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Tuomi AK, Rebane K, Arnstad ED, Berntson L, Fasth A, Glerup M, Herlin T, Kautiainen H, Nordal E, Peltoniemi S, Rygg M, Rypdal V, Zak M, Aalto K. Body mass index is associated with health-related quality of life and disease characteristics in young adults with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2024; 22:25. [PMID: 38308280 PMCID: PMC10837959 DOI: 10.1186/s12969-023-00931-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/15/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND There is a growing interest concerning the relationship between obesity and several medical conditions and inflammation. Nevertheless, there is a lack of studies regarding body mass index (BMI) among patients with juvenile idiopathic arthritis (JIA). Our aim was to investigate the impact of BMI on health-related quality of life (HRQoL) measured with a 36-Item Short Form Survey (SF-36), disease activity, and disability in young adults with JIA. METHODS This study is a part of the population-based Nordic JIA cohort study. All newly diagnosed patients with JIA were recruited consecutively between 1997-2000 in specific regions in the Nordic countries. Patients in this sub-study were enrolled from 434 patients who attended their 18-year follow-up visit. Patients were classified according to the World Health Organization (WHO) into four groups based on their BMI. HRQoL, disease characteristics, disability, fatigue, sleep quality, physical activity, pain, comorbidities, and social status were assessed. RESULTS Three hundred fifty-five patients from the original study cohort were enrolled in this study and 72% of them were female. Mean age was 23.9 (± SD 4.4) years. A significant relationship was found between the JIA categories and BMI groups (p = 0.014). A significant relationship was also found between BMI and disease activity scores (DAS28) (p = 0.028), disability (p < 0.001), pain (p = 0.013), fatigue (p = 0.035), and sleep quality (p = 0.044). Moreover, a significant relationship between BMI and HRQoL regarding bodily pain (p = 0.010) and general health (p = 0.048) was revealed when adjusted for sex, age, and JIA subtype. CONCLUSION We discovered that BMI was significantly related to HRQoL, disease activity, and disability. BMI deserves more attention considering the treatment options and outcome of JIA in young adults.
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Affiliation(s)
- Anna-Kaisa Tuomi
- Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, P.O. Box 347, FIN-00029 HUS, 00290, Helsinki, Finland.
| | - Katariina Rebane
- Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, P.O. Box 347, FIN-00029 HUS, 00290, Helsinki, Finland
| | - Ellen Dalen Arnstad
- Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Lillemor Berntson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mia Glerup
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Hannu Kautiainen
- Kuopio University Hospital, Primary Health Care Unit Kuopio, Pohjois-Savo, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Ellen Nordal
- Department of Pediatrics, University Hospital of North Norway and Pediatric Research Group, Tromsø, Norway
- Department of Clinical Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - Suvi Peltoniemi
- Helsinki University Central Hospital, HUS Inflammation Center, Rheumatology and University of Helsinki, Helsinki, Finland
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs University Hospital, Trondheim, Norway
| | - Veronika Rypdal
- Department of Pediatrics, University Hospital of North Norway and Pediatric Research Group, Tromsø, Norway
| | - Marek Zak
- Department of Pediatrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristiina Aalto
- Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, P.O. Box 347, FIN-00029 HUS, 00290, Helsinki, Finland
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McKenna SG, Larkin L, Donnelly A, Esbensen BA, Ng WL, Anjum AM, Fraser A, Kennedy N. 'I never thought exercise could help improve my sleep': experiences of people with rheumatoid arthritis on the impact of an 8-week walking-based exercise intervention in improving their sleep. Rheumatol Adv Pract 2024; 8:rkae008. [PMID: 38293633 PMCID: PMC10827360 DOI: 10.1093/rap/rkae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
Objective The purpose of this study was to explore the experiences of people with RA of participating in an exercise intervention to improve their sleep. Methods Using a qualitative descriptive design, semi-structured face-to-face interviews were conducted with 12 people with RA who had completed an 8-week walking-based exercise intervention to improve their total sleep time, sleep quality and sleep disturbance. Data were analysed using thematic analysis. Results Four themes were generated: positive impact of exercise on participants' sleep ('I really didn't think any type of exercise would help me sleep better, if I'm honest'); positive experiences of the exercise intervention ('I learnt so much regarding walking that I didn't even think about'); clear mental health benefits ('If you don't sleep well then it will have a knock-on effect to your mental health'); and achieving empowerment and ownership when exercising ('I feel empowered now and confident that I'm not doing harm to myself'). Conclusion The findings demonstrated that participants had not expected exercise to improve their sleep. Although there is a growing consensus that exercise will benefit sleep and mitigate some disease symptoms, research is severely lacking in people with RA.
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Affiliation(s)
- Seán G McKenna
- Department of Physiotherapy, Health Service Executive (HSE), University Hospital Limerick Group (UHLG), Limerick, Ireland
- Discipline of Physiotherapy, School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland
| | - Louise Larkin
- Discipline of Physiotherapy, School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland
| | - Alan Donnelly
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center for Head and Orthopedics, Rigshospitalet, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Wan Lin Ng
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - Aqeel Maqsood Anjum
- Department of Rheumatology, University Hospitals Group Limerick, Limerick, Ireland
| | - Alexander Fraser
- Department of Rheumatology, University Hospitals Group Limerick, Limerick, Ireland
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
| | - Norelee Kennedy
- Discipline of Physiotherapy, School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland
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Brodin N, Conradsson DM, Swinnen TW, Esbensen BA, Kennedy N, Hammer NM, McKenna S, Henriksson P, Nordgren B. Self-report and device-based physical activity measures and adherence to physical activity recommendations: a cross-sectional survey among people with inflammatory joint disease in four European countries. BMJ Open 2023; 13:e064278. [PMID: 36746546 PMCID: PMC9906173 DOI: 10.1136/bmjopen-2022-064278] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Self-monitoring of physical activity (PA) has the potential to contribute to successful behaviour change in PA interventions in different populations, including people with inflammatory joint diseases (IJDs). The objectives of this study were to describe the use and knowledge of self-report-based and device-based PA measures in people with IJDs in four European countries, and to explore if the use of such devices, sociodemographic or disease-related variables were associated with adherence to the recommendations of at least 150 min of moderate to vigorous PA per week. SETTING Cross-sectional survey, performed in 2015-2016. PARTICIPANTS People with IJDs in Belgium, Denmark, Ireland and Sweden. PRIMARY AND SECONDARY OUTCOME MEASURES Use of self-report and device-based PA measures, receipt of instructions how to use PA measures, confidence in using them, adherence to PA recommendations and associated factors for adherence to PA recommendations. RESULTS Of the 1305 respondents answering questions on PA measures, 600 (46%) reported use of any kind of self-report or device-based measures to self-monitor PA. Between country differences of 34%-58% was observed. Six per cent and four per cent received instructions from health professionals on how to use simple and complex devices, respectively. Independent associated factors of fulfilment of recommendations of PA were living in Ireland (OR=84.89, p<0.001) and Sweden (OR=1.68, p=0.017) compared with living in Denmark, not perceiving activity limitations in moderate activities (OR=1.92, p<0.001) and using a device to measure PA (OR=1.56, p<0.001). Those living in Belgium (OR=0.21, p<0.001) were less likely to fulfil recommendations of PA. CONCLUSIONS Almost half of the participants with IJDs used self-report-based or deviced-based PA measures, although few used wearable devices regularly. The results indicate that participants meeting public PA health guidelines were engaged in self-monitoring of PA.
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Affiliation(s)
- N Brodin
- Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Division of Physiotherapy, Orthopaedic Clinic, Danderyds Sjukhus AB, Stockholm, Sweden
| | - David Moulaee Conradsson
- Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Occupational Therapy & Physiotherapy, Theme Women's Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden
| | - Thijs Willem Swinnen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Division of Rheumatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research (Copecare), Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Norelee Kennedy
- Discipline of Physiotherapy, School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Nanna Maria Hammer
- Copenhagen Center for Arthritis Research (Copecare), Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Sean McKenna
- Health Service Executive, Department of Physiotherapy, University of Limerick Hospitals Group, Dooradoyle, Ireland
| | - Peter Henriksson
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Nordgren
- Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Occupational Therapy & Physiotherapy, Theme Women's Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden
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Correlates of physical activity in adults with spondyloarthritis and rheumatoid arthritis: a systematic review. Rheumatol Int 2022; 42:1693-1713. [PMID: 35672508 PMCID: PMC9439989 DOI: 10.1007/s00296-022-05142-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/30/2022] [Indexed: 11/25/2022]
Abstract
Physical activity (PA) is a primary non-pharmacological treatment option for those living with rheumatoid arthritis (RA) and spondyloarthritis (SpA). The aim of this systematic literature review was to summarize and present an updated synthesis of the factors associated with PA in the RA and SpA populations. A tailored search of PubMed (inc. Medline), Web of Science, Embase, APA PsycNET, and Scopus was conducted for research published between 2004 and June 2019. Methodological quality was assessed using The National Institutes of Health (NIH) Quality Assessment Tools for Observational Cohort and Cross-sectional Studies, Case–Control Studies, and Controlled Intervention Studies. Forty RA and eleven SpA articles met the inclusion criteria. Methodological quality was generally fair to good, with two RA studies rated as poor. Correlates are discussed in the sociodemographic, physical, psychological, social, and environmental categories. Environmental factors were not measured in any RA study. In individuals living with RA, consistent positive associations were found between PA and high-density lipoprotein, self-efficacy, and motivation. Consistent negative associations were found for functional disability and fatigue. In individuals with SpA, consistent positive associations were found between PA and quality of life, and consistent negative associations with functional disability. Physical and psychological factors are most consistently related with PA parameters in those living with RA and SpA. Many variables were inconsistently studied and showed indeterminant associations. Studies with prospective designs are needed to further understand the factors associated with PA in these populations, especially in those living with SpA.
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Loeppenthin K, Esbensen BA, Klausen JM, Østergaard M, Christensen JF, Tolver A, Thomsen T, Bech JS, Jennum P. Efficacy and Acceptability of Intermittent Aerobic Exercise on Polysomnography-Measured Sleep in People With Rheumatoid Arthritis With Self-Reported Sleep Disturbance: A Randomized Controlled Trial. ACR Open Rheumatol 2022; 4:395-405. [PMID: 35089655 PMCID: PMC9096512 DOI: 10.1002/acr2.11403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objective This study's objective was to investigate the efficacy and acceptability of intermittent aerobic exercise training on sleep parameters, fatigue, pain, depressive symptoms, physical function, and cardiorespiratory fitness in people with rheumatoid arthritis (RA). Methods Thirty‐eight people with RA were assigned to intermittent aerobic exercise training (three sessions/week for 6 weeks; intervention group, n = 17) or usual care (control group, n = 21). The primary outcome was a change in polysomnography‐assessed sleep efficiency from baseline to the end of the intervention. Secondary outcomes were sleep quality (Pittsburgh Sleep Quality Index), fatigue (Bristol Rheumatoid Arthritis Fatigue Multi‐Dimensional Questionnaire), depression (Center for Epidemiological Studies‐Depression), and cardiorespiratory fitness (watt max test). Results No between‐group differences were found in changes in polysomnography‐assessed sleep efficiency (0.04; 95% confidence interval [CI]: −0.02 to 0.09, P = 0.17). In the intervention group, sleep efficiency was improved significantly from baseline (0.84; 95% CI: 0.80‐0.88) compared with the end of the intervention (6 weeks) (0.88; 95% CI: 0.85‐0.92); however, there was no significant difference in the control group. Fatigue and depression measures were significantly lower in the intervention group than in the control group. Between‐group differences were overall fatigue (−16.1; 95% CI: −25.1 to −7.0, P = 0.001), physical fatigue (−5.0; 95% CI: −7.3 to −2.7, P = 0.0001), cognitive fatigue (−2.4; 95% CI: −4.2 to 0.6, P = 0.009), living with fatigue (−2.5; 95% CI: −4.5 to −0.5, P = 0.01), and depressive symptoms (−6.8; 95% CI: −12.4 to −1.1, P = 0.02). Conclusion The intervention yielded no significantly better sleep efficiency compared with usual care. However, aspects of fatigue, including physical and cognitive fatigue, and depressive symptoms were significantly improved in the intervention group.
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Affiliation(s)
- Katrine Loeppenthin
- Rigshospitalet, Glostrup, Denmark, and University of Copenhagen, Copenhagen, Denmark
| | - Bente Appel Esbensen
- Rigshospitalet, Glostrup, Denmark, and University of Copenhagen, Copenhagen, Denmark
| | | | - Mikkel Østergaard
- Rigshospitalet, Glostrup, Denmark, and University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Poul Jennum
- University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
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Crouthamel M, Mather RJ, Ramachandran S, Bode K, Chatterjee G, Garcia-Gancedo L, Kim J, Alaj R, Wipperman MF, Leyens L, Sillen H, Murphy T, Benecky M, Maggio B, Switzer T. Developing a Novel Measurement of Sleep in Rheumatoid Arthritis: Study Proposal for Approach and Considerations. Digit Biomark 2021; 5:191-205. [PMID: 34703974 DOI: 10.1159/000518024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022] Open
Abstract
The development of novel digital endpoints (NDEs) using digital health technologies (DHTs) may provide opportunities to transform drug development. It requires a multidisciplinary, multi-study approach with strategic planning and a regulatory-guided pathway to achieve regulatory and clinical acceptance. Many NDEs have been explored; however, success has been limited. To advance industry use of NDEs to support drug development, we outline a theoretical, methodological study as a use-case proposal to describe the process and considerations when developing and obtaining regulatory acceptance for an NDE to assess sleep in patients with rheumatoid arthritis (RA). RA patients often suffer joint pain, fatigue, and sleep disturbances (SDs). Although many researchers have investigated the mobility of joint functions using wearable technologies, the research of SD in RA has been limited due to the availability of suitable technologies. We proposed measuring the improvement of sleep as the novel endpoint for an anti-TNF therapy and described the meaningfulness of the measure, considerations of tool selection, and the design of clinical validation. The recommendations from the FDA patient-focused drug development guidance, the Clinical Trials Transformation Initiative (CTTI) pathway for developing novel endpoints from DHTs, and the V3 framework developed by the Digital Medicine Society (DiMe) have been incorporated in the proposal. Regulatory strategy and engagement pathways are also discussed.
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Affiliation(s)
- Michelle Crouthamel
- Digital Health & Innovation, Global Clinical Development, AbbVie Inc., North Chicago, Illinois, USA
| | - Robert J Mather
- Early Clinical Development, Pfizer Inc., Cambridge, Massachusetts, USA
| | - Suraj Ramachandran
- Global Regulatory Affairs and Clinical Safety (SR), MRL (KB), Merck & Co, Inc., Kenilworth, New Jersey, USA
| | - Kai Bode
- Global Regulatory Affairs and Clinical Safety (SR), MRL (KB), Merck & Co, Inc., Kenilworth, New Jersey, USA
| | - Godhuli Chatterjee
- Clinical Study Unit (India-South East Asia Cluster), Sanofi Healthcare India Private Limited, Mumbai, India
| | | | - Joseph Kim
- Translational Technology and Innovation, Office of Digital Health, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Rinol Alaj
- Clinical Outcomes Assessment and Patient Innovation, Global Study Strategy & Optimization (RA), Precision Medicine, Early Clinical Development & Experimental Sciences (MFW), Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Matthew F Wipperman
- Clinical Outcomes Assessment and Patient Innovation, Global Study Strategy & Optimization (RA), Precision Medicine, Early Clinical Development & Experimental Sciences (MFW), Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Lada Leyens
- Product Development Regulatory, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Tina Murphy
- Regulatory Affairs Innovation, Novartis Pharmaceuticals, East Hanover, New Jersey, USA
| | - Michael Benecky
- Global Regulatory Affairs, UCB Biosciences, Inc., Raleigh, North Carolina, USA
| | - Brandon Maggio
- Digital Trials - Global Clinical Operations, Boehringer-Ingelheim, Ridgefield, Connecticut, USA
| | - Thomas Switzer
- Early Clinical Development Informatics, Genentech, South San Francisco, California, USA
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Xu T, Jia X, Chen S, Xie Y, Tong KK, Iezzi T, Jackson T. Physical activity and sleep differences between osteoarthritis, rheumatoid arthritis and non-arthritic people in China: objective versus self report comparisons. BMC Public Health 2021; 21:1821. [PMID: 34627194 PMCID: PMC8501529 DOI: 10.1186/s12889-021-11837-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Objectively measured differences in physical activity (PA) and sleep have been documented among people with osteoarthritis (OA) and rheumatoid arthritis (RA) compared to non-arthritic controls. However, it is not clear whether OA and RA subgroups also differ on these indexes or the extent to which distinct arthritis subgroups versus controls can be accurately identified on the basis of objective PA and sleep indexes compared to self-report responses on questionnaires. This study addressed these gaps. METHODS This case-control study comprised Chinese adults with OA (N = 40) or RA (N = 40) diagnoses based on physician assessments as well as a control group of adults without chronic pain (N = 40). All participants wore a Sensewear Armband (SWA) for consecutive 7 days and completed the International Physical Activity Questionnaire Short Form-Chinese as well as Pittsburgh Sleep Diary to obtain objective and subjective PA and sleep data, respectively. RESULTS There were no differences between the three groups on any self-report indexes of PA or sleep. Conversely, OA and RA subgroups displayed significantly lower PA levels and more sleep problems than controls did on a majority of SWA indexes, though arthritis subgroups were not differentiated from one another on these measures. Logistic regression analyses indicated four non-multicollinear SWA indexes (i.e., steps, active energy expenditure, vigorous activity, time awake after sleep onset) correctly identified the subgroup membership of 75.0-82.5% of participants with RA or OA while classification accuracy results were attenuated for controls. CONCLUSIONS Where possible, objective measures should be used to assess PA and sleep of adults with OA and RA while particular self-report PA questionnaires should be used sparingly.
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Affiliation(s)
- Ting Xu
- Experimental Health Psychology, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, 400715, China
| | - Xiaojun Jia
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, 400715, China
| | - Shuanghong Chen
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, 400715, China
| | - Yingying Xie
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, 400715, China
| | - K K Tong
- Department of Psychology, University of Macau, Macau, 000978, Taipa S.A.R., China
| | - Tony Iezzi
- Department of Psychology, London Health Sciences Centre, London, ON, 97403, Canada
| | - Todd Jackson
- Department of Psychology, University of Macau, Macau, 000978, Taipa S.A.R., China.
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Hörnberg K, Pomeroy J, Sandberg C, Ångström L, Södergren A, Sundström B. Isotemporal Substitution of Time Between Sleep and Physical Activity: Associations With Cardiovascular Risk Factors in Early Rheumatoid Arthritis. ACR Open Rheumatol 2021; 3:138-146. [PMID: 33570840 PMCID: PMC7966882 DOI: 10.1002/acr2.11225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/31/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE We aimed to determine relationships between objectively measured nightly sleep, sedentary behavior (SB), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) with risk factors for cardiovascular disease (CVD) in patients with early rheumatoid arthritis (RA). Furthermore, we aimed to estimate consequences for these risk factors of theoretical displacements of 30 minutes per day in one behavior with the same duration of time in another. METHODS This cross-sectional study included 78 patients with early RA. Nightly sleep, SB, LPA, and MVPA were assessed by a combined heart rate and accelerometer monitor. Associations with risk factors for CVD were analyzed using linear regression models and consequences of reallocating time between the behaviors by isotemporal substitution modeling. RESULTS Median (Q1-Q3) nightly sleep duration was 4.6 (3.6-5.8) hours. Adjusted for monitor wear time, age, and sex, 30-minutes-longer sleep duration was associated with favorable changes in the values β (95% confidence interval [CI]) for waist circumference by -2.2 (-3.5, -0.9) cm, body mass index (BMI) by -0.9 (-1.4, -0.4) kg/m2 , body fat by -1.5 (-2.3, -0.8)%, fat-free mass by 1.6 (0.8, 2.3)%, sleeping heart rate by -0.8 (-1.5, -0.1) beats per minute, and systolic blood pressure by -2.5 (-4.0, -1.0) mm Hg. Thirty-minute decreases in SB, LPA, or MVPA replaced with increased sleep was associated with decreased android fat and lower systolic blood pressure levels. Replacement of SB or LPA with MVPA yielded lower BMIs. CONCLUSION Shorter sleep during the night is common among patients with early RA and is associated with adverse risk factors for CVD.
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Affiliation(s)
| | - Jeremy Pomeroy
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
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Abstract
PURPOSE OF REVIEW The aim of this article is to describe the benefits of physical activity and exercise on rheumatoid arthritis disease activity, functioning, and symptoms; and offer recommendations for promotion of physical activity and exercise among people with rheumatoid arthritis. RECENT FINDINGS In addition to well-known benefits of exercise such as improving cardiovascular health and metabolic syndrome and reducing obesity, exercise has consistently shown rheumatoid arthritis-specific benefits. Exercise and increases in physical activity improve clinically measured disease activity, reduce symptoms such as fatigue and pain, and improve function and mental health. In spite of these benefits, most people with rheumatoid arthritis are inactive. Patient barriers to engaging in physical activity may include fears of joint damage, rheumatoid arthritis symptoms, and lack of understanding that physical activity improves the symptoms that may be barriers. However, the greatest barrier to healthy levels of physical activity among individuals with rheumatoid arthritis appears to be the lack of direction from healthcare providers. SUMMARY Exercise is safe and highly beneficial for people with rheumatoid arthritis. Because receiving recommendations from healthcare providers may be the factor most strongly associated with engaging in physical activity or exercise, providers are encouraged to give patients positive messages about the benefits of physical activity and the extremely low risks of harm.
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The feasibility of an exercise intervention to improve sleep (time, quality and disturbance) in people with rheumatoid arthritis: a pilot RCT. Rheumatol Int 2021; 41:297-310. [PMID: 33386901 DOI: 10.1007/s00296-020-04760-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Current rheumatology guidelines recommend exercise as a key component in the management of people with RA, however, what is lacking is evidence on its impact on sleep. Objective is to assess the feasibility of a walking-based intervention on TST, sleep quality, and sleep disturbance and to generate potential effect size estimates for a main trial. Participants were recruited at weekly rheumatology clinics and through social media. Patients with RA were randomized to a walking-based intervention consisting of 28 sessions, spread over 8 weeks (2-5 times/week), with 1 per week being supervised by a physiotherapist, or to a control group who received verbal and written advice on the benefits of exercise. Primary outcomes were recruitment, retention, protocol adherence and participant experience. The study protocol was published and registered in ClinicalTrials.gov NCT03140995. One hundred and one (101) people were identified through clinics, 36 through social media. Of these, 24 met the eligibility criteria, with 20 randomized (18% recruitment; 100% female; mean age 57 (SD 7.3 years). Ten intervention participants (100%) and eight control participants (80%) completed final assessments, with both groups equivalent for all variables at baseline. Participants in the intervention group completed 87.5% of supervised sessions and 93% of unsupervised sessions. No serious adverse events were related to the intervention. Pittsburgh Sleep Quality Index global score showed a significant mean improvement between the exercise group-6.6 (SD 3.3) compared to the control group-0.25 (SD 1.1) (p = 0.012); Intervention was feasible, safe and highly acceptable to study participants, with those participants in the exercise group reporting improvements in sleep duration and sleep quality compared to the control group. Based on these findings, a fully powered randomized trial is recommended. Trial registration number: ClinicalTrials.gov Identifier: NCT03140995 (April 25th, 2017).
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Haider S, Sedlak M, Kapan A, Grabovac I, Lamprecht T, Erlacher L, Quittan M, Fenzl KH, Dorner TE. Factors Associated with Objectively Measured Physical Activity in Patients with Seropositive Rheumatoid Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239008. [PMID: 33287268 PMCID: PMC7730293 DOI: 10.3390/ijerph17239008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 12/13/2022]
Abstract
Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease, which is associated with low levels of physical activity (PA). However, the factors related to low physical activity levels have rarely been studied. Methods: In this cross-sectional study, 70 seropositive RA patients were included. Physical activity was objectively assessed with an ActiGraph GT3X+ accelerometer. In addition, body mass index, smoking status, work ability, and clinical parameters (functional disabilities, disease activity, disease duration, pain, and inflammation parameters) were measured. Results: RA patients performed a mean of 215.2 (SD: 136.6) min a week of moderate physical activity and 9.1 (SD: 26.3) min of vigorous physical activity. The total amount of moderate and vigorous physical activity (MVPA) was associated with BMI, and functional disabilities. In addition, non-smokers and patients with better work ability did more MVPA. No association could be seen with disease activity, disease duration, pain, and inflammatory markers. After mutual adjusting of all the variables, only BMI showed a significant relationship with MVPA. Conclusions: RA patients perform de facto no physical activity with vigorous intensity. Factors related to low physical activity are BMI, functional disabilities, workability and smoking status, whereas due to the study design no causal and temporal link could be made.
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Affiliation(s)
- Sandra Haider
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (S.H.); (M.S.); (A.K.); (T.E.D.)
| | - Michael Sedlak
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (S.H.); (M.S.); (A.K.); (T.E.D.)
| | - Ali Kapan
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (S.H.); (M.S.); (A.K.); (T.E.D.)
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (S.H.); (M.S.); (A.K.); (T.E.D.)
- Correspondence: ; Tel.: +431-40160-34897
| | - Thomas Lamprecht
- Karl Landsteiner Institute for Autoimmune Disease and Rheumatology, 1100 Vienna, Austria; (T.L.); (L.E.); (K.H.F.)
| | - Ludwig Erlacher
- Karl Landsteiner Institute for Autoimmune Disease and Rheumatology, 1100 Vienna, Austria; (T.L.); (L.E.); (K.H.F.)
- 2nd Medical Division, Rheumatology, Klinik Favoriten, 1130 Vienna, Austria
| | - Michael Quittan
- Karl Landsteiner Institute for Remobilization and Functional Health, 1130 Vienna, Austria;
| | - Karl Heinrich Fenzl
- Karl Landsteiner Institute for Autoimmune Disease and Rheumatology, 1100 Vienna, Austria; (T.L.); (L.E.); (K.H.F.)
| | - Thomas Ernst Dorner
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (S.H.); (M.S.); (A.K.); (T.E.D.)
- Karl Landsteiner Institute for Health Promotion Research, 3454 Sitzenberg-Reidling, Austria
- Social Insurance Fund for Public Service, Railway and Mining Industries, Health Promotion Facility Sitzenberg-Reidling, 3454 Sitzenberg-Reidling, Austria
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12
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Feehan LM, Lu N, Xie H, Li LC. Twenty-Four Hour Activity and Sleep Profiles for Adults Living with Arthritis: Habits Matter. Arthritis Care Res (Hoboken) 2020; 72:1678-1686. [PMID: 33025679 DOI: 10.1002/acr.24424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify 24-hour activity-sleep profiles in adults with arthritis and explore factors associated with profile membership. METHODS Our study comprised a cross-sectional cohort and used baseline data from 2 randomized trials studying activity counseling for people with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or knee osteoarthritis (OA). Participants wore activity monitors for 1 week and completed surveys for demographic information, mood (Patient Health Questionnaire 9), and sitting and walking habits (Self-Reported Habit Index). A total of 1,440 minutes/day were stratified into minutes off body (activity unknown), sleeping, resting, nonambulatory, and intermittent or purposeful ambulation. Latent class analysis determined cluster numbers; baseline-category multinomial logit regression identified factors associated with cluster membership. RESULTS Our cohort included 172 individuals, including 51% with RA, 30% with OA, and 19% with SLE. We identified 4 activity-sleep profiles (clusters) that were characterized primarily by differences in time in nonambulatory activity: high sitters (6.9 hours sleep, 1.6 hours rest, 13.2 hours nonambulatory activity, and 1.6 hours intermittent and 0.3 hours purposeful walking), low sleepers (6.5 hours sleep, 1.2 hours rest, 12.2 hours nonambulatory activity, and 3.3 hours intermittent and 0.6 hours purposeful walking), high sleepers (8.4 hours sleep, 1.9 hours rest, 10.4 hours nonambulatory activity, and 2.5 hours intermittent and 0.3 hours purposeful walking), and balanced activity (7.4 hours sleep, 1.5 hours sleep, 9.4 hours nonambulatory activity, and 4.4 hours intermittent and 0.8 hours purposeful walking). Younger age (odds ratio [OR] 0.95 [95% confidence interval (95% CI) 0.91-0.99]), weaker occupational sitting habit (OR 0.55 [95% CI 0.41-0.76]), and stronger walking outside habit (OR 1.43 [95% CI 1.06-1.91]) were each associated with balanced activity relative to high sitters. CONCLUSION Meaningful subgroups were identified based on 24-hour activity-sleep patterns. Tailoring interventions based on 24-hour activity-sleep profiles may be indicated, particularly in adults with stronger habitual sitting or weaker walking behaviors.
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Affiliation(s)
- Lynne M Feehan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Na Lu
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Hui Xie
- Arthritis Research Canada, Richmond, British Columbia, Canada, and Simon Fraser University, Surrey, British Columbia, Canada
| | - Linda C Li
- University of British Columbia, Vancouver, British Columbia, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
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13
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Davergne T, Rakotozafiarison A, Servy H, Gossec L. Wearable Activity Trackers in the Management of Rheumatic Diseases: Where Are We in 2020? SENSORS (BASEL, SWITZERLAND) 2020; 20:E4797. [PMID: 32854412 PMCID: PMC7506912 DOI: 10.3390/s20174797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 12/26/2022]
Abstract
In healthcare, physical activity can be monitored in two ways: self-monitoring by the patient himself or external monitoring by health professionals. Regarding self-monitoring, wearable activity trackers allow automated passive data collection that educate and motivate patients. Wearing an activity tracker can improve walking time by around 1500 steps per day. However, there are concerns about measurement accuracy (e.g., lack of a common validation protocol or measurement discrepancies between different devices). For external monitoring, many innovative electronic tools are currently used in rheumatology to help support physician time management, to reduce the burden on clinic time, and to prioritize patients who may need further attention. In inflammatory arthritis, such as rheumatoid arthritis, regular monitoring of patients to detect disease flares improves outcomes. In a pilot study applying machine learning to activity tracker steps, we showed that physical activity was strongly linked to disease flares and that patterns of physical activity could be used to predict flares with great accuracy, with a sensitivity and specificity above 95%. Thus, automatic monitoring of steps may lead to improved disease control through potential early identification of disease flares. However, activity trackers have some limitations when applied to rheumatic patients, such as tracker adherence, lack of clarity on long-term effectiveness, or the potential multiplicity of trackers.
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Affiliation(s)
- Thomas Davergne
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (UMRS 1136), 75013 Paris, France;
| | | | - Hervé Servy
- E-Health Services Sanoïa, 13420 Gémenos, France;
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (UMRS 1136), 75013 Paris, France;
- APHP, Rheumatology Department, Pitié Salpêtrière Hospital, 75013 Paris, France;
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14
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Sleep impairment: an obstacle to achieve optimal quality of life in rheumatoid arthritis. Rheumatol Int 2018; 38:2183-2192. [DOI: 10.1007/s00296-018-4155-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/06/2018] [Indexed: 01/08/2023]
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15
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McKenna SG, Donnelly AE, Esbensen BA, Fraser AD, Kennedy NM. The impact of exercise on sleep (time, quality, and disturbance) in patients with rheumatoid arthritis: a study protocol for a pilot randomised controlled trial. Rheumatol Int 2018; 38:1191-1198. [PMID: 29766257 DOI: 10.1007/s00296-018-4052-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022]
Abstract
Poor sleep is an issue for people with rheumatoid arthritis (RA), which may curtail their ability to function appropriately and reduce their activity levels. This paper describes a protocol for a pilot randomised controlled trial of an aerobic exercise intervention compared with exercise advice designed to improve sleep in people with RA. Objectives are to obtain reliable estimates regarding recruitment rates, participant retention and protocol adherence and to generate potential effect size estimates for a main trial. Participants will be identified from an existing database held at a University Hospital and in person at weekly rheumatology clinics. Participants meeting the inclusion criteria will be randomised into an intervention or control group. Those in the intervention group will participate in an 8-week walking-based exercise intervention consisting of 28 walking sessions, with 1 session per week being supervised by a trained physiotherapist, spread over a maximum of 8 weeks (2-5 times/week), while those in the control group will receive advice on the benefits of exercise for people with RA. Results will provide data for efficient recruitment and data collection, to determine if a larger, statistically powered main trial could be generalised to a multi-centre rheumatoid arthritis population. Given recent information that sleep is commonly reduced in people with RA and that physical activity and exercise profiles are lower, this study will contribute data to the field of exercise and sleep that is currently lacking and importantly will include people with RA in the study process prior to any fully powered trial.Trial registration number: ClinicalTrials.gov Identifier: NCT03140995 (April 25th, 2017).
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Affiliation(s)
- Sean G McKenna
- School of Allied Health, University of Limerick, Limerick, Ireland.
| | - Alan E Donnelly
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute (HRI), University of Limerick, Limerick, Ireland
| | - Bente A Esbensen
- Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Alexander D Fraser
- Department of Rheumatology, University Hospitals Group Limerick, Limerick, Ireland
| | - Norelee M Kennedy
- School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute (HRI), University of Limerick, Limerick, Ireland
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