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17-03-2021 | Rheumatoid arthritis | News

Interventions may be needed to encourage physical activity in patients with early RA

Author:
Hannah Kitt

medwireNews: A significant proportion of patients with rheumatoid arthritis (RA) are not doing any physical activity when starting methotrexate treatment or stop soon after, researchers report.

“Potentially interventions aiming to encourage people with RA to start exercising need to be delivered to these people at or close to the start of treatment, as it may become progressively harder to start physical activity as disease progresses,” write Suzanne Verstappen (University of Manchester, UK) and co-investigators in Rheumatology.

They add that “these interventions should be designed to mitigate socioeconomic barriers to participation, such as high cost, lack of childcare, lack of time and lack of awareness.”

Analyzing data from the UK-based Rheumatoid Arthritis Medication Study, the researchers found that 27.8% of 1468 patients with early RA (symptom duration ≤24 months) reported doing no physical activity when they started methotrexate treatment. Meanwhile, 35.3% of patients said they had low physical activity levels (at least 20 minutes 1–3 days per week) and 36.9% said they had high physical activity levels (at least 20 minutes of exercise 4–7 days per week).

The patients predominantly reported doing moderate intensity exercise, with 47.9% and 33.0% of patients in the low and high activity groups, respectively, saying their exercise did not result in sweating.

After the first 6 months of taking methotrexate, the majority of patients, at 73.9%, were performing some physical activity and 10.9% had increased from low to high levels of physical activity, but the researchers note that nearly a quarter (24.1%) of patients reported doing lower levels of physical activity than at baseline, and 11.3% had stopped all physical activity.

Similarly, at 12 months, 22.6% of patients were doing less physical activity than at 6 months and 10.2% had stopped completely. Among the 80.7% who reported some level of physical activity, 10.0% had gone from high to low levels and 9.5% had changed from low to high levels.

Patients were a significant 5.8-fold more likely to cease physical activity if they were current versus never smokers and patients with a greater level of disability were more likely to stop exercising than those with lower disability, with a 2.43-fold increase in risk for each unit increase in HAQ-DI score.

Greater socioeconomic deprivation was also associated with an increased risk for stopping physical activity. Patients scoring 3 or 4 points out of a possible 5 on the Index of Multiple Deprivation were a significant 74% and 79% less likely to stop doing any physical activity, respectively, than the most deprived patients.

The researchers postulate that “it is likely that many people with RA are reducing their physical activity levels in response to the symptoms of RA.

“This has implications for interventions; it may be easier to intervene early and maintain existing physical activity levels rather than trying to promote physical activity once individuals have stopped.”

They conclude: “[I]nterventions aiming to help maintain or begin physical activity in RA should be delivered early in the disease course and may best be targeted towards those with lower socioeconomic status.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

medwireNews: A significant proportion of patients with rheumatoid arthritis (RA) are not doing any physical activity when starting methotrexate treatment or stop soon after, researchers report.

“Potentially interventions aiming to encourage people with RA to start exercising need to be delivered to these people at or close to the start of treatment, as it may become progressively harder to start physical activity as disease progresses,” write Suzanne Verstappen (University of Manchester, UK) and co-investigators in Rheumatology.

They add that “these interventions should be designed to mitigate socioeconomic barriers to participation, such as high cost, lack of childcare, lack of time and lack of awareness.”

Analyzing data from the UK-based Rheumatoid Arthritis Medication Study, the researchers found that 27.8% of 1468 patients with early RA (symptom duration ≤24 months) reported doing no physical activity when they started methotrexate treatment. Meanwhile, 35.3% of patients said they had low physical activity levels (at least 20 minutes 1–3 days per week) and 36.9% said they had high physical activity levels (at least 20 minutes of exercise 4–7 days per week).

The patients predominantly reported doing moderate intensity exercise, with 47.9% and 33.0% of patients in the low and high activity groups, respectively, saying their exercise did not result in sweating.

After the first 6 months of taking methotrexate, the majority of patients, at 73.9%, were performing some physical activity and 10.9% had increased from low to high levels of physical activity, but the researchers note that nearly a quarter (24.1%) of patients reported doing lower levels of physical activity than at baseline, and 11.3% had stopped all physical activity.

Similarly, at 12 months, 22.6% of patients were doing less physical activity than at 6 months and 10.2% had stopped completely. Among the 80.7% who reported some level of physical activity, 10.0% had gone from high to low levels and 9.5% had changed from low to high levels.

Patients were a significant 5.8-fold more likely to cease physical activity if they were current versus never smokers and patients with a greater level of disability were more likely to stop exercising than those with lower disability, with a 2.43-fold increase in risk for each unit increase in HAQ-DI score.

Greater socioeconomic deprivation was also associated with an increased risk for stopping physical activity. Patients scoring 3 or 4 points out of a possible 5 on the Index of Multiple Deprivation were a significant 74% and 79% less likely to stop doing any physical activity, respectively, than the most deprived patients.

The researchers postulate that “it is likely that many people with RA are reducing their physical activity levels in response to the symptoms of RA.

“This has implications for interventions; it may be easier to intervene early and maintain existing physical activity levels rather than trying to promote physical activity once individuals have stopped.”

They conclude: “[I]nterventions aiming to help maintain or begin physical activity in RA should be delivered early in the disease course and may best be targeted towards those with lower socioeconomic status.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

Rheumatology 2021; doi:10.1093/rheumatology/keab060