Many Patients With Rheumatoid Arthritis Struggle to Engage in Physical Activity

Physical activity (PA) in patients with rheumatoid arthritis (RA) was analyzed through a qualitative synthesis of 15 studies, which emphasized that an RA diagnosis pervaded every facet of a patient’s perception of PA, both as motivators and as hinderances, according to a study published in RMD Open.¹ These results may be helpful in ultimately creating a PA strategy that can support each individual and improve clinical practice, thus mutually benefitting health professionals (HPs) and patients with RA.

While evidence shows that both aerobic and muscle-strengthening PA can reduce symptoms and comorbidity risk, regular PA levels remain low in this patient population for a multitude of reasons. Common factors include pain and fatigue, time and cost, low motivation and poor self-regulation skills, physical limitations, and a lack of knowledge on the part of both HPs and patients alike.

“There is currently a need for a synthesis that has a broader scope and includes a wide variety of phenomena related to PA in people with RA,” stated investigators. “Thus, the aim of our study was to review studies with a qualitative design and synthesize their findings in order to achieve a more comprehensive understanding of phenomena related to perceptions of PA in RA.”

Investigators used data from 3 online databases: PubMed, CINAHL, and Web of Science. Key search terms included in the sampling strategy were “qualitive methods,” “qualitative study,” “interviews,” “focus groups,” “PA,” “exercise,” and “RA.” There were no date limitations placed on potential studies. The 10-item Critical Appraisal Skills Programme (CASP) checklist was used to ensure the quality of the studies. Any text related to the findings were extracted and data such as author, year, country, participant characteristics, research aim, and sampling methods were collected. Investigators identified key concepts across each study and developed a thematic map to interpret the correlation between main themes and subthemes.

A total of 15 studies, which included 233 patients with RA (177 women, 56 men, aged 21-87 years) were analyzed. The studies all captured patient perspectives on PA as an agile, lifelong behavior. Investigators noted a persistent theme among all research: RA can either be a catalyst for or against PA, which underlines how the disease impacts the entire process of a patient’s life.

The analysis revealed 7 subthemes that were either interpreted as facilitators and/or challenges for patients with RA:

• Considering aggravated symptoms
  • This refers to fears about aggravating symptoms and making the disease worse. This includes safety concerns about engaging in PA.
• Acknowledging the impact on health
  • Patients realize how beneficial PA can be and want to participate. Benefits include coping, decreasing symptoms, and retaining independence.
• Becoming empowered and taking action
  • This involves taking accountability as far as goals, priorities, and responsibilities related to RA and PA.
• Keeping informed to increase awareness
  • Patients with RA want to learn and be informed about exercise, including restrictions, recommendations, frequency of exercise, and intensity.
• Creating body awareness
  • This theme focuses on the individual listening to their body during PA, as to reduce the risk of accidental overexertion or injury.
• Dealing with social support
  • Support through family, friends, rheumatologists, and physical therapists are paramount to a patient’s success.
• Feeling satisfied with circumstances and achievements
  • This emphasizes that a positive mindset towards PA will strengthen a long-term commitment to exercise and healthy behaviors.

While the study was strengthened by including studies with low CASP grading, investigators did not analyze unreviewed grey literature, which could be considered a limitation. Additionally, since levels of PA were not available in the participant samples, there may be some inherent bias towards only recruiting individuals with similar experiences and activity levels.

“This synthesis has identified several phenomena related to PA in RA and describes PA as an agile lifelong behaviour in which the disease pervades all aspects of an individuals’ perception of PA,” concluded investigators. “Placed in a theoretical context, our findings outline a model for tailoring PA support to the drivers and determinants of a certain individual, which will improve clinical practice for the benefit of both HPs and patients with RA.”

Reference:

Swärdh E, Opava C, Brodin N. Physical activity in patients with rheumatoid arthritis - an agile lifelong behaviour: a qualitative meta-synthesis. RMD Open. 2021;7(2):e001635. doi:10.1136/rmdopen-2021-001635