigorous PA (MVPA) and subjective vitality RA patients (n = 115) were randomized to a 3-month SDT-based psychological intervention + RA-tailored exercise program (experimental group, n = 59) or a RA-tailored exercise program only (control group, n = 56). During the program, the SDT-based intervention group received one-on-one consultations with a PA advisor trained in delivering strategies to promote autonomous motivation for PA. Well-established questionnaires assessed autonomous and controlled motivation for PA, MVPA (min/week), and subjective vitality at baseline (T1) and 3 months (T2). Path analysis examined the hypothesized theoretical process model. The model demonstrated an excellent fit to the data (n = 70, χ2 (26) = 28.69, p = .33, comparative fit index = 0.99, root square mean error of approximation = 0.04). The intervention corresponded to higher autonomous motivation and lower controlled motivation for PA at T2, after controlling for T1 autonomous and controlled motivation. In turn, changes in autonomous motivation from T1 to T2 significantly positively predicted changes in MVPA and subjective vitality. Results suggest an SDT based psychological intervention comprising autonomy-supportive strategies for PA predicted greater reported autonomous reasons for PA in RA patients participating in a tailored 3-month exercise program. Increased autonomous motivation linked to increased engagement in MVPA and feelings of vitality in these patients.
... [11][12] Physical activity significantly improved the joint motility, strength and functional ability in patients with either prediabetes or RA via altered pro-inflammatory muscle cytokines [13][14] and reduced the blood glucose levels, further lowering the risk for T2DM. 15) Unfortunately, 71% of adults with RA are unable to maintain normal physical activity, [16][17][18][19] owing to arthritis related barriers to physical activity. Joint pain, joint stiffness and deformity reduced the engagement of patients with RA in physical activity. ...
... In a Swedish randomized controlled study on selfassessed physical activity, including 228 patients with mean disease duration of 21 months, close to 50% reached the WHO recommendations for MVPA at baseline (48). The higher proportion of patients meeting the recommendations in our study may be due to differences in methodology (49), but also to the information on and support for physical activity offered by the team in the early arthritis clinic. ...
Objective: To investigate associations between physical activity and risk factors for cardiovascular disease (CVD), subclinical atherosclerosis, and disease activity in patients with early and long-standing rheumatoid arthritis (RA).
Method: This cross-sectional study included 84 patients with early and 37 with long-standing RA (disease duration, mean ± sd: 1.4 ± 0.4 and 16.3 ± 2.3 years, respectively). Physical activity was measured using a combined accelerometer and heart-rate monitor. Further assessments were disease activity (erythrocyte sedimentation rate, Disease Activity Score in 28 joints), functional ability (Health Assessment Questionnaire), risk factors for CVD (blood lipids, i.e. triglycerides, high-density lipoprotein, low-density lipoprotein; blood glucose, blood pressure, sleeping heart rate, waist circumference, body mass index, and body fat), and subclinical atherosclerosis (pulse-wave velocity, augmentation index, and carotid intima–media thickness).
Results: Physical activity variables did not differ between patients with early and long-standing RA. However, 37% of the patients with early and 43% of those with long-standing RA did not reach the World Health Organization’s recommended levels of moderate to vigorous physical activity (MVPA). In a final multiple regression model, adjusted for age, gender, disease duration, and activity monitor wear time, higher total physical activity was associated with lower body fat and higher functional ability. With the same adjustments, more time spent in MVPA was associated with lower high-density lipoprotein and lower sleeping heart rate.
Conclusions: Physical activity was associated with more favourable risk factors for CVD. However, many patients were physically inactive, stressing the importance of promoting physical activity in RA.
... Exercise is suggested as an important part of the management of RA [6,7], and for older adults the need for disability-preventing physical activity increases with age regardless of diagnosis [8,9]. However, older adults with RA are less physically active than healthy older adults and do not reach the level of physical activity recommended by international guidelines for health-enhancing physical activity [10,11]. Several diagnosis-specific barriers for adopting and participating in regular exercise have been reported, such as pain, fatigue, and reduced functional abilities, in addition to general barriers, such as lack of time or motivation [12]. ...
Background
Besides being health enhancing and disease preventing, exercise is also an important part of the management of chronic conditions, including the inflammatory joint disease rheumatoid arthritis (RA). However, older adults with RA present a lower level of physical activity than healthy older adults. The aim of this qualitative study was to explore aspects of participation in moderate- to high-intensity exercise with person-centred guidance influencing the transition to independent exercise for older adults with RA.
Methods
A qualitative interview study was conducted. In-depth interviews with 16 adults with RA aged between 68 and 75 years, who had taken part in the intervention arm of a randomized controlled trial performing moderate- to- high-intensity exercise with person-centred guidance, were analysed using qualitative content analysis.
Results
The analysis resulted in six main categories: A feasible opportunity to adopt exercise, Experiencing positive effects of exercise, Contextual factors affect the experience of exercise, Developing knowledge and thinking, Finding one’s way, and Managing barriers for exercise. The exercise with person-centred guidance was described as a feasible opportunity to start exercising as a basis for the transition to independent exercise. They described developing knowledge and thinking about exercise during the intervention enabling them to manage the transition to independent exercise. Finding one’s own way for exercise became important for sustaining independent exercise. Lastly, barriers for exercise and strategies for overcoming these were described. Reduced physical health, both temporary and permanent, was described as a considerable barrier for exercise.
Conclusion
The participants described several aspects of participating in exercise that influenced and facilitated their transition to independent exercise. The exercise was experienced as manageable and positive, by a careful introduction and development of an individual exercise routine in partnership with a physiotherapist. This seems to have favored the development of self-efficacy, with importance for future independent exercise. Reduced physical health, both temporary and permanent, was described as a considerable barrier for exercise. The personal process of trying to make the exercise one’s own, and developing knowledge about exercise and new thoughts about oneself, seemed to prepare the participants for managing independent exercise and overcoming barriers.
... Physical fitness is defined as "a set of attributes that are either health or skill related" [25]. In response to this, Tierney et al. [26] emphasizes the importance to research PA in its entirety and not exercise as single component. Therefore, the mix of different type of sports (aerobic/strength) in our analysis has been conceptually accomplished. ...
This review aims to determine the specific effects of PA on systemic levels of interleukins and inflammatory markers. A systematic literature search was conducted in three computerized bibliographic databases (Medline, Embase, CENTRAL) to identify randomized controlled trials and matched case studies. Applied key words were: RA and PA including the terms exercise, exercise therapy, gymnastics and exercise movement techniques. Inclusion criteria were data on all types of proinflammatory interleukins (IL), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). For data synthesis, the populations, interventions and outcomes were described according to the PRISMA statement. A total of 1289 publications were found. Fifteen papers, related to 14 different study populations, met the inclusion criteria. No study revealed a significant change regarding IL or CRP levels in response to the intervention (PA). In three study populations, a significant reduction of the ESR was identified, but the effect from PA was not discernible from effects of changes of the anti-rheumatic medication in these studies. The strong variability in study designs, cohort size and types of physical training programs remains an obstacle in the assessment of the measurable effects of PA on inflammatory markers in patients with RA. At present, there is no sufficient evidence to conclude that PA has a significant impact on systemic levels of inflammatory markers in RA.
... In a Swedish randomized controlled study on selfassessed physical activity, including 228 patients with mean disease duration of 21 months, close to 50% reached the WHO recommendations for MVPA at baseline (48). The higher proportion of patients meeting the recommendations in our study may be due to differences in methodology (49), but also to the information on and support for physical activity offered by the team in the early arthritis clinic. ...
Background
The excess risk for cardiovascular disease (CVD) in Rheumatoid Arthritis (RA), is partly attributable to traditional cardiovascular risk factors for CVD¹ and systemic inflammation,1, 2 factors known to be modified by physical activity.3, 4
Objectives
The aim of this cross-sectional study was to objectively measure and compare the level of physical activity in patients with early and long-standing RA, and to analyse possible associations with disease activity, risk factors for CVD and measures of subclinical atherosclerosis.
Methods
This study included 84 patients with early and 37 with long-standing RA (disease duration, mean [SD] 1.4 [0.4] and 16.3 [2.3] years respectively). Physical activity was measured using a combined accelerometer and heart rate monitor and included total physical activity (counts/min), proportion of moderate to vigorous physical activity (MVPA) and sedentary time. Further assessments were; disease activity (ESR, DAS28), functional ability (HAQ), risk factors for CVD (blood lipids, i.e., triglycerides, high density lipoprotein [HDL], low density protein [LDL], blood glucose, blood pressure, waist circumference, body mass index [BMI]), body fat (Dual-energy X-ray), and early signs of atherosclerosis (pulse wave velocity [PWV], augmentation index [AIx] and carotid intima-media thickness [cIMT]).
Results
Physical activity variables did not differ between patients with early and long-standing RA. Thirty-seven% of the patients with early and 43% of the patients with long-standing RA did not reach WHOs recommended levels of MVPA. Univariate linear regression analyses with the two groups combined, showed associations between total physical activity and younger age, lower values for HAQ and disease activity (ESR), as well as more beneficial values for blood glucose, triglycerides, waist circumference, BMI, body fat, sleeping heart rate (SHR), systolic, diastolic and central blood pressure and pulse pressure, Aix, PWV, and cIMT. More time spent in MVPA was associated with younger age and with favourable values of blood glucose, HDL, LDL, waist circumference, SHR and PWV. View this table:
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Abstract AB0257 – Table 1 Physical activity variables in patients with early and long-standing RA, presented as median with inter-quartile range (IQR). P-value refers to Mann-Whitney U-test.
Conclusions
Physical activity behaviour was similar in patients with early and long-standing RA. Total physical activity as well as more time spent in moderate to vigorous physical activity were associated with more favourable risk factors for CVD and measures of atherosclerosis. These results stress the importance of promoting physical activity in patients with RA.
References
[1] Crowson CS, et al. Annals of the rheumatic diseases2018;77(1):48–54. [2] Wallberg-Jonsson S, et al. The Journal of rheumatology1999;26(12):2562–71.
[3] Stavropoulos-Kalinoglou A, et al. Annals of the rheumatic diseases2013;72(11):1819–25.
[4] Metsios GS, et al. Annals of the rheumatic diseases2014;73(4):748–51.
Disclosure of Interest
None declared
... Individuals with RA have lower levels of physical activity than the population at large [3] and frequently do not reach recommended HEPA levels [4][5][6]. In our recent study, 70% of participants with RA reported compliance with HEPA but only 22% had maintained it for at least 6 months [7]. ...
Abstract Background We aimed to evaluate the 1-year and 2-year outcome of a health-enhancing physical activity (HEPA) support program on global pain, pressure pain sensitivity, and exercise-induced segmental and plurisegmental hypoalgesia (EIH) in persons with rheumatoid arthritis (RA). Methods Thirty participants (27 women and 3 men) were recruited from a larger intervention cohort that engaged in strength training and moderate-intensity aerobic activity. Assessments were performed before the HEPA intervention and at 1-year and 2-year follow-ups. Global pain was assessed on a visual analogue scale (0–100). Pressure pain thresholds (PPTs) and suprathreshold pressure pain at rest corresponding to 4/10 (medium pain) (SP4) and 7/10 (strong pain) (SP7) on Borg CR 10 scale were assessed by algometry. In a subsample (n = 21), segmental and plurisegmental EIH were assessed during standardized submaximal static contraction (30% of the individual maximum), by algometry, alternately at the contracting right M. quadriceps and the resting left M. deltoideus. Results Global pain decreased from before the intervention to 2-year follow-up (median 11 to median 6, P = 0.040). PPTs and SP4 pressure pain at rest did not change from before the intervention to 2-year follow-up, while SP7 decreased from mean 647 kPa to mean 560 kPa (P = 0.006). Segmental EIH during static muscle contraction increased from the assessment before the intervention (from mean 1.02 to mean 1.42, P = 0.001), as did plurisegmental EIH (from mean 0.87 to mean 1.41, P
... Physical activity has many benefits for patients with inflammatory RMDs, including reducing disease activity and pain, increasing functional capacity and improving psychological health [18,19], as well as potentially reducing the incidence of some co-morbidities, including cardiovascular disease, diabetes and osteoporosis [20]. There is some evidence that patients with inflammatory RMDs are less physically active than the general population [2123]. ...
Objectives:
To compare the prevalence and incidence of chronic co-morbidities in people with inflammatory rheumatic and musculoskeletal diseases (iRMDs), and to determine whether the prevalent co-morbidities are associated with physical activity levels in people with iRMDs and in those without iRMDs.
Methods:
Participants were recruited to the UK Biobank; a population-based cohort. Data were collected about demographics, physical activity, iRMDs (RA, PsA, AS, SLE) and other chronic conditions, including angina, myocardial infarction, stroke, hypertension, pulmonary disease, diabetes and depression. The standardized prevalence of co-morbidities in people with iRMDs was calculated. Cox regression was used to determine the relationship between the presence of an iRMD and an incident co-morbidity. The relationship between the presence (versus absence) of a (co-)morbidity and physical activity level (low, moderate, high) in people with iRMDs and in those without was assessed using multinomial logistic regression.
Results:
A total of 488 991 participants were included. The estimated prevalence of each co-morbidity was increased in participants with an iRMD, compared with in those without, particularly for stroke in participants with SLE (standardized morbidity ratio (95% CI), 4.9 (3.6, 6.6). Compared with people with no iRMD and no morbidity, the odds ratios (95% CI) for moderate physical activity were decreased for: no iRMD and morbidity, 0.87 (0.85, 0.89); iRMD and no co-morbidity, 0.71 (0.64, 0.80); and iRMD and co-morbidity, 0.58 (0.54, 0.63).
Conclusion:
Having a (co-)morbidity is associated with reduced physical activity in the general population, and to a greater extent in participants with an iRMD. Optimal management of both iRMDs and co-morbidities may help to reduce their impact on physical activity.
... Regular physical activity (PA) is associated with improvements in health-related outcomes, such as quality of life, aerobic fitness and disease-related characteristics, including pain and stiffness in people with inflammatory joint diseases (IJDs). [1][2][3][4] However, research has shown lower levels of PA in the arthritis population, [5][6][7][8][9] thus better promotion of PA among people with IJDs is necessary. 10 Health professionals (HPs) are ideally placed to promote PA and its health benefits with their patients. ...
Objectives
The objectives of this study were to determine rheumatology health professionals' (HPs)' awareness of and confidence in using physical activity (PA) measures in people with inflammatory joint diseases (IJDs), their own self-reported PA levels and to identify HP-related educational needs.
Methods
Rheumatology HPs in Denmark, Sweden, Ireland and Belgium participated in an on-line survey. Descriptive statistics and latent class analysis (LCA) were undertaken SPSS (v21and SASv9.4) to describe data aggregates and range and to identify subclasses of groups with respect to use of PA measures.
Results
322 (n=322, 75.5% women) HPs responded from Denmark (n=50, 15.5%), Sweden (n=66, 20.5%), Ireland (n=28, 8.7%) and Belgium (n=178, 55.3%) and the majority of respondents (n=286, 91.7%) reported it was important to measure PA in people with IJDs. Only 28.2% of HPs used simple body worn sensors to measure PA levels in their patients. The majority were interested in on-line education on measuring PA (82.9%). LCA, used to generate classes of PA measures employed by HPs, revealed three distinct classes reflecting differences in self-reported PA levels, awareness of PA measures, further education requirements and professional background.
Conclusions
The majority of respondents reported that they considered measuring PA as important in people with IJDs; however, the majority lacked confidence in how to measure it. There was strong interest in further education around measuring PA. Three distinct respondent classes were identified to inform targeted education on how to measure PA.
... HEPA might be particularly important to reduce the increased risk of cardiovascular disease and early mortality seen in rheumatoid arthritis (RA) 4 . Nevertheless, a majority of people with RA do not maintain regular physical activity 5,6 . ...
Objective:
To describe changes of health-enhancing physical activity (HEPA), health perception, and functioning during the second year of a 2-year support program, determine aspects of adherence and response, and describe perceptions of the program.
Methods:
Out of 220 individuals with rheumatoid arthritis (RA), 177 participated in the followup. Group support, strength training, and moderate-intensity aerobic activity were encouraged. Data collection included HEPA, perceived health, functioning, and perceptions of the program. Participants with unchanged/improved general health perception and at least 2 of aerobic capacity, grip strength, or timed standing were considered responders.
Results:
Current and maintained HEPA decreased from 82% to 75% (p = 0.0141) and from 41% to 27% (p < 0.0001) during the second year. Minor declines in quality of life and activity limitation occurred (p = 0.0395 and 0.0038, respectively), while outcome expectations for benefits of physical activity increased (p = 0.0010 and 0.0186) and waist circumference tapered off (p = 0.0070). Strength training was performed on average 41 and 35 times among responders (n = 54) and nonresponders (n = 105), respectively (p = 0.2708); HEPA 194 and 171 days, respectively (p = 0.0828); and support group meetings 12 and 10 times, respectively (p = 0.0943). Strength training, aerobic activity, and short text message reminders were perceived as most valuable; step registration and the self-monitoring walk tests were less appreciated.
Conclusion:
About one-fourth of the originally sedentary individuals with RA sustained their new HEPA behaviors after 2 years and most improvements of health and functioning were sustained. Structured use of behavior change techniques and a second year to support maintenance with a reduced program might help patients with RA to sustain HEPA behavior.
... The physical activity level in patients with RA, especially in those older than 55 years, is lower than the level recommended by international guidelines for health-enhancing physical activity and is lower than that among healthy persons (12,13). The reduced physical activity level in patients with RA is partly due to a worry that exercise could damage the joints (14,15), but no harmful side effects from exercise has been documented (5) and no joint damage is seen at long time follow-up after high-intensity exercise (16). ...
Objective
To evaluate the effect of a person‐centered, moderate‐to‐high intensity, aerobic and resistance exercise protocol on older adults with rheumatoid arthritis (RA), through a randomized controlled multi‐center trial.
Methods
Older adults (65‐75 years) with RA (n=74) were randomized to either a 20‐week person‐centered exercise intervention at a gym (n=36) or to home‐based exercise of light intensity (n=38). Assessments were performed at baseline, at 20 weeks, and at 12 months. Primary outcome was the difference in the Health Assessment Questionnaire ‐ Disability Index (HAQ‐DI), and the secondary outcomes were the differences in physical fitness assessed by a cardiopulmonary exercise test, an endurance test, Timed Up and Go, Sit To Stand test and isometric elbow flexion force.
Results
No significant differences between the groups were found for the primary outcome HAQ‐DI. Within the intervention group there was a significant improvement of HAQ‐DI when compared to baseline (p=0.022). Aerobic capacity (p<0.001) and three out of four additional performance‐based tests of endurance and strength significantly improved (p<0.05) in the intervention group when compared to the control group. In the intervention group 71% rated their health as much or very much improved compared to 24% of the control group (p<0.001). At the 12‐month follow‐up, there were no significant difference of change between the two groups on HAQ‐DI. A significant between‐group difference was found for change in an endurance test (p=0.022).
Conclusion
Person‐centered aerobic and resistance exercise improved physical fitness in terms of aerobic capacity, endurance and strength in older adults with RA.
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... The accurate evaluation of CV risk among patients with RA remains an area of diligent research. A significantly lower VO 2 max levels were repeatedly demonstrated in patients with RA compared with healthy counterparts, most likely attributed to their low levels of physical activity [9,19] and increased disease activity/severity. Accordingly, we also recorded that VO 2 max level found to be significantly lower in patients with RA compared with control group. ...
Aim The aim of this study was to evaluate maximal oxygen uptake (VO2 max) as a marker of cardiovascular disease (CVD) in rheumatoid arthritis (RA) and its relation to the CVD risk factors in a cohort of female patients with RA without associated lung disease.
Patients and methods A total of 132 female patients with RA were assessed for cardiopulmonary fitness with a VO2 max testing. Moreover, 100 healthy female individuals were recruited as control group. Exclusion of patients with pulmonary fibrosis/nodules by using high-resolution computed tomography was done. Traditional CVD risk factors and disease characteristics and their correlation with VO2 max level were assessed in all patients.
Results Based on VO2 max mean, patients were classified into three groups: unfit (25.6 ml/kg/min). Patients had significantly worse VO2 max mean (21.28±6.96 ml/kg/min) compared with control (30.88±7.36 ml/kg/min). Patients with poor VO2 max level were more likely to be older, hypertensive, with family history of CVD, with high BMI, and with high mean of Framingham risk score. Significant differences were detected between the fitness subgroups in mean of carotid intima–media thickness and presence of carotid plaques. Long duration of RA, uncontrolled disease activity, high health assessment questionnaire, high C-reactive protein, and positive anticyclic citrullinated protein antibodies were correlated significantly with reduced VO2 max level.
Conclusion VO2 max test can be used as a surrogate CVD marker in patients with RA. VO2 max can be used as a noninvasive test to detect and quantify fitness defects in patients with RA at increased risk of CVD.
Sarcopenia, a disorder that involves the generalized loss of skeletal muscle strength and mass, was formally recognized as a disease by its inclusion in the International Classification of Diseases in 2016. Sarcopenia typically affects older people, but younger individuals with chronic disease are also at risk. The risk of sarcopenia is high (with a prevalence of ≥25%) in individuals with rheumatoid arthritis (RA), and this rheumatoid sarcopenia is associated with increased likelihood of falls, fractures and physical disability, in addition to the burden of joint inflammation and damage. Chronic inflammation mediated by cytokines such as TNF, IL-6 and IFNγ contributes to aberrant muscle homeostasis (for instance, by exacerbating muscle protein breakdown), and results from transcriptomic studies have identified dysfunction of muscle stem cells and metabolism in RA. Progressive resistance exercise is an effective therapy for rheumatoid sarcopenia but it can be challenging or unsuitable for some individuals. The unmet need for anti-sarcopenia pharmacotherapies is great, both for people with RA and for otherwise healthy older adults.
Objectives
1) Identify the incidence, risk factors, and outcomes of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD); and 2) assess time-trends in the incidence and mortality of RA-ILD.
Methods
We included adult residents of Olmsted County, Minnesota with incident RA during 1999-2014. Subjects were followed until death, emigration, or 4/30/2019. ILD was defined as the presence of a radiologist-defined pattern consistent with ILD on chest CT. When chest CT was absent, the combination: 1) chest X-ray abnormalities compatible with ILD; and 2) restrictive pattern on pulmonary function testing was considered consistent with ILD. Potential risk factors included age, sex, smoking, obesity, seropositivity, extra-articular manifestations (EAMs), and medications. For survival analysis, we matched RA-ILD patients to RA-non-ILD comparators. The frequency and mortality from clinician-diagnosed RA-ILD during 1999-2014 was compared against a cohort from 1955-1994.
Results
During 1999-2014, 645 individuals (70% women) had incident RA; median age was 55.3 years, and 53% never smoked. Twenty-two patients had ILD before RA, and 51 (67% women) developed ILD during follow-up. The 20-year cumulative incidence of RA-ILD was 15.3%. Ever-smoking (HR=1.92), age (HR=1.89 per 10-year increase) at RA onset, and severe EAMs (HR=2.29) were associated with incident RA-ILD. The RA-ILD cases had higher mortality than their matched RA comparators (HR=2.42). Incidence of RA-ILD was non-significantly lower in 1999-2014 than 1955-1994, but mortality was improved.
Conclusions
RA-ILD occurs in nearly 1 in 6 patients with RA within 20 years and is associated with shorter survival. Lack of significant change in RA-ILD incidence over 6 decades deserves further investigation.
Objectives
This study aimed to explore the impact of the coronavirus disease 2019 (COVID-19) pandemic on self-care of individuals living with rheumatoid arthritis (RA).
Methods
Guided by a constructivist, qualitative design, we conducted one-to-one in-depth telephone interviews between March and October 2020 with participants with RA purposively sampled for maximum variation in age, sex and education, who were participating in one of two ongoing randomized-controlled trials. An inductive, reflexive thematic analysis approach was used.
Results
Twenty-six participants (aged 27–73 years; 23 females) in British Columbia, Canada were interviewed. We identified three themes: (1) Adapting to maintain self-care describes how participants took measures to continue self-care activities while preventing virus transmissions. While spending more time at home, some participants reported improved self-care. (2) Managing emotions describes resilience-building strategies such as keeping perspective, positive reframing and avoiding negative thoughts. Participants described both letting go and maintaining a sense of control to accommodate difficulties and emotional responses. (3) Changing communication with health professionals outlined positive experiences of remote consultations with health professionals, particularly if good relationships had been established prepandemic.
Conclusion
The insights gained may inform clinicians and researchers on ways to support the self-care strategies of individuals with RA and other chronic illnesses during and after the COVID-19 pandemic. The findings reveal opportunities to further examine remote consultations to optimize patient engagement and care.
Patient or Public Contribution
This project is jointly designed and conducted with patient partners in British Columbia, Canada. Patient partners across the United Kingdom also played in a key role in providing interpretations of themes during data analysis.
Objective:
We aim to broaden understanding of the perspectives of persons with arthritis on their use of wearables to self-monitor physical activity, through a synthesis of evidence from qualitative studies.
Methods:
We conducted a systematic search of 5 databases (including Medline, CINAHL, and Embase) from inception to 2018. Eligible studies qualitatively examined the use of wearables from the perspectives of persons with arthritis. All relevant data were extracted and coded inductively in a thematic synthesis.
Results:
Of 4358 records retrieved, 7 articles were included. Participants used a wearable during research participation in 3 studies and as part of usual self-management in 2 studies. In remaining studies, participants were shown a prototype they did not use. Themes identified were: 1) Potential to change dynamics in patient-health professional communication: Articles reported a common opinion that sharing wearable data could possibly enable them to improve communication with health professionals; 2) Wearable-enabled self-awareness; a benefit or downside?: There was agreement that wearables could increase self-awareness of physical activity levels, but perspectives were mixed on whether this motivated more physical activity; 3) Designing a wearable for everyday life: Participants generally felt the technology was not obtrusive in their everyday lives, but it was speculated certain prototypes may embarrass or stigmatize persons with arthritis.
Conclusion:
Themes hint toward an ethical dimension, as participants perceive their use of wearables may positively or negatively influence their capacity to shape their everyday self-management. We suggest ethical questions pertinent to the use of wearables in arthritis self-management for further exploration.
Objective
Rheumatoid arthritis (RA) is an autoimmune disease, characterised by high-grade systemic inflammation, pain, and swollen joints. RA patients have an increased risk for cardiovascular disease (CVD). This study examined if a 3-month individualised RA-tailored exercise programme with one-on-one Self-Determination Theory (SDT)-based support for physical activity (PA), facilitated autonomous motivation, increased PA behaviour, and induced greater improvements in cardiovascular and RA-related disease characteristics, and wellbeing in RA, compared to a standard provision tailored exercise programme.
Methods
115 RA patients were randomised into either the SDT-based psychological intervention + exercise programme (experimental group) or an exercise programme only (control group). Cardiorespiratory fitness (primary outcome), self-reported PA, disease characteristics, CVD risk, wellbeing, and SDT constructs were assessed at baseline (pre-intervention), 3-months (post-intervention), 6-months, and 12-months follow-up. Mixed linear modelling was used to examine within- and between participant changes in these outcome measures.
Results
In 88 patients with complete baseline data, cardiorespiratory fitness did not change from baseline to 3-, 6- or 12-months in either group. CVD risk, disease characteristics, wellbeing, and need satisfaction did not change, with the exception of diastolic blood pressure. Significant group by time interaction effects were found for functional ability (6- & 12-m), CVD risk (6-m) and PA (3-m). Autonomous motivation increased and controlled motivation decreased more in the experimental compared to the control group at 3-m.
Conclusions
Despite improving quality of motivation for exercise, no changes in cardiorespiratory fitness or other psychological and physiological health outcomes were found. This suggests more intensive support is needed when initiating an exercise programme to achieve health benefits in RA.
Objectives
The purposes of this study were to compare physical activity(PA) in a group of psoriatic arthritis(PsA) patients versus healthy controls and to determine whether the mobility of these patients is affected by disease activity.
Methods
A group of 52 PsA patients and 53 controls were included in this case‐control study. PA was assessed by accelerometry in both groups and additionally with the International Physical Activity Questionnaire(IPAQ) in PsA patients. Multiple regression analysis was used to compare PA between groups and to determine the relationship between PA and PsA features, including disease activity, as assessed by Disease Activity Score(DAS)28 and Disease Activity Index for Psoriatic Arthritis(DAPSA). In a group of 36 patients, a test‐retest study was carried out after 6 months.
Results
Time engaged in moderate and vigorous activity(MVPA)/day, as evaluated by accelerometry, and adjusted by confounders, proved similar in PsA patients and controls. In PsA patients, disease activity was inversely related to PA as assessed either by IPAQ or accelerometry. When PA was compared in PsA patients between the two visits, a significant difference in the amount of time doing MVPA was found (42±33 vs 30±22 min/day,p=0.004). Interestingly, in the test‐retest study variations in disease activity overtime based on DAPSA (r=‐0.49,p=0.002) and DAS28‐PCR (r=‐0.4,p=0.017) were inversely correlated with changes in PA, as determined by accelerometry.
Conclusions
PsA patients show levels of PA like healthy controls. In PsA patients, disease activity and PA are inversely correlated and the evaluation of PA by accelerometry is sensitive to changes in disease activity.
Autoimmune diseases are a kind of chronic diseases with unclear etiology, which has the characteristics of repetition and difficulty to cure completely. Aerobic exercise, as an effective intervention method for chronic diseases, has also received extensive attention in the field of the prevention and treatment of autoimmune diseases. In this paper, the effects of aerobic exercise on immune system and autoimmune diseases in recent years are reviewed, and the related mechanisms are discussed. It is pointed out that aerobic exercise can improve the homeostasis of immune environment by affecting the number and function of immune cells, inhibit the systemic inflammatory response of the body, and then delay the occurrence and development of autoimmune diseases.
Background and aims
Preclinical animal models are crucial to study pain mechanisms and assess antinociceptive effects of medications. One major problem with current animal behavioral models is their lack of face validity with human nociception and the vulnerability for false-positive results. Here, we evaluated the usefulness of rotarod as a new way to assess inflammatory nociception in rodents.
Methods
Adult male mice were injected with saline or Complete Freund’s Adjuvant (CFA) in the left hindpaws. Mechanical allodynia and rotarod performance were evaluated before and after the administration of CFA. Mechanical allodynia was measured using von Frey filaments. Long-term effect of CFA on rotarod performance was also assessed for 2 weeks.
Results
Our results showed that CFA administration decreased pain threshold and increased sensitivity to von Frey filaments compared to control group. In rotarod experiments, the starting speed of the rod rotation started at four RPM, and accelerated until it reached 40 RPM in 5 min. Rotarod performance was enhanced from day to day in the control group. However, rotarod performance in CFA group was attenuated after CFA administration, which was significant after 24 h compared to vehicle. This attenuation was blocked by ibuprofen. Haloperidol administration (positive control) produced similar results to CFA administration. CFA did not produce significant attenuation of rotarod performance after 1 week post-injection.
Conclusions
Collectively, our findings could encourage the use of rotarod assay to measure acute (but not chronic) inflammatory nociception as a useful tool in rodents.
Background:
Rheumatic disease and gout are particularly known to be associated with metabolic syndrome.
Purpose:
To compare incidence, physiological indices, and risk factors of metabolic syndrome in patients with rheumatic diseases or gout.
Methods:
Data were collected from medical records of 220 patients with rheumatic disease or gout.
Results:
The incidence rate and most physiological indices of metabolic syndrome (body mass index, blood pressure, serum triglyceride, and fasting blood glucose levels) were significantly higher in the gout group than in the rheumatic disease group. In terms of risk factors of metabolic syndrome, age, gender, and steroid use were significant in the rheumatic disease group, whereas smoking and gout duration were significant in the gout group.
Conclusions:
Men with a rheumatic disease taking steroids warrant additional attention regarding metabolic syndrome development. Special supports are also needed for people with gout who are smokers and who have suffered from gout for a longer duration.
Relatively little is known about what motivates or prevents patients with rheumatoid arthritis (RA) from adopting physically active lifestyles. This study aimed to evaluate the levels of physical activity and to identify the factors affecting a physically active lifestyle among Korean patients with RA. In this cross-sectional study, data were collected from a rheumatology outpatient clinic of a university-affiliated hospital in South Korea. The levels of physical activity were self-reported using the International Physical Activity Questionnaire. Participants who engaged in more than 600 metabolic equivalent task-minutes/week of physical activity and moderate activity or walking at least three times per week were considered physically active in this study. Structured questionnaires were used to assess perceived barriers and self-efficacy for exercise. Of 345 patients with RA included in this study, about 22% of patients were classified as physically active. Factors associated with a physically active lifestyle were good physical function (odds ratio [OR] = 0.56; 95% confidence interval [CI]: 0.36–0.87) and high levels of exercise self-efficacy (OR = 1.36; 95% CI: 1.20–1.54). Common barriers identified were fatigue, interference with other responsibilities, and a lack of time. Participants showed the lowest self-efficacy for exercise when they had pain and were busy with other activities. The level of physical function and exercise self-efficacy were predictors of physical activity. Individualized physical activity programs tailored to personal abilities and barriers and increasing exercise self-efficacy are needed to facilitate engagement of physical activity in Korean patients with RA.
Key Points
• Factors associated with a physically active lifestyle were good physical function and high levels of exercise self-efficacy.
• The levels of exercise self-efficacy in Korean patients with RA are low compared to those in other populations.
• Frequently encountered barriers in the subjects were being too tired, interference with other responsibilities, and lack of time.
• Individualized physical activity programs tailored to personal abilities and barriers and increasing exercise self-efficacy are needed to facilitate engagement of physical activity in Korean patients with RA.
Rheumatoid arthritis (RA) is characterised by functional disability, pain, fatigue and body composition alterations that can further impact on the physical dysfunction seen in RA. RA is also associated with systemic manifestations, most notably an increased risk for cardiovascular disease. There is strong evidence to suggest that increasing physical activity and/or exercise can simultaneously improve symptoms and reduce the impact of systemic manifestations in RA. However, implementation of interventions to facilitate increased physical activity and/or exercise within routine clinical practice is slow because of not only patient-specific and healthcare professional-related barriers but also lack of relevant infrastructure and provision. We review the evidence supporting the physiological adaptations and beneficial effects occurring as a result of increased physical activity and/or exercise in RA and propose an implementation model for facilitating the long-term engagement of patients with RA. We propose that implementation should be led, in a pragmatic manner, by rheumatology healthcare practitioners and supported by social innovation.
Bewegung zählt aufgrund der guten Evidenz und des breiten Wirkspektrums zu den wichtigsten Therapiebausteinen in der Behandlung von entzündlich rheumatischen Erkrankungen. Wegen der häufigen Überlagerung krankheits- und altersspezifischer Aspekte bei älteren Patienten ist die Umsetzung der aktuellen Nationalen Empfehlungen für Bewegung und Bewegungsförderung ärztlich zu prüfen und zu begleiten. Um ältere Patienten nachhaltig in Bewegung zu bringen, bedarf es eines patientenzentrierten Vorgehens unter Berücksichtigung sowohl der individuellen Gesundheitsprobleme als auch des aktuellen Lebenskontextes. Der Beitrag liefert eine Übersicht zur Charakteristik älterer Rheumapatienten aus aktivitäts- und bewegungsbezogener Perspektive. Vor diesem Hintergrund wird ein einfacher Leitfaden zur Bewegungsberatung innerhalb ärztlicher Konsultationen skizziert, der Besonderheiten älterer Rheumapatienten berücksichtigt. So kann eine gezielte, ressourcen- und budgetschonende Bewegungsförderung im Einklang mit den „Nationalen Empfehlungen für Bewegung und Bewegungsförderung“ in den Praxisalltag integriert werden.
In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation.
Primary recommendation:
To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)]
OBJECTIVE--To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention. PARTICIPANTS--A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented. EVIDENCE--The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles. CONSENSUS PROCESS--Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise \"public health message was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine. CONCLUSION--Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the weekType: CONSENSUS DEVELOPMENT CONFERENCEType: JOURNAL ARTICLEType: REVIEWLanguage: Eng
This paper aims to highlight the importance of exercise in patients with rheumatoid arthritis (RA) and to demonstrate the multitude of beneficial effects that properly designed exercise training has in this population. RA is a chronic, systemic, autoimmune disease characterised by decrements to joint health including joint pain and inflammation, fatigue, increased incidence and progression of cardiovascular disease, and accelerated loss of muscle mass, that is, "rheumatoid cachexia". These factors contribute to functional limitation, disability, comorbidities, and reduced quality of life. Exercise training for RA patients has been shown to be efficacious in reversing cachexia and substantially improving function without exacerbating disease activity and is likely to reduce cardiovascular risk. Thus, all RA patients should be encouraged to include aerobic and resistance exercise training as part of routine care. Understanding the perceptions of RA patients and health professionals to exercise is key to patients initiating and adhering to effective exercise training.
Several lines of evidence have emphasized an improvement in aerobic capacity and muscle strength after physical exercise programs in rheumatoid arthritis (RA) patients. Our objective was to evaluate the efficacy of aerobic exercises in RA on quality of life, function, and clinical and radiologic outcomes by a systematic literature review and a meta-analysis.
A systematic literature search was performed in the Medline, EMBase, and Cochrane databases up to July 2009 and in the abstracts presented at rheumatology scientific meetings during the last 5 years. Randomized controlled trials (RCTs) comparing aerobic exercises with non-aerobic interventions in RA patients were included. Outcomes studied were postintervention quality of life, function assessed by the Health Assessment Questionnaire (HAQ), a pain visual analog scale (VAS), joint count, the Disease Activity Score in 28 joints (DAS28), and radiologic damage. Efficacy was assessed by standardized mean differences (SMDs; difference between groups of mean outcome variation from baseline/SD at baseline) of aerobic exercises versus non-aerobic rehabilitation. Heterogeneity was tested. SMDs were pooled by a meta-analysis using the inverse of variance model.
Fourteen RCTs, including 1,040 patients, met the inclusion criteria. Exercise improved the postintervention quality of life (SMD 0.39, P < 0.0001), HAQ score (SMD 0.24, P = 0.0009), and pain VAS (SMD 0.31, P = 0.02). Exercise in this RA population appeared safe, since global compliance, DAS28, and joint count were similar in both groups.
Cardiorespiratory aerobic conditioning in stable RA appears to be safe and improves some of the most important outcome measures. However, the degree of the effect of aerobic exercise on the abovementioned parameters is small.
To explore the associations between measures of physical activity (PA) and measures of physical function (PF) in women with rheumatoid arthritis (RA). We hypothesized that the strength of the associations between PA and PF would be moderate, and that after controlling for social and biomedical characteristics, the associations would decrease.
Women with RA (n = 47, mean +/- SD age 56.5 +/- 7.0 years) participated in the cross-sectional analysis of this study. Social and biomedical characteristics explored included age, ethnicity, disease duration, marital and educational status, height, weight, comorbidity, and disease activity. PF was measured by the self-reported Health Assessment Questionnaire (HAQ) and by a battery of performance-based measures that included self-selected gait speed, the 5 chair rise test, and the single leg stance test. PA was measured by a portable activity monitor worn for 10 days, and was characterized in 2 ways: daily average number of steps and daily energy expenditure during moderate levels of PA.
Correlations between measures of PA and PF were small to moderate (zero-order correlations = 0.189-0.479). After controlling for social and biomedical characteristics, the correlations became smaller (semi-partial correlations = 0.095-0.277) and only HAQ score remained significantly associated with PA.
Associations between measures of PA and measures of PF were explained, in part, by social and biomedical characteristics in women with RA. The results indicate that measures of PF and PA may represent different constructs and support the need to measure PA in rehabilitation research in RA.
Exercise is commonly used in the management of patients with rheumatoid arthritis (RA); however, there is little consensus in the literature to support its use. This systemic review aimed to determine the effects of dynamic exercise on patients with RA. A systematic search of Medline (1949–2007), Cinahl (1982–2007), Embase (1974–2007) and Cochrane library was performed for randomised-controlled trials using the keywords “rheumatoid arthritis” and “exercise” or “training” or “sport”. The methodological quality of studies was assessed using a ten-point scale. Eighteen papers relating to 12 different studies met inclusion criteria. The mean methodological quality score was 6.9/10. Studies using aerobic training, strength training and combinations of both were included. Patients with early, stable, and active RA were studied. A number of studies reported improvement in muscle strength, physical function and aerobic capacity with dynamic exercise. Some studies also reported improvements in disease activity measures, and small improvements in hip bone mineral density. One study reported significantly less progression of small joint radiographic damage of the feet in the dynamic exercise group. However, one study also reported worse large joint radiographic damage in patients using dynamic exercise who had pre-existing large joint damage, though this was a retrospective analysis. No studies reported worse outcomes for function, disease activity or aerobic capacity with dynamic exercise. Cardiovascular outcomes were not reported in any study, and no data were presented to assess the effect of exercise on patients with significant underlying cardiovascular disease. This systematic review suggests that the majority of patients with RA should be encouraged to undertake aerobic and/or strength training exercise. Exercise programmes should be carefully tailored to the individual, particularly for patients with underlying large joint damage or pre-existing cardiovascular disease.
To evaluate the functional, clinical, radiological and quality of life outcomes of a 4-week dynamic exercise programme (DEP) in RA.
Patients matched on the principal medico-social parameters were randomly assigned to either the DEP or the conventional joint rehabilitation group. Primary end point for judging effectiveness was functional status assessed by HAQ. Secondary outcomes included Nottingham Health Profile (NHP), Arthritis Impact Measurement Scale 2-Short Form (AIMS2-SF) and radiological worsening measured by Simple Narrowing Erosion Score (SENS). Clinical evaluation consisted of disease activity score (DAS 28), cycling aerobic fitness and dexterity. Dexterity was measured using Sequential Occupational Dexterity Assessment (SODA) and Duruoz Hand Index (DHI). Data were collected at baseline 1, 6 and 12 months.
Fifty patients were enrolled. HAQ improved throughout the length of the trial in the DEP group. This improvement was greater in DEP than in the standard joint rehabilitation group at 1 month (-0.2 vs no variation from baseline, P = 0.04), but not at 6 months (-0.2 vs -0.1 in control group, P = 0.25) or 12 months (-0.1 vs no variation in control group, P = 0.51). DEP improved NHP (-23 vs + 7% in control group, P = 0.01) and aerobic fitness (+0.3 vs + 0.1 km per 5 min in control group, P = 0.02) at 1 month but the progress was not statistically significant thereafter. DEP also improved DHI, SODA, DAS 28 and AIMS2-SF, although not significantly.
DEP was effective on functional status assessed by HAQ, quality of life and aerobic fitness at 1 month.
Accurate assessment is required to assess current and changing physical activity levels, and to evaluate the effectiveness of interventions designed to increase activity levels. This study systematically reviewed the literature to determine the extent of agreement between subjectively (self-report e.g. questionnaire, diary) and objectively (directly measured; e.g. accelerometry, doubly labeled water) assessed physical activity in adults.
Eight electronic databases were searched to identify observational and experimental studies of adult populations. Searching identified 4,463 potential articles. Initial screening found that 293 examined the relationship between self-reported and directly measured physical activity and met the eligibility criteria. Data abstraction was completed for 187 articles, which described comparable data and/or comparisons, while 76 articles lacked comparable data or comparisons, and a further 30 did not meet the review's eligibility requirements. A risk of bias assessment was conducted for all articles from which data was abstracted.
Correlations between self-report and direct measures were generally low-to-moderate and ranged from -0.71 to 0.96. No clear pattern emerged for the mean differences between self-report and direct measures of physical activity. Trends differed by measure of physical activity employed, level of physical activity measured, and the gender of participants. Results of the risk of bias assessment indicated that 38% of the studies had lower quality scores.
The findings suggest that the measurement method may have a significant impact on the observed levels of physical activity. Self-report measures of physical activity were both higher and lower than directly measured levels of physical activity, which poses a problem for both reliance on self-report measures and for attempts to correct for self-report - direct measure differences. This review reveals the need for valid, accurate and reliable measures of physical activity in evaluating current and changing physical activity levels, physical activity interventions, and the relationships between physical activity and health outcomes.
We describe the usage of various assistive devices and identify factors associated with usage in patients with rheumatoid arthritis (RA). A cross-sectional, multicentre study was performed in three outpatient rheumatology clinics in the Netherlands. Two hundred forty patients with RA participated in the study. The main measures were questionnaires and a semi-structured interview regarding the possession and usage of 21 common assistive devices in the ISO9999 categories orthopaedic footwear, personal care, mobility, household and adaptations for housing. Potential factors associated with usage included sociodemographic variables, health status, quality of life, coping strategies, self-efficacy, outcome expectations and satisfaction. Out of 240 patients, 213 (89%) had one or more assistive devices in possession (median number of devices 3.0, interquartile range 3.0). The proportions of patients never using a device in possession varied between 8% for orthopaedic insoles and 23% for grab bars. The main factors related to usage varied among categories, but common determinants were a specific impairment or disability, satisfaction with the device or related services, self-efficacy and the number of devices in possession. In conclusion, in patients with RA, possession rates are high, with 23% or less of the devices in possession being abandoned. Overall, satisfaction rates were high. Factors associated with usage varied among categories and comprised, apart from the number of devices in possession and variables related to health status, also aspects of satisfaction with the device or related services or self-efficacy. The latter findings underline the need for a systematic evaluation of the outcomes of assistive devices by prescribing health professionals or suppliers in every individual case.
The cytokines IL-1 beta and TNF-alpha cause cachexia and hypermetabolism in animal models, but their role in human inflammation remains controversial. The relationship between in vitro cytokine production and metabolism was examined in 23 adults with RA and 23 healthy control subjects matched on age, sex, race, and weight. Body composition was measured by multicompartmental analysis of body cell mass, water, fat, and bone mass. Resting energy expenditure (REE) was measured by indirect calorimetry. Cytokine production by PBMC was measured by radioimmunoassay. Usual energy intake, physical activity, disability scores, medication use, and other confounders were also measured. Body cell mass was 13% lower (P < 0.00001), REE was 12% higher (P < 0.008), and physical activity was much lower (P < 0.001) in subjects with RA. Production of TNF-alpha was higher in RA than controls, both before and after stimulation with endotoxin (P < 0.05), while production of IL-1 beta was higher with endotoxin stimulation (P < 0.01). In multivariate analysis, cytokine production was directly associated with REE (P < 0.001) in patients but not in controls. While energy and protein intake were similar in the two groups and exceeded the Recommended Dietary Allowances, energy intake in subjects with RA was inversely associated with IL-1 beta production (P < 0.005). In this study we conclude that: loss of body cell mass is common in RA; cytokine production in RA is associated with altered energy metabolism and intake, despite a theoretically adequate diet; and TNF-alpha and IL-1 beta modulate energy metabolism and body composition in RA.
It is 40 yr since the last age- and sex-specific estimates of the prevalence of rheumatoid arthritis (RA) for the UK were published. Since then the classification criteria for RA have been revised and there has been evidence of a fall in the incidence of RA, especially in women.
To estimate the age- and sex-specific point prevalence of RA (defined as fulfilment of a modification of the 1987 ACR classification criteria for RA on the day of assessment). The estimate was made in the primary care setting in Norfolk, UK.
A stratified random sample was drawn from seven age and gender bands. The 7050 individuals selected were mailed a screening questionnaire. Positive responders were invited to attend for a clinical examination. The sample was matched against the names in the Norfolk Arthritis Register (NOAR), a register of incident cases of inflammatory polyarthritis which has been in existence since 1990.
The overall response rate was 82%. Sixty-six cases of RA were identified. Extrapolated to the population of the UK, the overall minimum prevalence of RA is 1.16% in women and 0.44% in men. A number of incident cases of RA previously notified to NOAR were not identified as cases in the survey because they had entered into treatment-induced remission. In addition, some cases who failed to attend for examination had significant disability. These prevalence figures are therefore an underestimate.
The prevalence of RA in women, but not in men, in the UK may have fallen since the 1950s.
The accurate measurement of physical activity is fraught with problems in adults, but more especially in children because they have more complex and multi-dimensional activity patterns. In addition, the results of different studies are often difficult to interpret and compare, because of the diversity of methodological approaches, differences in data analysis and reporting, and the adoption of varying definitions of what constitutes an appropriate level of activity. Furthermore, inactivity is seldom quantified directly. Although there exists an extensive literature documenting the health benefits of regular physical activity in adults, activity-health relationships in children are not clear-cut. Current recommendations reinforce the concept of health-related activity, accumulating 30 min moderate-intensity exercise on at least 5 d/week (adults) and 1 h moderate-intensity exercise/d (children). Evidence suggests a high prevalence of inactivity in adults, but whether or not inactivity is increasing cannot be assessed currently. Similarly, no definite conclusions are justified about either the levels of physical activity of children, or whether these are sufficient to maintain and promote health. Data to support the belief that activity levels in childhood track into adulthood are weak. Inactivity is associated with an increased risk of weight gain and obesity, but causality remains to be established. In children there is strong evidence to demonstrate a dose response relationship between the prevalence and incidence of obesity and time spent viewing television. Future research should focus on refining methodology for physical activity assessment to make it more sensitive to the different dimensions and contexts of activity in different age-groups.
The aim of the study was to validate a diet history interview (DHI) method and a 3-day activity registration (AR) with biological markers.
The reported dietary intake of 33 rheumatoid arthritis patients (17 patients on a Mediterranean-type diet and 16 patients on a control diet) participating in a dietary intervention study was assessed using the DHI method. The total energy expenditure (TEE), estimated by a 3-day AR, was used to validate the energy intake (EI). For nine subjects the activity registration was also validated by means of the doubly labelled water (DLW) method. The excretion of nitrogen, sodium and potassium in 24-h urine samples was used to validate the intake of protein, sodium and potassium.
There was no significant difference between the EI and the TEE estimated by the activity registration or between the intake of protein, sodium and potassium and their respective biological markers. However, in general, the AR underestimated the TEE compared to the DLW method. No significant differences were found between the subjects in the Mediterranean diet group and the control diet group regarding the relationship between the reported intakes and the biological markers.
The DHI could capture the dietary intake fairly well, and the dietary assessment was not biased by the dietary intervention. The AR showed a bias towards underestimation when compared to the DLW method. This illustrates the importance of valid biological markers.
Physical inactivity is a modifiable risk factor for cardiovascular disease. However, little is known about the effects of physical activity on life expectancy with and without cardiovascular disease. Our objective was to calculate the consequences of different physical activity levels after age 50 years on total life expectancy and life expectancy with and without cardiovascular disease.
We constructed multistate life tables using data from the Framingham Heart Study to calculate the effects of 3 levels of physical activity (low, moderate, and high) among populations older than 50 years. For the life table calculations, we used hazard ratios for 3 transitions (healthy to death, healthy to disease, and disease to death) by levels of physical activity and adjusted for age, sex, smoking, any comorbidity (cancer, left ventricular hypertrophy, arthritis, diabetes, ankle edema, or pulmonary disease), and examination at start of follow-up period.
Moderate and high physical activity levels led to 1.3 and 3.7 years more in total life expectancy and 1.1 and 3.2 more years lived without cardiovascular disease, respectively, for men aged 50 years or older compared with those who maintained a low physical activity level. For women the differences were 1.5 and 3.5 years in total life expectancy and 1.3 and 3.3 more years lived free of cardiovascular disease, respectively.
Avoiding a sedentary lifestyle during adulthood not only prevents cardiovascular disease independently of other risk factors but also substantially expands the total life expectancy and the cardiovascular disease-free life expectancy for men and women. This effect is already seen at moderate levels of physical activity, and the gains in cardiovascular disease-free life expectancy are twice as large at higher activity levels.
To compare leisure activities and associated factors in a group with recent onset RA and matched community derived controls, to examine whether leisure activities are altered during the early years of disease and to seek predictors.
One hundred and forty-seven consecutive persons with early RA were followed for 0.9-5.9 yr. One hundred and forty-four RA patients were compared cross-sectionally at baseline with community-derived controls matched for age, gender and residential area. Leisure activities were evaluated with an interest checklist (20 domains). Socio-demographic variables, disease activity (DAS) and disability (HAQ) were evaluated as possible predictors for loss of participation in leisure activities at baseline and longitudinally (using area under the curve analyses).
At baseline (mean disease duration 7 months) RA patients performed less (8.2 vs 9.9 domains, P < 0.001) but did not have significantly less interest (10.9 vs 11.4 domains, P = 0.15) in leisure activities compared with controls. Decrease in performed leisure activities was only significant in those with a low level of education. At baseline, in RA patients, low education (P = 0.035), age (P = 0.019) and HAQ (P < 0.001) significantly predicted performed leisure activity. No loss in performed leisure activities was seen during follow-up and no significant predictors were found for individual change.
Loss of performed leisure activities occurs early in RA and chiefly in those with low formal education. Disability was associated with early loss, but not with change during follow-up. Other factors, possibly related to individual personality and resources, may be more important for predicting changes in leisure activities.
To determine geographical variation in the prevalence of rheumatoid arthritis (RA) and spondyloarthropathies (SpA) in France.
The survey sample was drawn from 7 areas of France. Households were randomly selected using the national telephone directory, and an individual within each household was randomly chosen by the next-birthday method. All cases of suspected RA and SpA were confirmed by the patient's rheumatologist or by clinical examination. Standardized estimates of prevalence were compared between regions and groups of regions.
In total 15,219 anonymous telephone numbers were selected. An average response rate of 64% led to a total of 9395 respondents included in the study. The highest regional rates of RA were observed in the south (range 0.59-0.66%), and the lowest in the north (range 0.14-0.24%), with a national rate of 0.31% (95% CI 0.18-0.48%). Regional heterogeneity was observed for SpA, with the highest rates in Bretagne (0.47%) and the Sud-Est (0.53%) and a national rate of 0.30% (95% CI 0.17-0.46%).
This study is the largest of its kind conducted in France. It shows inter-regional variations, mainly in RA, with a higher prevalence in the south of the country. The many potential reasons for the heterogeneity observed, including genetic and environmental factors, warrant further research.
This systematic review investigates the effectiveness of exercise interventions in improving disease-related characteristics
in patients with rheumatoid arthritis (RA). It also provides suggestions for exercise programmes suitable for improving the
cardiovascular profile of RA patients and proposes areas for future research in the field. Six databases (Medline, Cochrane
Library, CINAHL, Google Scholar, EMBASE and PEDro) were searched to identify publications from 1974 to December 2006 regarding
RA and exercise interventions. The quality of the studies included was determined by using the Jadad scale. Initial searches
identified 1342 articles from which 40 met the inclusion criteria. No studies were found investigating exercise interventions
in relation to cardiovascular disease in RA. There is strong evidence suggesting that exercise from low to high intensity
of various modes is effective in improving disease-related characteristics and functional ability in RA patients. Future studies
are required to investigate the effects of exercise in improving the cardiovascular status of this patient population.
Context Although it is widely recommended that clinical trials undergo some
type of quality review, the number and variety of quality assessment scales
that exist make it unclear how to achieve the best assessment.Objective To determine whether the type of quality assessment scale used affects
the conclusions of meta-analytic studies.Design and Setting Meta-analysis of 17 trials comparing low-molecular-weight heparin (LMWH)
with standard heparin for prevention of postoperative thrombosis using 25
different scales to identify high-quality trials. The association between
treatment effect and summary scores and the association with 3 key domains
(concealment of treatment allocation, blinding of outcome assessment, and
handling of withdrawals) were examined in regression models.Main Outcome Measure Pooled relative risks of deep vein thrombosis with LMWH vs standard
heparin in high-quality vs low-quality trials as determined by 25 quality
scales.Results Pooled relative risks from high-quality trials ranged from 0.63 (95%
confidence interval [CI], 0.44-0.90) to 0.90 (95% CI, 0.67-1.21) vs 0.52 (95%
CI, 0.24-1.09) to 1.13 (95% CI, 0.70-1.82) for low-quality trials. For 6 scales,
relative risks of high-quality trials were close to unity, indicating that
LMWH was not significantly superior to standard heparin, whereas low-quality
trials showed better protection with LMWH (P<.05).
Seven scales showed the opposite: high quality trials showed an effect whereas
low quality trials did not. For the remaining 12 scales, effect estimates
were similar in the 2 quality strata. In regression analysis, summary quality
scores were not significantly associated with treatment effects. There was
no significant association of treatment effects with allocation concealment
and handling of withdrawals. Open outcome assessment, however, influenced
effect size with the effect of LMWH, on average, being exaggerated by 35%
(95% CI, 1%-57%; P=.046).Conclusions Our data indicate that the use of summary scores to identify trials
of high quality is problematic. Relevant methodological aspects should be
assessed individually and their influence on effect sizes explored.
The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a “classification tree” schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91–94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.
Objective
To evaluate the impact of a 2-year program of strength training on muscle strength, bone mineral density (BMD), physical function, joint damage, and disease activity in patients with recent-onset (<2 years) rheumatoid arthritis (RA).Methods