Moderate-to-high intensity exercise with person-centered guidance influences fatigue in older adults with rheumatoid arthritis

Daniel Kucharski,Kaisa Mannerkorpi,Sara Svedlund,Caroline Feldthusen,Alastair B Ross,Elvira Lange,Inger Gjertsson,Karin Önnheim

doi:10.1007/s00296-019-04384-8

Abstract

Fatigue is described as a dominant and disturbing symptom of rheumatoid arthritis (RA) regardless of the advances in pharmacological treatment. Fatigue is also found to correlate with depression. The objective was to evaluate the impact of moderate-to-high intensity, aerobic and resistance exercise with person-centered guidance on fatigue, anxiety and depression, in older adults with RA. Comparisons were made between older adults (> 65 years) with RA taking part in a 20-week moderate-to-high intensity exercise at a gym (n = 36) or in home-based exercise of light intensity (n = 38). Assessments were performed at baseline, at 20 weeks, and at 52 weeks. Outcomes were differences in Multidimensional Fatigue Inventory (MFI-20), Visual Analog Scale Fatigue (VAS fatigue), and Hospital Anxiety and Depression Scale (HADS). Analysis of metabolomics was also performed. The subscales “physical fatigue” and “mental fatigue” in MFI-20 and symptoms of depression using HADS depression scale improved significantly at week 20 in the exercise group compared with the control group. Exercise did not influence global fatigue rated by VAS or subscales “reduced motivation”, “reduced activity” and “general fatigue” in MFI-20. No significant change was found on the anxiety index of HADS. The improvements in physical fatigue were associated with changes in the metabolism of lipids, bile acids, the urea cycle and several sugars. Moderate-to-high intensity exercise with person-centered guidance decreased fatigue and improved symptoms of depression and were accompanied by metabolic changes in older adults with RA.

Highlights

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint pain, stiffness and inflammation of joint synovial tissue
The subgroup analysis indicates that the participants with a lower disease activity at baseline got the best effects of moderate-to-high intensity exercise on fatigue and depression
The metabolomic profiling included in this study revealed changes attributable to the exercise intervention in eight of the identified metabolites, with only one of these metabolites being significantly associated with the decrease in physical fatigue shown by the MFI-20 analysis

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint pain, stiffness and inflammation of joint synovial tissue. Pharmacological treatments of RA have undergone revolutionary developments that have led to better control of inflammation and reduced joint destruction. The majority of the patients with RA, still suffer from fatigue [1], which they find to be a dominant and disturbing symptom [2,3,4]. Fatigue correlates strongly with pain, depression [9,10,11] and sleep disturbances. The many effects of fatigue on the individual include disability, anxiety, reduced selfefficacy, feelings of helplessness and limitations in social functioning [13]. A third of RA patients suffer from depression

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Results

Conclusion