Physical Inactivity Levels Associated with Higher Pain Scores, Depression Rates in Patients with Rheumatoid Arthritis

A relationship between low physical activity (PA) levels and depression, obesity, fatigue, and poor sleep was observed in patients with rheumatic disease, such as rheumatoid arthritis, according to a study published in Journal of Rheumatology.¹ Additionally, levels of vigorous PA were lower among older patients.

“Despite the multiple benefits offered by PA, the proportion of older adults meeting PA guidelines is between 27% to 44%,” investigators explained. “Across all surveys, Non-Hispanic White males reported higher levels of PA which declined with age and functional limitation across all groups. Rheumatic and musculoskeletal diseases (RMDs) like RA, spondyloarthritis (SpA), systemic lupus erythematous (SLE) and osteoarthritis (OA) are a diverse group of multi-system diseases that commonly affect the joints. As older adults with RMDs can have significant functional limitation, it is important to understand the level of PA in this group.”

A cross-sectional analysis of adults aged 65 years or older with rheumatic disease was conducted using data from FORWARD and the National Databank (NDB) for Rheumatic Diseases to determine levels of PA, the primary exposure of interest, in this patient population. PA, as defined as exercise, sports, and brisk walking or cycling, was classified as either high (vigorously active for at least 30 minutes, 3 times per week), moderate (moderate activity for at least 3 times per week), or low (seldom activity).

Self-reported levels of PA were compared across different types of rheumatic diseases and the association between levels of PA and patient-reported outcomes (PROs), including the Patient-Reported Outcomes Measurement Information System (PROMIS-29) assessment, was evaluated.

Rheumatoid arthritis (68%, n = 2278) was the most commonly reported rheumatic disease among the 3343 participants followed by 4.8% (n = 161) with osteoarthritis, 4.1% (n = 137) with SLE, and 3.3% (n = 111) with SpA. The mean age was 74.4 years and 83% of patients were women. Most (54%, n = 1799) patients reported moderate PA, while 14% (n = 468) were placed in the vigorous PA group.

Patients reported a median of 7 days of moderate to vigorous PA for 30 minutes or more per month overall (IQR 0-15, mean 9.3). Compared with non-obese participants, obese patients were significantly more likely to report low levels of activity (25% vs 44%, respectively). Further, patients with low PA levels had worse pain scores, worse Health Assessment Questionnaire-Disability Index (HAQ-DI) scores, worse PROMS-29 scores related to sleep, pain, and fatigue, and higher depression rates. Female participants were more likely to report low levels of physical activity compared with men (34% vs 24%, respectively).

The strengths of the study include the large number of older adults with a variety of rheumatic diseases, as well as capturing PROs and symptoms. The PROMIS-29 allowed investigators to compare results with the general population. However, the questionnaire-based study is prone to volunteer and recall biases. Further, there may differences in physical activity reporting, specifically for those who have a lower PA level, and perceived PA is prone to desirability bias in addition to bias related to severely de-conditioned participants. Another limitation is that physician-assessed disease activity measures were not collected. Lastly, as this study was cross-sectional in nature, investigators were unable to draw conclusions about causation or temporality about the link between PROs and PA,

“Activity trackers may be an effective technology to encourage physical activity among older adults,” investigators concluded. “However, initial positive response to tracker use does not guarantee tracker use maintenance. Maintenance depends on recognizing the long-term benefits of tracker use, social support, and internal motivation. Furthermore, additional efforts are needed to encourage rheumatology providers to council patients on the importance for physical activity. Innovative efforts to promote and sustain physical activities among older adults should be initiated as well as programs that help providers create meaningful change.”

Reference:

Kumthekar A, Pedro S, Michaud K, et al. Physical activity habits among older adults living with rheumatic disease [published online ahead of print, 2023 Jan 15]. J Rheumatol. 2023;jrheum.211244. doi:10.3899/jrheum.211244