Physical Activity Improves Depression, Fatigue in Patients with Arthritis

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Patients with inflammatory arthritis who exhibited moderate and high physical activity were shown to have better control of disease activity in addition to lower levels of depression and fatigue.1 However, investigators noted an omnipresent kinesiophobia, which is indicative of a strong need for continuous education about the benefits of physical activity and the way in which patients can properly exercise.

“The adequate level of physical activity is considered beneficial for disease activity, muscle strength, flexibility and aerobic capacities of the patients,” wrote a team of investigators led by Sretko Lukovic, an internal medicine resident at the Institute of Rheumatology Belgrade. “In addition, exercise helps to enhance energy and stamina by decreasing fatigue and improving sleep. The need for optimizing mental and physical health in patients could be met by exercising. Due to chronic illness, lower level of fitness, pain and biomechanical abnormalities as well as the fear of arthritis relapse or worsening by exercising, many patients avoid this activity.”

To determine the level of physical activity among patients with inflammatory arthritis, investigators conducted an observational, cross-sectional study enrolling patients with rheumatoid arthritis (n = 152), ankylosing spondylitis (n = 77), and psoriatic arthritis (n = 31). The prevalent barriers for regular exercise were also evaluated.

Subjects completed questionnaires including the Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue Scale, the International Physical Activity Questionnaire (IPAQ), the Tampa scale of Kinesiophobia (TSK), the screening questionnaire for sarcopenia (SARC-F), and the Patient health Questionnaire (PHQ9). Demographic characteristics, medical history, and treatment information were collected via medical charts.

The age, fatigue score, risk for sarcopenia, disease activity, level of kinesiophobia, and symptoms of depression were compared in groups corresponding to the different levels of physical activity and between different diagnoses. The latent class analysis (LCA) statistical method was employed to find possible subgroups with similar characteristics to evaluate groups with differing levels of physical activity.

In total, 60% of patients reported a moderate level of physical activity and 11.6% reported low levels. Patients with lower levels of physical activity had higher levels of fatigue (P = .001) and a higher risk of sarcopenia (P = .006). Further, there was a positive correlation between IPAQ score and FACIT fatigue score (P = .04) as well as a negative correlation between IPAQ score and SARC-F score (P = .05).

The LCA showed 3 latent classes with population both share and predicted possibilities of belonging in each one. Subjects with low disease activity were more likely to be in the second class (30%), with a population share of 13.7%, which was characterized by older age, being overweight, lower education level, longer disease duration and steroid use, and had the lowest possibility of being in disease remission (35%). Conversely, patients in this class had the highest possibility of having serious kinesiophobia (82%), sarcopenia (78%), fatigue (60%), and depression symptoms (45%).

In the third class (population share 29.3%), the probability of having high or moderate physical activity was almost 95%. These patients were more likely to be younger (78%), highly educated, employed without marriage and children, and had the highest possibility of disease remission. These patients were more likely to have a diagnosis of ankylosing spondylitis, significant biologics use, less fatigue, and less depression.

Class I (57%) were more likely to have moderate physical activity, were middle aged, married, had children, and had a higher rate of comorbidities.

References

1. ^{Lukovic S, Tomonjic N, Đurđević J, Barac B, et al. Physical Activity in Adults with Inflammatory Arthritis: Latent Class Analysis Approach. Presented at: EULAR. Vienna, Austria. June 12 – 15, 2024.}