Validity of the Nurses\u2019 health study physical activity questionnaire in estimating physical activity in adults with rheumatoid arthritis

Thomas Quinn,Michelle Frits Bs,Nancy A Shadick,Maura D Iversen,Michael Weinblatt,Johan Von Heideken,Christine Iannaccone

doi:10.1186/s12891-017-1589-y

Abstract

BackgroundPatients with rheumatoid arthritis (RA) demonstrate reduced aerobic capacity, excess cardiovascular risk, mobility limitations and are less physically active than their healthy peers. Physical activity may decrease RA disease activity through its anti-inflammatory effects and psychological and health benefits. To successfully manage RA symptoms and reduce cardiovascular risks associated with RA through increased physical activity (PA), accurate physical activity assessments are critical. Accelerometry is an objective physical activity measure, but not widely used. Validity of the Nurses’ Health Study physical activity questionnaire II (NHSPAQ) has not been determined for estimation of physical activity in RA. This study examined NHSPAQ validity in adults with RA compared to accelerometry-based metabolic equivalents determined (METs) and results of performance tests. We hypothesized NHSPAQ scores would correlate moderately (0.4–0.5) with accelerometer physical activity estimates.MethodsThirty-five adults with RA (mean age [SD] 62 (Williams et. al, Health Qual Life Outcomes10:28, 2012) years, 28 females (80%) recruited from a hospital-based clinic registry participated in a one-week accelerometry trial. Medical data was compiled. Participants completed the NHSPAQ, a self-paced 20-m walk test, and modified timed step test. Participants wore an accelerometer for 7 consecutive days, then completed a physical activity log and another NHSPAQ. Metabolic equivalents (METs) were derived from NHSPAQ and accelerometers using standardized formulas. NHSPAQ METs were correlated with accelerometer METs and data from performance measures.ResultsAverage disease duration was 21 years (SD = 11), 63% patients took biologics. The average weekly METs reported were 29 (SD = 33) and accelerometer METs were 33 (SD = 22). NHSPAQ METs correlated moderately with accelerometer-derived METs (r = 0.48 95% CI (0.15–0.70). Self-reported PA correlated moderately with Step Test performance (r = 0.50 95% CI (0.18–0.72).ConclusionPatients with RA exhibit low physical activity levels. General fitness measures were moderately correlated with physical activity levels. A moderate significant correlation existed between NHSPAQ and accelerometry METs. These preliminary data suggest the NHSPAQ may be useful to describe physical activity levels in this population.

Highlights

Patients with rheumatoid arthritis (RA) demonstrate reduced aerobic capacity, excess cardiovascular risk, mobility limitations and are less physically active than their healthy peers
To successfully manage RA symptoms and reduce cardiovascular risks associated with RA through increased physical activity (PA) [4], an accurate measure of daily activity is essential for both the clinician and the patient
Given the evidence suggesting individuals with RA are at high risk for cardiovascular disease, this study aimed to examine the validity of the Nurses’ Health Study physical activity questionnaire II (NHSPAQ) in the estimation of daily PA levels in adults with RA, in order to determine whether the NHSPAQ might be useful in clinical practice or in large epidemiologic studies of PA in RA

Summary

Introduction

Patients with rheumatoid arthritis (RA) demonstrate reduced aerobic capacity, excess cardiovascular risk, mobility limitations and are less physically active than their healthy peers. Rheumatoid arthritis (RA) associated symptoms such as joint damage, joint pain, inflammation, and cardiovascular disease place these adults at greater risk of physical inactivity [1]. To successfully manage RA symptoms and reduce cardiovascular risks associated with RA through increased physical activity (PA) [4], an accurate measure of daily activity is essential for both the clinician and the patient. One MET is operationally defined as the quantity of oxygen consumed while sitting at rest and equals 3.5 milliliters of oxygen per kilogram of body weight per minute This MET notion represents a practical and understandable method for expressing the energy cost of physical activities in relation to resting metabolic rate [7]. A simpler, more cost-effective method to accurately determine daily PA including estimated METs in adults with RA is clinically necessary to effectively manage RA symptoms through exercise and increased daily activity

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