Improving RA Outcomes by Promoting Engagement in Physical Activity

Promoting engagement in physical activity in early rheumatoid arthritis (RA) can provide small benefits, according to results from a proof of concept study published in Musculoskeletal Care.

People with RA tend to have less physical activity (PA) than the general population, even though PA decrease chronic inflammation and reduces pain.

“People with RA report a range of barriers to PA and are often reluctant to participate for fear of exacerbating symptoms,” the authors explained. “It is therefore essential to provide appropriate support to overcome barriers soon after diagnosis, in order to optimize PA, minimize inappropriate health beliefs and prevent unnecessary reductions in function.”

The authors designed an intervention that could be delivered in a primary care setting for patients with newly diagnosed RA. While they initially set out to recruit 36 participants, the study ultimately included only 9 women and 3 men who provided consent.

They noted there were some challenges to recruiting patients into secondary care, such as rheumatology staff forgetting to inform patients, nursing staff and administrators being too busy to screen records for the right patients who could join the study, and one instance in which a site commenced its own PA program. Some individuals noted that they did not want to participate because of travel time or the distance to the program; existing commitments, such as work; or they were already physically active.

Over 12 weeks, intervention delivered 4 group sessions and a 1-on-1 session. Sessions included patient education and support for behavior change and a supervised exercise. At baseline and at 12 weeks, patients completed outcomes. The researchers also collected data on attendance, adverse events, and queries that the research team received from the physiotherapists who delivered the intervention.

The overall attendance was 85% and the median number of sessions attended was 4. Sessions were missed because of illness or disease flare. No serious adverse events were reported, but the physiotherapists reported “some participants did not fully participate in the exercise component, predominantly due to fatigue,” and 1 participant was unable to participate due to dizziness.

From baseline to the end of the intervention after 12 weeks, only 2 participants changed their level of activity. One of them showed improvements, while the other demonstrated a deterioration due to RA flare. Of the 9 participants who completed both the pretest and posttest, 7 participants demonstrated improvement in the 6-minute walk test.

Three participants showed meaningful change in function over the course of the intervention. Six participants had a worse level of fatigue, 3 were better, and 2 were unchanged. While there were no clinically significant changes for quality of life, 4 participants had clinically important improvements in pain.

Finally, there was an improvement in self-efficacy for exercise and motivation to exercise, according to the changes from baseline to 12 weeks.

“Participants were positive about [promoting engagement in physical activity in early rheumatoid arthritis] with several indicating that they would recommend it to others,” the authors concluded. “It appears to be feasible, acceptable and safe for people with a recent RA diagnosis and consideration should be given to offering the intervention immediately following diagnosis.”

Reference

Cramp F, Thomas R, Haase AM, et al. Promoting engagement in physical activity in early rheumatoid arthritis: a proof-of-concept intervention study. Musculoskeletal Care. Published online July 14, 2020. doi:10.1002/msc.1493