T. Thomsen

Physical activity maintenance in patients with rheumatoid arthritis: a qualitative study

Objective: To describe the experience of physical activity maintenance in patients with rheumatoid arthritis. Design: A qualitative salutogenic-oriented interview study. Setting: A rheumatology outpatient clinic. Subjects: A purposive sample of 16 physically active patients (mean age 50, range 37–67) diagnosed with rheumatoid arthritis on average 21 years previously (range 4–46 years). Methods: In-depth interviews were conducted using a semi-structured interview guide to illuminate how the phenomenon ‘physical activity maintenance’ was experienced by patients with rheumatoid arthritis. The interviews were analysed using systematic text condensation, inspired by Giorgi’s descriptive phenomenological methodology. Results: The analysis revealed three categories: (1) knowing and enjoying the body; (2) responsibility and challenges; (3) autonomy and social belonging. On the basis of these categories, the essential meaning of the phenomenon of physical activity maintenance for patients with rheumatoid arthritis was summarized into ‘striving for a transparent body and participation’, pointing to experiences of sensations of wellbeing, liberation from restrictions and social participation on equal terms with non-arthritis populations. Conclusion: This study demonstrates that physical activity in patients with rheumatoid arthritis may be understood as a resource to resist disability and to feel and stay healthy while creating and sustaining meaningfulness in life.

Effect of intermittent aerobic exercise on sleep quality and sleep disturbances in patients with rheumatoid arthritis – design of a randomized controlled trial

BackgroundPoor sleep is prevalent in patients with systemic inflammatory disorders, including rheumatoid arthritis, and, in addition to fatigue, pain, depression and inflammation, is associated with an increased risk of co-morbidity and all-cause mortality. Whereas non-pharmacological interventions in patients with rheumatoid arthritis have been shown to reduce pain and fatigue, no randomized controlled trials have examined the effect of non-pharmacological interventions on improvement of sleep in patients with rheumatoid arthritis. The aim of this trial was to evaluate the efficacy of an intermittent aerobic exercise intervention on sleep, assessed both objectively and subjectively in patients with rheumatoid arthritis.Methods/designA randomized controlled trial including 44 patients with rheumatoid arthritis randomly assigned to an exercise training intervention or to a control group. The intervention consists of 18 session intermittent aerobic exercise training on a bicycle ergometer three times a week. Patients are evaluated according to objective changes in sleep as measured by polysomnography (primary outcome). Secondary outcomes include changes in subjective sleep quality and sleep disturbances, fatigue, pain, depressive symptoms, physical function, health-related quality of life and cardiorespiratory fitness.DiscussionThis trial will provide evidence of the effect of intermittent aerobic exercise on the improvement of sleep in patients with rheumatoid arthritis, which is considered important in promotion of health and well-being. As such, the trial meets a currently unmet need for the provision of non-pharmacological treatment initiatives of poor sleep in patients with rheumatoid arthritis.Trial registrationClinicalTrials.gov Identifier: NCT01966835

The efficacy of motivational counseling and SMS-reminders on daily sitting time in patients with rheumatoid arthritis: protocol for a randomized controlled trial

BackgroundPatients with RA (Rheumatoid Arthritis) are more sedentary than the general population. Reduction of Sedentary Behaviour (SB) has been suggested as a mean for improvement of health in patients with chronic diseases and mobility problems. Short-term intervention studies have demonstrated that SB can be reduced by behavioural interventions in healthy populations. However, it remains unexplored whether it is valid for patients with RA also.Therefore, the aim of this trial is to investigate the efficacy of an individually tailored, theory-based motivational counseling intervention on reducing daily sitting time in sedentary patients with RA. Additionally, to explore whether a reduction in daily sitting time is associated with reduced pain and fatigue, self-reported physical function, self-efficacy, improved health-related quality of life (HR-QoL) and cardiovascular biomarker levels, and finally to assess the cost-effectiveness of the intervention.Methods/DesignFor this parallel group randomized trial, 150 patients with RA and at least 5 hours of sitting time per day, will be recruited from a rheumatology outpatient clinic, and block-randomized to the intervention group or the control group receiving usual care. The intervention includes: 1) individual motivational counseling (in total 3 sessions) on reduction of daily sitting time in combination with 2) individual Short Text Message Service (SMS) reminders over a 16-week intervention period. Primary outcome is change in daily sitting time (minutes) from baseline to 16 weeks measured objectively using an ActivPAL® Activity Monitor. Secondary outcomes include fatigue, pain, physical function, HR-QoL, self-efficacy, costs and cost-effectiveness. Furthermore, anthropometric measures will be included as well as measurement of blood pressure and serum lipids. All outcomes are assessed at baseline and repeated after 16 weeks. Follow-up assessments are made at 6 and 18 months post-intervention.DiscussionThe intervention is simple, non-invasive and may be implemented at low costs. If the study confirms the positive results expected, the intervention might be implemented in clinical practice and potentially transferred to other clinical populations.Trial registrationClinicalTrial.gov registration number: NCT01969604. Date of registration: 17 October 2013.

Sedentary behaviour in patients with rheumatoid arthritis: A qualitative study

Background Despite increasing interest in investigating sedentary behaviour (SB) in the general population and in patients with rheumatoid arthritis (RA), there is little documentation of the subjective experiences of SB in patients with RA. This study aimed to examine how patients with RA describe their daily SB. Methods Fifteen patients with RA (10 women and 5 men) from 23 to 73 years of age and with a disease duration ranging from 4 to 27 years were interviewed following a semi-structured interview guide. Data were analysed using the content analysis method described by Graneheim. Results SB appeared in three categories covering: 1) A constant battle between good and bad days; SB could be a consequence of RA in terms of days with pronounced pain and fatigue resulting in many hours of SB. 2) Adaptation to everyday life; living with the unpredictability of RA included constant modification of physical activity level causing increase in SB, especially during periods of disease flare. Prioritizing and planning of SB also functioned as part of self-management strategies. 3) It has nothing to do with my arthritis; for some patients, SB was not related to RA, but simply reflected a way of living independent of the disease. Conclusions SB is perceived, motivated, and performed differently in patients with RA. An individually tailored approach may be essential in understanding and encouraging patients’ motivation towards sustainable change in SB and activity patterns.

The efficacy of motivational counselling and SMS reminders on daily sitting time in patients with rheumatoid arthritis: a randomised controlled trial

Objectives The aim of this report is to investigate the efficacy of an individually tailored, theory-based behavioural intervention for reducing daily sitting time, pain and fatigue, as well as improving health-related quality of life, general self-efficacy, physical function and cardiometabolic biomarkers in patients with rheumatoid arthritis (RA). Methods In this randomised controlled trial 150 patients with RA were randomised to an intervention or a no-intervention control group. The intervention group received three individual motivational counselling sessions and short message service or text messages aimed at reduction of sedentary behaviour during the 16-week intervention period. Primary outcome was change in daily sitting time measured objectively by ActivPAL. Secondary outcomes included change in pain, fatigue, physical function, general self-efficacy, quality of life, blood pressure, blood lipids, haemoglobin A1c, body weight, body mass index, waist circumference and waist–hip ratio. Results 75 patients were allocated to each group. Mean reduction in daily sitting time was −1.61 hours/day in the intervention versus 0.59 hours/day increase in the control group between-group difference −2.20 (95% CI −2.72 to −1.69; p<0.0001) hours/day in favour of the intervention group. Most of the secondary outcomes were also in favour of the intervention. Conclusion An individually tailored, behavioural intervention reduced daily sitting time in patients with RA and improved patient-reported outcomes and cholesterol levels. Trial registration number NCT01969604; Results.

OP0286-HPR The Efficacy of Motivational Counselling and SMS-Reminders on Daily Sitting Time in Patients with Rheumatoid Arthritis: A Randomised Controlled Trial

Background Patients with rheumatoid arthritis (RA) are more sedentary than the general population, which can have serious health consequences. Reducing sedentary behaviour (SB) and increasing light intensity physical activity is advocated as a potentially more achievable health promotion focus in patients with chronic diseases and mobility problems. Intervention studies have shown that behavioural approaches are effective in reducing SB in healthy populations. Whether this applies to patients with RA is yet to be determined. Objectives To test the efficacy of a 16-week individually tailored, behavioural intervention in reducing daily sitting time, pain and fatigue and improving health-related quality of life, self-efficacy, physical function and cardio-metabolic disease risk in patients with RA. Methods Parallel-group, observer-blinded randomised controlled trial (N=150). RA patients >18 years of age, self-reported daily sitting time >5 hours and Health Assessment Questionnaire (HAQ) score <2.5 were consecutively recruited from a rheumatology outpatient clinic. The intervention group (n=75) received three individual motivational counselling sessions with a health professional and text messages aiming at improving motivation for light intensity physical activity through reduction of SB. The control group (n=75) was encouraged to maintain usual lifestyle. Primary outcome was change from baseline in daily sitting time measured objectively by ActivPAL, analysed using ANCOVA with a factor for group and adjustment for the outcome level at baseline. Primary analyses were based on the intention-to-treat population. Secondary outcomes included patient-reported outcomes and cardio-metabolic biomarkers (blood pressure, cholesterol levels, blood glucose, body weight and waist circumference). Results After 16 weeks, three participants were lost to follow-up. There was a mean decrease in daily sitting time of 1.61 hours (h)/day with the intervention and an increase of 0.59 h/day in the control group; between-group difference was -2.20 h/day (95%CI: -2.72 to -1.69; p<.0001) in favour of the intervention group. Most of the secondary outcomes were also in favour of the intervention; VAS-pain: -22.36 (-29.27 to -15.44); VAS-fatigue: -26.80 (-34.32 to -19.30), physical function (HAQ): -0.42, (-0.54 to -0.30) and total cholesterol: -0.37 (-0.50 to -0.24) mmol/l. Conclusions An individually tailored, behavioural intervention effectively reduced daily sitting time by on average more than two hours in patients with RA and additionally improved patient-reported clinical outcomes and cholesterol levels. The results may be important for clinical practise and physical activity recommendations for patients with RA and can most likely be generalised to other populations with chronic disease and mobility limitations. Disclosure of Interest None declared

SAT0585-HPR Sedentary Behaviour in Patients with Rheumatoid Arthritis. A Qualitative Study

Background Sedentary behaviour (SB) has been defined as any waking behaviour characterized by an energy expenditure < 1.5 METs while in a sitting or reclining position and not simply as the absence of physical activity. SB and in particular watching TV has been identified as an independent predictor of e.g. cardiovascular disease mortality and type 2 diabetes in healthy persons. Currently there exist few intervention studies investigating the health effects of reducing SB. Patients with rheumatoid arthritis (RA) have increased risk of cardiovascular diseases. In addition, many patients are physically inactive and may be unable to adopt recommended levels of regular physical activity. Reducing SB rather than solely increasing physical activity may be suitable in sedentary patients with RA. However, SB is not well investigated, specifically not how patients perceive SB in their everyday life. Objectives The aim of this study was to describe how and when patients with RA engage in SB. Furthermore, to illuminate what from patients perspective is influencing SB Methods A qualitative study was conducted based on individual semi-structured interviews. Patients were recruited from a cross-sectional questionnaire study (N=438) investigating physical activity in patients with RA (unpublished data). Patients with more than four hours of self-reported daily leisure time SB were invited to participate. In total, 15 patients (10 women and five men; mean age 57 years), diagnosed with RA for an average of 13 years (range: 4-27 years) covering different degrees of disability were included. The recorded interviews were transcribed verbatim and analyzed using qualitative content analysis and by use of Nvivo software program. Results Patients with RA mainly engage in SB during mornings and evenings. In addition, they plan rest time and small breaks of sitting during the day and in between daily activities. SB includes activities such as computer, TV watching, resting in bed, reading and creative hobbies, e.g. needlework and painting. The analysis revealed four main categories influencing SB: (1) Fatigue and pain: referring to two dominant symptoms of RA influencing SB, (2) SB as an adaptation to RA referring to patients’ fear of straining the joints and thus planning of daily rest time with prolonged sitting, (3) Social network referring to influences from partners, children, grandchildren and friends and (4) SB is independent of RA referring to patients’ premorbid habits, their feeling of not being limited by RA, doing as usual, being lazy and finding pleasure in SB. Conclusions Patients with RA described their daily SB as related to their disease and something that was influenced by significant others. They also described influences from partners and other members of the family. They also described SB as a strategy to protect themselves against pain through planning of SB and at the same time by listening to their body’s signals. However, SB did not need to be related to RA but could be an expression of the individual’s everyday life. Disclosure of Interest None Declared