An Outsourced Health-enhancing Physical Activity Program for People with Rheumatoid Arthritis: Study of the Maintenance Phase

Nordgren, Birgitta; Fridén, Cecilia; Demmelmaier, Ingrid; Bergström, Günnar; Lundberg, Ingrid E.; Nessen, Thomas; Dufour, Alyssa B.; Opava, Christina H.

doi:10.3899/jrheum.171002

Cited by 15 publications

(11 citation statements)

References 44 publications

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“…The HEPA support program employed in the present study included behavioral change techniques to support not only adoption but maintenance of physical activity [ 24 , 41 ]. Despite major positive outcome and experiences, the results of the main PARA intervention study clearly illustrate the complexity and difficulty of keeping physical activity at a moderate or higher intensity level over time [ 29 , 42 , 43 ]. A few previous studies on short-term supervised exercise exist but report conflicting results.…”

Section: Discussionmentioning

confidence: 99%

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Long-term, health-enhancing physical activity is associated with reduction of pain but not pain sensitivity or improved exercise-induced hypoalgesia in persons with rheumatoid arthritis

et al. 2018

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BackgroundWe 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).MethodsThirty 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.ResultsGlobal 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 <0.001). There were no statistically significant changes in segmental or plurisegmental EIH from before the intervention to 2-year follow-up.ConclusionParticipation in a long-term HEPA support program was associated with reduced global pain, whereas pressure pain sensitivity at rest was not reduced and EIH did not change. Thus, our results do not favor the hypothesis that long-term HEPA reduces pain by improving descending pain inhibition in persons with RA.Trial registrationISRCTN25539102, ISRCTN registry, date assigned March 4, 2011. The trial was retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

“…Two short text messages (short message service (SMS)) were sent once each week to collect data on the number of days during the past week that participants performed circuit training and on how many additional days they performed at least moderate-intensity physical activity for at least 30 min [ 29 ].…”

Section: Methodsmentioning

confidence: 99%

Long-term, health-enhancing physical activity is associated with reduction of pain but not pain sensitivity or improved exercise-induced hypoalgesia in persons with rheumatoid arthritis

et al. 2018

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“…Our research group has shown that older adults (> 65 years) with RA experiences moderate-to high intensity exercise with person-centred guidance as manageable [6] and that they gained good effect on physical fitness and rated their health as much improved [7]. Exercise with person-centred guidance also seemed to prepare the participants for independent exercise [6] and 7 months after completion of intervention the participants were still active to a large extent when compared to previous studies among adults with RA reporting maintenance of exercise after an intervention [8,9].…”

Section: Introductionmentioning

confidence: 93%

Long-time follow up of physical activity level among older adults with rheumatoid arthritis

Lange

Gjertsson

Mannerkorpi

2020

Eur Rev Aging Phys Act

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Background: Physical activity and exercise are acknowledged as important parts in the management of rheumatoid arthritis (RA). However, long-term maintenance of exercise is known to be difficult. The aim of this study was to evaluate change in physical activity and physical fitness after four years in older adults with RA who had previously participated in exercise with person-centred guidance compared to controls. Method: A follow-up study was performed where older adults (> 65 years) who had participated in a randomized controlled trial where they were allocated to either exercise with person-centred guidance or home-based, lightintensity exercise (controls) were invited to one visit and assessed with performance-based test, blood-sampling and self-reported questionnaires. Forty-seven out of 70 older adults accepted participation, 24 from the exercise group and 23 from the control group. Comparisons of the result with baseline values were performed and explanatory factors for increase of physical activity were examined with logistic regression. Results: The result show that there was no significant difference in weekly hours of physical activity when groups where compared. However, participants in the exercise group rated significantly increased weekly hours of physical activity after four years (p = 0.004) when compared to baseline. Higher levels of fatigue, BMI and physical activity, at baseline were negatively associated with increased physical activity after four years. There was no significant difference in change of physical fitness between the groups. Within group analysis showed that the control group reported increased pain (p = 0.035), fatigue (p = 0.023) increased number of tender joints (p = 0.028) higher disease activity (p = 0.007) and worsening of global health (p = 0.004) when compared to baseline while the exercise group remained at the same level as at baseline. Conclusion: These results indicate that introducing moderate-to high intensity exercise with person-centred guidance might favor increased physical activity after four years in older adults with RA. Previous partaking in moderate-to high intensity exercise might also be protective against increased disease activity, pain and fatigue over time.

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“…A two-year program of Physical Activity in RA (PARA) 2010 was designed to investigate its feasibility and to study changes in self-reported variables, physical capacity measurements, in ammation, pain modulation and cardiovascular risk 11 . Positive changes during the two-year study period were observed for HEPA participants concerning symptoms and physical capacity [12][13] and cardiovascular risk factors [14][15] , while pain modulation did not change 16 . In this context we performed a pilot study with focus on protein adaptations in muscle tissue in a subgroup of people with RA who consented to repeated muscle biopsies.…”

Section: Introductionmentioning

confidence: 93%

“…Participants in the PARA 2010 study were recruited from the Swedish Rheumatology Quality registers (SRQ). They were asked to participate in a two-year program aimed to increase and maintain HEPA levels among people with RA in line with public health recommendations [11][12][13] For this sub-study six women who consented to donate muscle biopsies at baseline, at one-and two-year follow-ups were included. The participants were independent in daily living, interested in physical activity support, uent in Swedish, not already obtaining HEPA as per recommendations and without major diseases preventing HEPA 11 .…”

Section: Participants and Samplesmentioning

confidence: 99%

Effects of a two-year health-enhancing physical activity program on skeletal muscle protein profiles in people with rheumatoid arthritis

Ossipova

Idborg

Fridén

et al. 2020

Preprint

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Background Rheumatoid arthritis (RA) induces loss of muscle mass and impairments, which discourage physical activity. Consequently, RA is associated with decreased levels of exercise. Positive effects of exercise on physical and mental health without increasing pain or disease activity have been demonstrated but the influence of moderate-intensity physical activity on the molecular effects in skeletal muscle in people with RA remains unclear. In this pilot study we investigated the impact of a two-year health-enhancing physical activity (HEPA) program on protein profiles in skeletal muscle biopsies from people with RA based on a unique set of interdisciplinary variables. Methods Six people with RA participated. Muscle biopsies were taken from m. vastus lateralis, and perceived disease impact, anthropometrics and physical capacity tests were assessed at baseline and year 1 and 2. Mass spectrometry-based quantitative proteomics and immunohistochemistry analysis were employed to examine molecular changes in the skeletal muscle in response to long-term HEPA. Results The study participants had moderate to low adherence to the HEPA program, the perceived disease impact and anthropometric parameters were not altered. Among the physical capacity tests, the Timed-stands test showed a significant improvement after one year. Mean pressure pain threshold was significantly reduced after 1- and 2-year HEPA participation. Proteome analysis of the muscle biopsies showed an up-regulation of proteins in the mitochondrial respiratory chain and predicted increased ATP production and improved muscle contractility in response to HEPA. Molecular pathways identified by proteome analysis revealed correlations to pain variables. Conclusions Our results indicate that long-term physical activity in people with RA may up-regulate proteins in the mitochondrial respiratory chain predicting increased ATP production and muscle contractility similar to what has been reported in healthy young men and might have a positive impact on muscle tissue by decreased muscle cell death.

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An Outsourced Health-enhancing Physical Activity Program for People with Rheumatoid Arthritis: Study of the Maintenance Phase

Cited by 15 publications

References 44 publications

Long-term, health-enhancing physical activity is associated with reduction of pain but not pain sensitivity or improved exercise-induced hypoalgesia in persons with rheumatoid arthritis

Long-term, health-enhancing physical activity is associated with reduction of pain but not pain sensitivity or improved exercise-induced hypoalgesia in persons with rheumatoid arthritis

Long-time follow up of physical activity level among older adults with rheumatoid arthritis

Effects of a two-year health-enhancing physical activity program on skeletal muscle protein profiles in people with rheumatoid arthritis

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