Abstract
BackgroundA 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.MethodsQuestionnaires 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.ResultsForty-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.ConclusionsMaintenance 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.
Highlights
A large number of patients with rheumatoid arthritis (RA) do not adhere to the recommended levels of physical activity to enhance health
Maintenance of physical activity over a long period of time is challenging for patients with established RA
The patients who were lost to followup were at inclusion in the Better Anti-Rheumatic PharmacOTherapy (BARFOT) cohort, older (mean age 58 (SD 16) years vs. 52 (SD 13) years; p < 0.001), had a worse 28-joint Disease Activity Score (DAS28) (mean 5.34 (SD 1.23) vs. 5.12 (SD 1.24); p < 0.001), and a worse Health Assessment Questionnaire (HAQ) (mean 1.02 (SD 0.63) vs. 0.96 (SD 0.59); p = 0.024)
Summary
A large number of patients with RA do not adhere to the recommended levels of physical activity to enhance health. Promoting a healthy lifestyle has been popular in the past decade, in the general population [1, 2] and for people with chronic inflammatory diseases. Interventions to support changes in lifestyle such as healthy eating and drinking, smoking cessation, and increasing the amount of weekly physical activity and exercise have been recommended in a number of guidelines to promote health in the rheumatoid arthritis (RA) population [3, 4]. 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
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