Patients with rheumatoid arthritis (RA) tend to be more sedentary than the general population, which can have serious health consequences, including an increased risk of cardiovascular disease and premature death.
The results of a study presented today at the European League Against Rheumatism Annual Congress (EULAR 2016) showed for the first time that a combination of text messages and individual counseling sessions to motivate patients with RA to be more active resulted in improved patient-reported clinical outcomes. This type of behavioral intervention was effective at reducing daily sitting time by an average of more than two hours in RA patients, and also reduced their cholesterol levels.
‘A combination of text messages and individual counseling sessions to motivate patients with rheumatoid arthritis to be more active resulted in improved outcomes.’
In Denmark, 67% of patients with RA do not meet public health recommendations for daily moderate and vigorous physical activity, and similar proportions of physically inactive RA patients are found in Germany (68%) and the United Kingdom (67%). Patients with RA already have an increased risk of cardiovascular disease and premature death, partly caused by the chronic inflammatory rheumatic disease itself, and partly by traditional risk factors, such as hyperlipidaemia.
Although exercise is known to have a positive effect on pain and physical functioning in patients with RA, pain often acts as a barrier against maintenance of a physically active lifestyle. A more feasible approach for improving health and well-being in RA patients would therefore be to focus on reducing sedentary behavior and increasing light intensity activity, rather than solely concentrating on increasing moderate and vigorous physical activity.
"We know that behavioral approaches are effective in reducing sedentary behavior in healthy populations," said Miss Tanja Thomsen of the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark. Our findings support the introduction of behavioral approaches as an effective way to improve the health of rheumatoid arthritis patients, which may also be applicable in other populations with chronic disease and limited mobility," Miss Thomsen added.
75 adult RA patients with a self-reported daily sitting time greater than five hours and Health Assessment Questionnaire score less than 2.5 underwent a 16-week individually tailored, behavioral intervention that included three individual motivational counseling sessions with a health professional and regular text messages aimed at improving motivation to reduce daily sitting time and replacing it with light intensity physical activity. A control group of 75 healthy adult patients matched for other characteristics was encouraged to maintain their usual lifestyle. Daily sitting time was recorded using a wearable activity monitor.
After 16 weeks, there was a significant between-group difference in average daily sitting time in favour of the intervention group of 2.20 hours per day (p<0.0001, with a mean decrease of 1.61 hours per day in the intervention group; an increase of 0.59 hours per day in controls). Secondary outcomes that were also in favor of the intervention group included self-assessment scores of pain, fatigue, physical function and blood measurements of total cholesterol.