Physical Activity to Reduce Fatigue in Rheumatoid Arthritis: A Randomized Controlled Trial

Abstract

Objective. Effective treatments for rheumatoid arthritis (RA) fatigue are limited. We tested the effect of a pedometerbased intervention on increasing physical activity and decreasing fatigue among individuals with RA. Methods. Participants completed baseline questionnaires; had 1 week of activity monitoring; were randomized to control (education [EDUC]), pedometer and step-monitoring diary (PED), or pedometer and diary plus step targets (PED+) groups, and were followed for 21 weeks. At week 10, questionnaires were administered by phone to all participants. During the final week, all participants again had 1 week of activity monitoring. Primary outcomes were changes in average weekly steps and fatigue (Patient-Reported Outcomes Measurement Information System 7-item questionnaire) from baseline to week 21. Secondary outcomes were self-reported disease activity, physical function, pain interference, and depressive symptoms. Changes in steps were tested using a linear mixed model. Changes in fatigue were tested with repeated-measures models, including baseline, week-10, and week-21 scores. Results. A total of 96 individuals participated. Eight did not complete the 21-week assessments. Both intervention groups significantly increased steps (+1,441 [P = 0.004] for PED and +1,656 [P = 0.001] for PED+), and the EDUC group decreased steps (-747 [P = 0.14]) (group-by-time interaction P = 0.0025). Between-group changes in fatigue were not significantly different (interaction P = 0.21). Mean changes in fatigue scores from baseline to week 21 were -1.6 (withgroup P = 0.26), -3.2 (P = 0.02), and -4.8 (P = 0.0002) for EDUC, PED, and PED+ groups, respectively. Function and self-reported disease activity also improved in the PED and PED+ groups. Conclusion. Provision of pedometers, with and without providing step targets, was successful in increasing activity levels and decreasing fatigue in this sample of individuals with RA.

Use of Wearable Activity Trackers to Improve Physical Activity Behavior in Patients With Rheumatic and Musculoskeletal Diseases: A Systematic Review and Meta‐Analysis

“…Among the 17 studies, 9 (53%) were related to osteoarthritis, 5 (29%) to low-back pain, and only 3 (18%) to chronic inflammatory rheumatic diseases. When reported, the mean disease duration was 8-14 years (14,31,32,36,41). Overall, 41.3% of the population was male.…”

“…When reported, the mean disease duration was 8-14 years (14,31,32,36,41). Among the 17 studies, 9 (53%) were related to osteoarthritis, 5 (29%) to low-back pain, and only 3 (18%) to chronic inflammatory rheumatic diseases.…”

“…Risk of bias was low for 5 studies (30)(31)(32)(33)39), unclear for 5 studies (27,29,36,38,40) Risk of bias was low for 5 studies (30)(31)(32)(33)39), unclear for 5 studies (27,29,36,38,40) …”

“…The electronic search yielded 2,795 potentially relevant hits ( Figure 1). In total, 17 studies were included in the review, of which 10 were pooled for metaanalysis (14,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42). One study was potentially relevant, but the full text was not available (43) (27), and 5 studies included elderly patients with osteoarthritis (the remaining 4 studies on osteoarthritis were not related specifically to elderly patients) (35,38,(40)(41)(42).…”

2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis

“…This can be done by PA assessments and any other assessments related to the individual aims. As PA assessments, performance–based tests, patient-reported outcome measures (eg, SQUASH,104 PASE94) and self-monitoring tools (eg, wearables such as Fitbit,100 pedometer99 or accelerometer101) were identified. However, we did not evaluate the validity and reliability of the assessments applied.…”