Effectiveness of community based physical activity on step count and sedentary behaviour in people with rheumatoid arthritis within the first five years of diagnosis

• Main Author: Elramli, Amal
• Published: University of Glasgow 2017
• Subjects: 616.7; RA Public aspects of medicine
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.724059

Background: Rheumatoid Arthritis (RA) is associated with increased risk of cardiovascular disease (CVD). Physical inactivity is a modifiable risk factors of CVD and frequently associated with impaired functional status and health related quality of life. Objectives: This single blind randomised controlled trial investigated the impact of a pedometer-supported walking and education programme (Walk for RA-WARA) on PA, sedentary time, PA self-efficacy, disease activity, functional capacity, quality of life and cardiovascular (CV) risk in people with RA. Methods: Seventy-six individuals, aged 56 (±15) years and within 5 years from RA diagnosis were randomly assigned to either the WARA intervention group (six weekly group education sessions and two booster sessions at 3 and 6 months) or the control group (single session). Demographic data were recorded and Body Mass Index (BMI), Waist-Hip ratio (WHR), Waist-Height ratio (WHtR), and blood pressure were measured. The primary outcomes were objectively measured PA profiles, daily step counts and time spent sedentary, using an activPALTM and self-reported using international physical activity questionnaire (IPAQ). Functional status was assessed with six-minute walk test (6MWT), health assessment questionnaire (HAQ), and hand grip strength. Rheumatoid arthritis quality of life (RAQoL) and PA Self-efficacy were evaluated. Blood samples were taken and the 10-year risk of CVD scores were calculated, using the Scottish Intercollegiate Guidelines Network (ASSIGN). Data were analysed descriptively and mixed generalised linear models (GLM) were used incorporating restricted maximum likelihood (REML) and post-hoc analyses. Interviews were undertaken with 10 people from the intervention and data were analysed thematically using the framework approach and NVivo 11 software. Results: The intervention group showed a significantly greater increase than the control group in steps/day at 3 months (by 3413 (1835-4990) steps/day, mean (95%CI)) (P < 0.001), and 6 months (3599 (2135-5062) steps/day) (P < 0.001) and a significant reduction in IPAQ weekday (P=0.014) and weekend sitting time (P=0.046). There were significant improvements in 6MWT (P < 0.001), PA self-efficacy (P=0.008), systolic blood pressure (P=0.002) and ASSIGN scores (P < 0.001) in the intervention group. Participants found education sessions, booster sessions, hand-outs, pedometer, PA diaries were important factors in increasing their step counts. In addition, they stated that WARA programme was enjoyable and helpful in terms of raising their knowledge regarding their condition. They also reported they felt much healthier and their mood had improved. Conclusions: The 6-month WARA intervention was effective in promoting PA, PA self-efficacy, physical function, and reducing the 10-year risk of CVD. The WARA programme may be a useful adjunct to current clinical practice in rheumatology.