Association of Light-Intensity Physical Activity With Lower Cardiovascular Disease Risk Burden in Rheumatoid Arthritis

Follow-up of health-related quality of life and pain in a cohort of patients with rheumatoid arthritis before and after COVID-19

BACKGROUND

The foot is one of the anatomical structures of the body most affected in rheumatoid arthritis (RA), associated with the disability of patients, even more during COVID-19. The aim of this study was to analyse whether the period of physical inactivity during COVID-19 is an influential factor on health-related quality of life and foot pain in patients with RA.

METHODS

162 patients with foot pain and RA, recruited from the Hospital Virgen de las Nieves, Granada (Spain) were included. Data was collected during two different periods: January - December 2018 in person and June - September 2021 by phone. Patients were asked to complete the Spanish adapted version of the 12-Item Short Form Survey (SF-12) and the Visual Analogue Scale (VAS).

RESULTS

The results from the SF-12 questionnaires were divided between its two subscales (i.e., mental, and physical component). The physical component shows an improvement between 2018 and 2021, from 32.05 in 2018-35.18 in 2021 (p < 0.05). The opposite happened with the mental component, showing a deterioration, from 39.69 in 2018-34.48 in 2021 (p < 0.05). Regarding pain, VAS shows higher levels of pain with statistically significant differences, both in general pain (from 6 in 2018-7 in 2012) and in foot pain (from 5 to 7), (p < 0.05).

CONCLUSION

Mental quality of life and pain, both general and foot pain, are influenced by the period of physical inactivity during COVID-19.

LEVEL OF EVIDENCE

Level II.

Effects of lifestyle physical activity and sedentary behaviour interventions on disease activity and patient- and clinician- important health outcomes in rheumatoid arthritis: a systematic review with meta-analysis

BACKGROUND

Lifestyle physical activity (PA) is defined as any type of PA undertaken as part of daily life. It can include engagement in activities of daily living (i.e., household chores, gardening, walking to work), incidental PA, walking and/or reducing sedentary or sitting behaviours (SB). Regular PA is recommended for people with Rheumatoid Arthritis (RA) to reduce disease activity and systemic inflammation, as well as to improve patient- and clinician-important health outcomes. However, there is no summarised evidence of the effectiveness of interventions specifically targeting lifestyle PA and SB in this population. The aims of this systematic review with meta-analysis were to evaluate interventions targeting lifestyle PA and/or SB on 1) disease activity; 2) PA, SB and 3) patient- and clinician-important outcomes in people with RA.

METHODS

Eight databases [Medline, Cochrane Library CENTRAL, Web of Science, PsychINFO, Cumulative Index to Nursing & Allied Health Literature, Scopus, Excerpta Medica database and Physiotherapy Evidence Database] were searched from inception-August 2022. Inclusion criteria required interventions to target lifestyle PA and/or SB, conducted in adults with RA, assessing patient- and/or clinician-important outcomes.

RESULTS

Of 880 relevant articles, 16 interventions met the inclusion criteria. Meta-analyses showed statistically significant effects of interventions on disease activity (standardised mean difference = -0.12 (95% confidence interval = -0.23 to -0.01, I2 = 6%, z = 2.19, p = .03), moderate-to-vigorous PA, light/leisure PA, steps, functional ability, and fatigue. Whereas, no intervention effects were visualised for total PA, pain, anxiety or quality of life.

CONCLUSIONS

Lifestyle PA interventions led to increased PA, reductions in SB and improvements in disease activity and other patient- and/or clinician-important health outcomes in people with RA. Future interventions should be less heterogenous in content, structure, focus and outcome measures used to aid understanding of the most effective intervention components for improving health. More SB interventions are needed to determine their effectiveness at producing clinical benefits.

A Mendelian randomization study on causal effects of leisure sedentary behaviour on the risk of rheumatoid arthritis

BACKGROUND

The causal inference between leisure sedentary behaviour (LSB) and rheumatoid arthritis (RA) is still controversial because of potential residual confounding and reverse causality.

METHODS

The present study used publicly available large-scale genome-wide association studies (GWAS) of LSB (television watching, computer use, and driving) and RA to perform a two-sample Mendelian randomization (MR) study to evaluate the causal effect of LSB on the risk of RA. We detected significant causal associations using the multiplicative random effects-inverse variance weighted (MRE-IVW) method, the maximum likelihood, robust adjusted profile scores, the weighted median, MR-Egger regression, and several complementary sensitivity analyses. Risk factor analysis was also conducted to further investigate potential mediators linking causal inference.

RESULTS

Increased genetic liability to leisure television watching was significantly associated with a higher risk of RA (MRE-IVW method; OR = 2.46, 95% CI 1.77-3.41; p = 8.35 × 10^-8 ). MR estimates indicated that prolonged leisure computer use was causally associated with a lower risk of RA (MRE-IVW method; OR = 0.23, 95% CI 0.12-0.46; p = 2.19 × 10^-5 ). However, we found no evidence for a causal effect of leisure driving on the risk of RA (MRE-IVW method; OR = 0.59, 95% CI 0.10-3.41; p = 0.557). No pleiotropy was detected by the sensitivity analysis.

CONCLUSIONS

This study supports a causal association between prolonged leisure television watching and an increased risk of RA. Additionally, prolonged computer use might be a protective factor for RA.

Correlates of physical activity in adults with spondyloarthritis and rheumatoid arthritis: a systematic review

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.

Effect of Foot Orthosis Treatment on Quality of Life in Secondary Sarcopenia Patients with Rheumatoid Arthritis-Related Foot Impairment

Objectives:

Patients with rheumatoid arthritis (RA)-related foot impairment have a high rate of sarcopenia. Treatment using a foot orthosis (FO) enables not only a reduction in pain while walking but also an increase in physical activity, helping to prevent further loss of muscle mass. However, the primary goal of treating RA is to maximize patients’ long-term quality of life (QOL). We investigated whether FO treatment both increases physical activity and improves QOL.

Methods:

Among 31 patients with RA-related foot impairment, 15 with sarcopenia were treated with an FO for 6 months. Foot-specific QOL (measuring using the Self-Administered Foot Evaluation Questionnaire), foot pain, activities of daily living, and physical activity (walking-intensity activity and moderate- to vigorous-intensity activity) were compared before treatment and after 6 months of treatment.

Results:

Ten patients who completed 6 months of follow-up were analyzed. Significant QOL improvements were found in the Pain and Pain-Related category and the Physical Functioning and Daily Living category (P = 0.02–0.04); however, no significant changes were found in the Social Functioning, General Health and Well-Being, or Shoe-Related categories (P = 0.09–0.21). Foot pain and activities of daily living significantly improved (P = 0.01–0.04). Physical activity significantly increased for walking-intensity activity (P = 0.04) but did not change for moderate- to vigorous-intensity activity (P = 1.00).

Conclusions:

FO treatment in patients with RA-related foot impairment and sarcopenia increased light-intensity physical activity such as walking and improved physical QOL.

Evaluation of the mechanisms of sarcopenia in chronic inflammatory disease: protocol for a prospective cohort study

Background

Several chronic inflammatory diseases co-exist with and accelerate sarcopenia (reduction in muscle strength, function and mass) and negatively impact on both morbidity and mortality. There is currently limited research on the extent of sarcopenia in such conditions, how to accurately assess it and whether there are generic or disease-specific mechanisms driving sarcopenia. Therefore, this study aims to identify potential mechanisms driving sarcopenia within chronic inflammatory disease via a multi-modal approach; in an attempt to help define potential interventions for future use.

Methods

This prospective cohort study will consist of a multi-modal assessment of sarcopenia and its underlying mechanisms. Recruitment will target three chronic inflammatory diseases: chronic liver disease (CLD) (n=50), with a subset of NAFLD (n=20), inflammatory bowel disease (IBD) (n=50) and rheumatoid arthritis (RA) (n=50) both before and after therapeutic intervention. In addition, 20 age and sex matched healthy individuals will be recruited for comparison. Participants will undergo 4 assessment visits at weeks 0, 2, 12 and 24. Visits will consist of the following assessments: blood tests, anthropometrics, functional assessment, quadriceps muscle imaging, actigraphy, quality of life questionnaires, food diary collection and muscle biopsy of the vastus lateralis (at weeks 2 and 24 only). In addition, stool and urine samples will be collected for future microbiome and metabolomics analysis.

Discussion

This is the first study to use a multi-modal assessment model to phenotype sarcopenia in these chronic inflammatory diseases. We hope to identify generic as well as disease-specific mechanisms driving sarcopenia. We appreciate that these cohorts do require separate standards of care treatments which limit comparison between groups.

Ethics and dissemination

The study is approved by the Health Research Authority - West Midlands Solihull Research Ethics Service Committee Authority (REC reference: 18/WM/0167). Recruitment commenced in January 2019 and will continue until July 2021. The study was halted in March 2020 and again in January 2021 with the COVID-19 pandemic. The findings will be disseminated through peer-reviewed publications and conference presentations. All data will be stored on a secure server.

Trial registration

ClinicalTrials.gov Identifier: NCT04734496

Physical activity and sleep differences between osteoarthritis, rheumatoid arthritis and non-arthritic people in China: objective versus self report comparisons

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.

Effects of physical activity on vascular function in autoimmune rheumatic diseases: a systematic review and meta-analysis

OBJECTIVES

To summarize existing evidence and quantify the effects of physical activity on vascular function and structure in autoimmune rheumatic diseases (ARDs).

METHODS

Databases were searched (through March 2020) for clinical trials evaluating the effects of physical activity interventions on markers of micro- and macrovascular function and macrovascular structure in ARDs. Studies were combined using random effects meta-analysis, which was conducted using Hedges' g. Meta-analyses were performed on each of the following outcomes: microvascular function [i.e. skin blood flow or vascular conductance responses to acetylcholine (ACh) or sodium nitropusside (SNP) administration]; macrovascular function [i.e. brachial flow-mediated dilation (FMD%) or brachial responses to glyceryl trinitrate (GTN%); and macrovascular structure [i.e. aortic pulse wave velocity (PWV)].

RESULTS

Ten studies (11 trials) with a total of 355 participants were included in this review. Physical activity promoted significant improvements in microvascular [skin blood flow responses to ACh, g = 0.92 (95% CI 0.42, 1.42)] and macrovascular function [FMD%, g = 0.94 (95% CI 0.56, 1.02); GTN%, g = 0.53 (95% CI 0.09, 0.98)]. Conversely, there was no evidence for beneficial effects of physical activity on macrovascular structure [PWV, g = -0.41 (95% CI -1.13, 0.32)].

CONCLUSIONS

Overall, the available clinical trials demonstrated a beneficial effect of physical activity on markers of micro- and macrovascular function but not on macrovascular structure in patients with ARDs. The broad beneficial impact of physical activity across the vasculature identified in this review support its role as an effective non-pharmacological management strategy for patients with ARDs.

Assessment of Physical Activity in Adults using Wrist Accelerometers

The health benefits of physical activity have been widely recognized, yet traditional measures of physical activity including questionnaires and category-based assessments of volume and intensity provide only broad estimates of daily activities. Accelerometers have advanced epidemiologic research on physical activity by providing objective and continuous measurement of physical activity in free-living conditions. Wrist-worn accelerometers have become especially popular due to low participant burden. However, the validity and reliability of wrist-worn devices for adults have yet to be summarized. Moreover, accelerometer data provide rich information on how physical activity is accumulated throughout the day, but only a small portion of these rich data have been utilized by researchers. Lastly, new methodological developments that aim to overcome some of the limitations of accelerometers are emerging. The purpose of this review is to provide an overview of accelerometry research, with a special focus on wrist-worn accelerometers. We describe briefly how accelerometers work, summarize the validity and reliability of wrist-worn accelerometers, discuss the benefits of accelerometers including measuring light-intensity physical activity, and discuss pattern metrics of daily physical activity recently introduced in the literature. A summary of large-scale cohort studies and randomized trials that implemented wrist-worn accelerometry is provided. We conclude the review by discussing new developments and future directions of research using accelerometers, with a focus on wrist-worn accelerometers.

Isotemporal Substitution of Time Between Sleep and Physical Activity: Associations With Cardiovascular Risk Factors in Early Rheumatoid Arthritis

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.

Risk factors for hypertension in rheumatoid arthritis patients-A systematic review

INTRODUCTION

Rheumatoid arthritis is frequently associated with hypertension, which has been shown to increase the risk of cardiovascular disease in these patients. The aim of this systematic review was to explore demographic, behavioural or clinical factors including medication use, associated with incident hypertension in rheumatoid arthritis.

METHODS

MEDLINE and Scopus were searched for eligible studies that longitudinally investigated incident hypertension or changes in blood pressure (BP) in rheumatoid arthritis patients. Publications were screened by two reviewers according to predetermined inclusion and exclusion criteria. The quality of included studies was assessed via the Newcastle Ottawa Scale and Cochrane Risk of Bias Tool.

RESULTS

Fourteen studies were deemed eligible and included in this review. The proportion of female subjects ranged from 12 to 87% and the mean age ranged from 47 to 61 years. Regular exercise was associated with a decrease in systolic BP, p = 0.021. Methotrexate was associated with decreased risk of hypertension in two studies. LEF was associated with increased BP in two studies. COX-2 inhibitors were associated with systolic BP and diastolic BP variability (p = 0.009, 0.039, respectively) in one study. Prednisone was found to increase BP and risk of hypertension in three studies. The risk of hypertension in patients taking biologic disease modifying anti-rheumatic drugs (DMARDs) is unclear as some studies report increased BP while others report no difference for biologic compared to conventional DMARDs.

CONCLUSION

Despite limited longitudinal studies exploring this topic, methotrexate and exercise were shown to protect against risk of hypertension in RA patients, while prednisone and COX-2 inhibitors may increase risk of hypertension.

Are Reallocations between Sedentary Behaviour and Physical Activity Associated with Better Sleep in Adults Aged 55+ Years? An Isotemporal Substitution Analysis

Physical activity has been proposed as an effective alternative treatment option for the increasing occurrence of sleep problems in older adults. Although higher physical activity levels are associated with better sleep, the association between specific physical activity intensities and sedentary behaviour (SB) with sleep remains unclear. This study examines the associations of statistically modelled time reallocations between sedentary time and different physical activity intensities with sleep outcomes using isotemporal substitution analysis. Device-measured physical activity data and both objective and subjective sleep data were collected from 439 adults aged 55+ years. Replacing 30 min of SB with moderate to vigorous intensity physical activity (MVPA) was significantly associated with an increased number of awakenings. Moreover, a reallocation of 30 min between light physical activity (LPA) and MVPA was significantly associated with increased sleep efficiency. Furthermore, reallocating 30 min of SB to LPA showed a significant association with decreased sleep efficiency. There were no significant associations of time reallocations for wake time after sleep onset, length of awakenings, and sleep quality. These results improve our understanding of the interrelationships between different intensities of movement behaviours and several aspects of sleep in older adults.

Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment

Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.

Factors Associated with Objectively Measured Physical Activity in Patients with Seropositive Rheumatoid Arthritis

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.

The effect of physical exercise on rheumatoid arthritis: An overview of systematic reviews and meta-analysis

AIMS

To determine which outcomes will be improved by different exercise interventions and the evidence quality for each intervention.

DESIGN

Overview of systematic reviews and meta-analysis.

DATA SOURCES

PubMed, Cochrane, Web of Science, CINAHL, and Embase. Published from the establishment of the database to 3 September 2019.

REVIEW METHODS

AMSTAR 2 and PRISMA were used to evaluate methodological and reporting quality. Evidence quality of the effect of each intervention was assessed according to GRADE guidelines. Meta-analysis of original studies was conducted for comparison of systematic reviews and to explore the effect of different exercise interventions on the same outcome.

RESULTS

Ten systematic reviews were included in the overview. A significant improvement was seen in: aerobic exercise for aerobic capacity; strength training for erythrocyte sedimentation rate and 50-foot walking time; aerobic exercise combined with strength training for aerobic capacity, physical function, and fatigue; hand exercise for hand function.

CONCLUSIONS

For the maximum benefit of rheumatoid arthritis (RA) patients, different exercise methods should be selected according to the symptoms. For RA patients, any exercise is better than no exercise, but the intensity, frequency, and period of exercise for better results are not determined.

IMPACT

What problem did the study address is which outcomes will be improved by different exercise interventions. For maximum benefit for RA patients, different exercise methods should be selected according to symptoms. The research summarized the evidence of exercise rehabilitation of RA and will help RA patients or their caregivers choose the appropriate type of exercise, which will play a positive role on the rehabilitation of patients with RA.

Diurnal patterns of sedentary time in rheumatoid arthritis: associations with cardiovascular disease risk

Objectives

Research demonstrates that sedentary behaviour may contribute towards cardiovascular disease (CVD) risk in rheumatoid arthritis (RA). This study explored diurnal patterns of sedentary time and physical activity (PA) in RA and examined associations with long-term CVD risk.

Methods

97 RA patients wore an accelerometer for 7 days to assess sedentary time, light-intensity and moderate-to-vigorous-intensity PA. Estimated 10-year CVD risk was determined via QRISK score. Hourly estimates of sedentary time and PA (min/hour) were computed for valid-wear hours (ie, valid-wear = 60 min/hour of activity data, ≥3 days). Hourly data were averaged across time periods to represent morning (08:00–11:59), afternoon (12:00–17:59) and evening (18:00–22:59) behaviour. Participants providing data for ≥2 complete time periods/day (eg, morning/evening, or morning/afternoon) were used in the main analysis (n = 41). Mixed linear modelling explored the associations between 10-year CVD risk and within-person (time: morning, afternoon, evening) changes in sedentary time and PA.

Results

Sedentary time was higher, and light-intensity and moderate-to-vigorous-intensity PA lower in the evening, compared to morning and afternoon. Significant interactions revealed individuals with higher CVD risk were more sedentary and did less light-intensity PA during the afternoon and evening. Findings remained significant after adjustment for disease duration, functional ability and erythrocyte sedimentation rate.

Conclusion

Results suggest that the evening time period may offer a significant window of opportunity for interventions to reduce sedentary behaviour in RA and contribute to associated improvements in CVD risk. Due to inverse patterns of engagement, replacing sedentary time with light-intensity PA may offer an effective approach for intervention.

Mobile App-Based Small-Group Physical Activity Intervention for Young African American Women: a Pilot Randomized Controlled Trial

A lack of adequate physical activity among young African American women remains a serious public health challenge. Few evidence-based interventions are available to increase physical activity in this population, and none has leveraged mobile technologies, even though African Americans are among the most avid users of mobile applications (apps). We conducted a pilot randomized controlled trial to test the efficacy of a mobile app-based small-group intervention in increasing physical activity among African American women aged 18 to 35 years (N = 91) in Philadelphia, PA. Cohorts of eight participants were randomized in a 1:1 ratio to a 4-women small-group intervention or an individual control condition. Control participants used the app to track their own activities. Small-group participants could track their own activities and those of the other three women in their group and could message the other women using a chatting tool. The primary outcome was meeting the goal of engaging in at least 90 min/day of light physical activity during the 3-month study period objectively assessed by a Fitbit device. Data were collected in 2016 and analyzed in 2017. Group participants had higher odds of meeting the goal (OR = 1.48, p = .048) than did control participants, an effect that did not wane during the 3-month study period. Irrespective of condition, participants had lower body-mass index (p = .01) and performed more push-ups (p < .0001) at the 1-month and 3-month assessments compared with the baseline measures. Mobile apps facilitating small online groups can contribute to efforts to increase physical activity among young African American women.This study is registered at www.clinicaltrials.gov NCT02736903.

Relationship Between Pain and Sedentary Behavior in Rheumatoid Arthritis Patients: A Cross-Sectional Study

OBJECTIVE

Despite the known benefits of physical activity, high numbers of individuals with rheumatoid arthritis (RA) remain physically inactive and sedentary. Little is known about the determinants of sedentary behavior (SB) in RA. This cross-sectional study was undertaken to examine a range of pain characteristics and RA-related symptoms and their relationship with objectively measured SB.

METHODS

In total, 76 adults with RA wore an activPAL4 accelerometer (PAL Technologies) over a 7-day period. Pain characteristics (pain intensity, painful joint count, nonarticular pain), fatigue, sleep, depression, anxiety, and disease activity were assessed. Analyses were first conducted to evaluate correlations with sedentary time. The independent contribution of pain characteristics to variation in SB was analyzed with multivariable linear regression (adjusted for demographic data and disease activity).

RESULTS

Participants with valid accelerometer data (n = 72) spent a mean ± SD of 533.7 ± 100.1 minutes/day in SB. Positive associations with daily SB were found for pain intensity (r = 0.31, P < 0.01) and number of painful joints (r = 0.24, P < 0.05) but not nonarticular pain. In multivariable analyses, pain characteristics were not independently associated with SB. Analyses indicated that disease activity had an indirect association with SB mediated by pain intensity. Other correlates of daily SB included anxiety and depression but not fatigue or sleep.

CONCLUSION

Results suggest that while pain and other RA-related factors do play a role in SB, they do not appear to have a significant influence after accounting for other variables. Future research should investigate SB and the role of factors unrelated to the symptoms of RA.

Associations of physical activity and sleep with cardiometabolic risk in older women

In this study, we investigate the associations of objectively measured waking (sedentary, light physical activity [LPA] and moderate-to-vigorous physical activity [MVPA]) and sleep duration and quality characteristics with cardiometabolic risk among older women. Participants from the Healthy Women Study 2010–11 follow-up visit (n = 136, age = 73 ± 2 years, white = 91.9%) concurrently wore an ActiGraph GT1M accelerometer and Actiwatch-2 for seven days. A composite cardiometabolic risk score was calculated by transforming metabolic syndrome (MetS) components and summing z-scores. Multivariable regression models were fitted to relate waking and sleep estimates with the MetS z-score after adjustment for covariates. Compositional data analysis was used to predict the MetS z-score when fixed durations of time were reallocated from one characteristic to another. MVPA (per 10 min/day increase; β = −7.80, P < 0.01), LPA (per 30 min/day increase; β = −0.29, P = 0.04), and sleep efficiency (β = −0.10, P = 0.04) were inversely associated with MetS z-score, while sedentary time (per 30 min/day increase; β = 0.34, P = 0.01) was positively associated with MetS z-score. Reallocation of 5 min from MVPA to sleep, sedentary, or LPA resulted in the greatest predicted change in MetS z-score. On average, the reallocation of 5 min from MVPA to other characteristics predicted an 11% increase in triglycerides, 6% decrease in HDL-C, and 5% increase in waist circumference. Lastly, reallocating 30 min of sedentary time to LPA was associated with a modestly lower predicted MetS z-score. This study suggests that MVPA is the most important contributor of MetS and that maintaining MVPA and increasing LPA may be beneficial for reducing cardiometabolic risk among older women.

Theory-informed interventions to promote physical activity and reduce sedentary behaviour in rheumatoid arthritis: a critical review of the literature

Moderate-intensity physical activity (PA) is recommended for the management of Rheumatoid Arthritis (RA). Recent evidence suggests that reducing sedentary behaviour (promoting 'sedentary breaks' and light intensity PA) may also offer potential for improving RA outcomes, independently of the benefits of moderate-intensity PA. Unfortunately, people living with RA engage in very little moderate-intensity PA, and the spend the majority of the day sedentary. Interventions to support PA and sedentary behaviour change in this population are therefore required. Psychological theory can provide a basis for the development and implementation of intervention strategies, and specify the cognitive processes or mechanisms assumed to result in behavioural change. Application of psychological theory to intervention development and evaluation, therefore, permits evaluation of "how things work", helping to identify optimal intervention strategies, and eliminate ineffective components. In this review, we provide an overview of existing PA and sedentary behaviour change interventions in RA, illustrating the extent to which current interventions have been informed by psychological theories of behaviour change. Recommendations are provided for future interventional research in this domain, serving as a reference point to encourage proper application of behavioural theories into intervention design, implementation and appraisal.

A randomized controlled trial to reduce sedentary time in rheumatoid arthritis: protocol and rationale of the Take a STAND for Health study

Background

Patients with rheumatoid arthritis spend most of their daily hours in sedentary behavior (sitting), a predisposing factor to poor health-related outcomes and all-cause mortality. Interventions focused on reducing sedentary time could be of novel therapeutic relevance. However, studies addressing this topic remain scarce. We aim to investigate the feasibility and efficacy of a newly developed intervention focused on reducing sedentary time, and potential clinical, physiological, metabolic and molecular effects in rheumatoid arthritis.

Methods

The Take a STAND for Health study is a 4-month, parallel-group, randomized controlled trial, in which postmenopausal patients with rheumatoid arthritis will set individually tailored, progressive goals to replace their sedentary time with standing and light-intensity activities. Patients will be recruited from the Clinical Hospital (School of Medicine, University of Sao Paulo) and will be assessed at baseline and after a 4-month follow up. Outcomes will include objectively measured sedentary behavior (primary outcome) and physical activity levels, clinical parameters, anthropometric parameters and body composition; aerobic fitness, muscle function, blood pressure, cardiovascular autonomic function, vascular function and structure, health-related quality of life, and food intake. Blood and muscle samples will be collected for assessing potential mechanisms, through targeted and non-targeted approaches.

Discussion

Findings will be of scientific and clinical relevance with the potential to inform new prescriptions focused on reducing sedentary behavior, a modifiable risk factor that thus far has been overlooked in patients with rheumatoid arthritis.

Trial registration

ClinicalTrials.gov, NCT03186924. Registered on 14 June 2017.

Could Omega 3 Fatty Acids Preserve Muscle Health in Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by a high prevalence of death due to cardiometabolic diseases. As observed during the aging process, several comorbidities, such as cardiovascular disorders (CVD), insulin resistance, metabolic syndrome and sarcopenia, are frequently associated to RA. These abnormalities could be closely linked to alterations in lipid metabolism. Indeed, RA patients exhibit a lipid paradox, defined by reduced levels of total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol whereas the CVD risk is increased. Moreover, the accumulation of toxic lipid mediators (i.e., lipotoxicity) in skeletal muscles can induce mitochondrial dysfunctions and insulin resistance, which are both crucial determinants of CVD and sarcopenia. The prevention or reversion of these biological perturbations in RA patients could contribute to the maintenance of muscle health and thus be protective against the increased risk for cardiometabolic diseases, dysmobility and mortality. Yet, several studies have shown that omega 3 fatty acids (FA) could prevent the development of RA, improve muscle metabolism and limit muscle atrophy in obese and insulin-resistant subjects. Thereby, dietary supplementation with omega 3 FA should be a promising strategy to counteract muscle lipotoxicity and for the prevention of comorbidities in RA patients.

Physical activity, sedentary behaviour and their associations with cardiovascular risk in systemic lupus erythematosus

Objective

Using a novel isotemporal substitution paradigm, this study aimed to estimate the cross-sectional associations of objectively measured sedentary behaviour and physical activity (PA) with cardiovascular risk factors among patients with SLE.

Methods

This was a cross-sectional study of adult SLE patients without documented cardiovascular disease (CVD). Cardiovascular risk factors were measured, including BMI, blood pressure, fasting glucose and lipid profile. Ten-year CVD risk was estimated using the American College of Cardiology/American Heart Association risk assessment tool. Time in sedentary behaviour, light PA, and moderate–vigorous PA (MVPA) was measured by accelerometry. We used three linear regression models—single-activity models, partition models, and isotemporal substitution models—to evaluate the associations of time spent at each movement intensity with each CVD risk variable.

Results

There were 100 SLE patients [92% female; mean (s.d.) age 52.4 (14.4) years]. Only 11 participants adhered to current PA recommendations (⩾150 MVPA min/week in ⩾10-min bouts). In isotemporal substitution, reallocating 10 min from sedentary behaviour to MVPA was associated with lower systolic (β = –2.15 mmHg; P = 0.01) and diastolic blood pressure (β = –1.56 mmHg; P = 0.01), as well as lower estimated 10-year CVD risk (RR 0.81, 95% CI 0.70, 0.93). Time reallocation from light PA to MVPA was associated with lower diastolic blood pressure (β = –1.45 mmHg; P = 0.01) and lower 10-year CVD risk estimates (RR 0.80, 95% CI 0.69, 0.94).

Conclusion

Given that reallocating time from other movement intensities to MVPA is associated favourably with lower cardiovascular risk, PA interventions are needed to address suboptimal MVPA levels among SLE patients.

Physical activity, sedentary behavior, and long-term cardiovascular risk in individuals with rheumatoid arthritis

Objective: Individuals with rheumatoid arthritis (RA) have increased risk of cardiovascular disease (CVD). Lifestyle factors such as prolonged sedentary behavior (SB) and reduced physical activity (PA) may heighten the risk of CVD. The objective of the study was to investigate the role of SB and PA as predictors for long-term CVD risk in RA patients.Methods: A subsample of 273 people diagnosed with RA was extracted from the 2003-2006 National Health and Nutrition Examination Survey and included in this cross-sectional study. Valid accelerometry data were categorized into sedentary behavior, very light, light, and moderate-to-vigorous physical activity. Functional limitations were assessed using a physical function questionnaire. The Framingham risk score (FRS) was used to calculate 10-year CVD risk. Regression models were used to examine the relationships between SB, PA, and 10-year CVD risk while controlling for potential confounders.Results: Participants spent an average of 9 h/day sedentary, 4 h in very light PA, 1 h in light PA, and 0.4 h in moderate-to-vigorous PA. Greater sedentary time was associated with higher 10-year CVD risk (p= 0.019). Increased daily PA, at all intensities, was inversely associated with 10-year CVD risk (p< 0.01). In the fully adjusted regression model, associations between 10-year CVD risk and SB (β = 0.31, R² = 0.27, p< 0.01), very light PA (β = -0.19, R² = 0.26, p< 0.01), light PA (β = -0.16, R² = 0.25, p< 0.01), and moderate-to-vigorous PA (β = -0.15, R² = 0.25, p< 0.01) remained significant.Conclusions: Strategies for decreasing SB and increasing PA should be explored with individuals with RA in order to decrease long-term CVD risk.

Sedentary Time, Physical Activity, and Sleep Duration: Associations with Body Composition in Fibromyalgia. The Al-Andalus Project

To explore the individual–independent relationships of sedentary time (ST) and physical activity (PA) (light and moderate-to-vigorous intensity (MVPA)), with sleep duration and body composition (waist circumference, body mass index (BMI), body fat percentage, and muscle mass index) in women with fibromyalgia, and to determine whether these associations are independent of physical fitness. This cross-sectional study involved 385 women with fibromyalgia. ST and PA were assessed by triaxial accelerometry, sleep duration was self-reported. Waist circumference was measured using an anthropometric tape, and body weight, body fat percentage, and muscle mass were estimated using a bio-impedance analyzer. In individual regression models, ST and sleep were directly associated with waist circumference, BMI, and body fat percentage (β between 0.10 and 0.25; all p < 0.05). Light PA and MVPA were inversely associated with waist circumference, BMI, and body fat percentage (β between −0.23 and −0.12; all p < 0.05). In multiple linear regression models, ST (β between 0.17 and 0.23), light PA (β between −0.16 and −0.21), and sleep duration (β between 0.11 and 0.14) were independently associated with waist circumference, BMI, and body fat percentage (all p < 0.05). MVPA was associated with waist circumference independent of light physical activity (LPA) and sleep duration (β = −0.11; p < 0.05). Except for MVPA, these associations were independent of physical fitness. These results suggest that longer ST and sleep duration, and lower PA levels (especially light intensity PA), are independently associated with greater adiposity, but not muscle mass, in women with fibromyalgia. These associations are, overall, independent of physical fitness.

Exercise is Associated With Increased Small HDL Particle Concentration and Decreased Vascular Stiffness in Rheumatoid Arthritis

OBJECTIVE

Patients with rheumatoid arthritis (RA) have increased cardiovascular (CV) risk. In the general population, exercise improves several CV risk factors. In a cross-sectional study, we examined the hypothesis that more exercise is associated with protective traditional and non-traditional CV risk factor profile in patients with RA.

METHODS

Patient-reported exercise outside of daily activities was quantified by time and metabolic equivalents per week (METmin/week) and CV risk factors including blood pressure, standard lipid profiles, lipoprotein particle concentrations (NMR spectroscopy), and vascular indices were measured in 165 patients with RA. The relationship between exercise and CV risk factors was assessed according to whether patients exercised or not, and after adjustment for age, race and sex.

RESULTS

Over half (54%) of RA patients did not exercise. Among those who did exercise, median value for exercise duration was 113 min/week [IQR: 60, 210], and exercise metabolic equivalent expenditure was 484 METmin/week [IQR: 258, 990]. Disease activity (measured by DAS28 score), C-reactive protein, waist-hip ratio, and prevalence of hypertension were lower in patients who exercised compared to those who did not (all p-values < 0.05) but standard lipid profile and body mass index were not significantly different. Patients who exercised had significantly higher concentrations of HDL particles (p = 0.004) and lower vascular stiffness as measured by pulse wave velocity (p = 0.005).

CONCLUSIONS

More self-reported exercise in patients with RA was associated with a protective CV risk factor profile including lower waist-hip ratio, higher HDL particle concentration, lower vascular stiffness, and a lower prevalence of hypertension.

Physical activity and sedentary behavior in women with rheumatoid arthritis: a comparison of patients with low and high disease activity and healthy controls

Objective: In rheumatoid arthritis (RA) patients, low levels of physical activity (PA) and high levels of sedentary behavior (SB) may play a role in enhancing cardiovascular risk. We do not know how long-term control of disease activity impacts upon daily PA levels and if treated patients attain PA levels seen in healthy controls. We therefore compared habitual levels of PA and SB between female RA patients with low disease activity achieved by anti-tumor necrosis factor (TNF) therapy, those with active arthritis (aRA) and non-RA controls.

Methods: We carried out a cross-sectional comparison of 40 RA patients on anti-TNF therapy for >2 years with DAS28<3.2 (tRA), 32 patients on conventional disease modifying anti-rheumatic drugs with DAS28>3.2 (aRA) and 34 healthy controls (C) with the groups matched for age and body mass index. PA was assessed using the ActiGraph accelerometer to determine step count and time spent in moderate-to-vigorous physical activity (MVPA), light activity and sedentary time.

Results: Daily step count was 72% higher in tRA and 40% higher in C in comparison to aRA (p<0.01). Sedentary time (as a proportion of wear time) was 10% less in tRA than aRA (p=0.03), while light activity time was 18% higher (p=0.014). Both RA groups had 40% lower MVPA time than C (p=0.001). Only half of either RA group fulfilled current WHO guidelines for PA compared with 82% of controls.

Conclusion: RA patients who had long-term disease suppression were more physically active with less SB compared to RA patients with active disease. They had similar light PA and SB to controls although lower MVPA. Behavioral change interventions are likely to be needed in order to restore moderate exercise, further reduce SB and to meet guidelines for daily PA.

Objective measurement of sedentary time and physical activity in people with rheumatoid arthritis: protocol for an accelerometer and activPALTM validation study

BACKGROUND

The accurate measurement of sedentary time and physical activity in Rheumatoid Arthritis (RA) is critical to identify important health consequences and determinants of these behaviours in this patient group. However, objective methods have not been well-validated for measurement of sedentary time and physical activity in RA.

AIMS

Specific objectives are to: 1) validate the ActiGraph GT3X+ accelerometer and activPAL3μTM against indirect calorimetry and direct observation respectively, and define RA-specific accelerometer cut-points, for measurement of sedentary time and physical activity in RA; 2) validate the RA-specific sedentary time accelerometer cut-points against the activPAL3μTM; 3) compare sedentary time and physical activity estimates in RA, using RA-specific vs. widely-used non-RA accelerometer cut-points.

METHODS

Objective 1: People with RA will wear an ActiGraph GT3X+, activPAL3μTM, heart rate monitor and indirect calorimeter, whilst being video-recorded undertaking 11 activities representative of sedentary behaviour, and light and moderate intensity physical activity. Objectives 2 and 3: People with RA will wear an ActiGraph GT3X+ and activPAL3μTM for 7 days to measure free-living sedentary time and physical activity.

DISCUSSION

This will be the first study to define RA-specific accelerometer cut-points, and represents the first validation of the ActiGraph accelerometer and activPALTM, for measurement of sedentary time and physical activity in RA. Findings will inform future RA studies employing these devices, ensuring more valid assessment of sedentary time and physical activity in this patient group.

Motivational Counseling and Text Message Reminders: For Reduction of Daily Sitting Time and Promotion of Everyday Physical Activity in People with Rheumatoid Arthritis

Most patients with rheumatoid arthritis tend to be physically inactive and spend more time in sedentary behaviors compared with the general population. This inactive lifestyle can lead to serious health consequences, for example, increased risk of cardiovascular disease. For this reason, there is an interest in increasing participation in physical activity in patients with rheumatoid arthritis. The relatively new approach of reducing sedentary behavior and replacing it with light-intensity physical activity has been shown to be feasible and effective in promoting physical activity in patients with rheumatoid arthritis. However, methods to facilitate this behavior have not yet been fully explored.

Cardiovascular risk management in rheumatoid and psoriatic arthritis: online survey results from a national cohort study

BACKGROUND

Chronic inflammatory arthritis is associated with increased cardiovascular (CV) morbidity and mortality. Pharmacological management and healthy lifestyle modification is recommended to manage these risks, but it is not known how often these are utilised and whether there is any difference in their use between patients with different types of arthritis. The aim of this study was to determine and compare the proportion of participants with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) receiving pharmacological or lifestyle management strategies for CV risk factors. The secondary objective was to identify factors associated with use of management strategies.

METHODS

A survey was sent to online participants in the Australian Rheumatology Association Database, a voluntary national registry for inflammatory arthritis. Participants were asked whether they took medications for hypertension, hyperlipidaemia and diabetes, and to report their height, weight, level of physical activity, and dietary changes made. The use of management strategies was compared between participants with RA and PsA. Logistic regression analyses were performed to identify factors associated with physical activity and dietary changes.

RESULTS

There were 858 respondents with RA and 161 with PsA (response rate 64.5%). Pharmacological treatment was reported by 93% of participants with hypertension and 70% with hyperlipidaemia. All participants with diabetes reported being managed with dietary modification, pharmacological treatment, or a combination of both. Adequate physical activity was reported by 50.8%. Only 27% of overweight or obese participants reported making any dietary change for their health in the past year. There was no difference between RA and PsA in reported utilisation of management strategies. Hyperlipidaemia and being overweight were associated with making dietary change. Obesity and arthritis disease activity were negatively associated with physical activity.

CONCLUSIONS

Most participants with RA and PsA reported using pharmacological treatment for CV risk factors. Relatively few reported using lifestyle modifications. Targeted lifestyle interventions should be implemented for RA and PsA patients.

Sarcopenia

Sarcopenia is defined as a combination of low muscle mass with low muscle function. The term was first used to designate the loss of muscle mass and performance associated with aging. Now, recognized causes of sarcopenia also include chronic disease, a physically inactive lifestyle, loss of mobility, and malnutrition. Sarcopenia should be differentiated from cachexia, which is characterized not only by low muscle mass but also by weight loss and anorexia. Sarcopenia results from complex and interdependent pathophysiological mechanisms that include aging, physical inactivity, neuromuscular compromise, resistance to postprandial anabolism, insulin resistance, lipotoxicity, endocrine factors, oxidative stress, mitochondrial dysfunction, and inflammation. The prevalence of sarcopenia ranges from 3% to 24% depending on the diagnostic criteria used and increases with age. Among patients with rheumatoid arthritis 20% to 30% have sarcopenia, which correlates with disease severity. Sarcopenia exacts a heavy toll of functional impairment, metabolic disorders, morbidity, mortality, and healthcare costs. Thus, the consequences of sarcopenia include disability, quality of life impairments, falls, osteoporosis, dyslipidemia, an increased cardiovascular risk, metabolic syndrome, and immunosuppression. The adverse effects of sarcopenia are particularly great in patients with a high fat mass, a condition known as sarcopenic obesity. The diagnosis of sarcopenia rests on muscle mass measurements and on functional tests that evaluate either muscle strength or physical performance (walking, balance). No specific biomarkers have been identified to date. The management of sarcopenia requires a multimodal approach combining a sufficient intake of high-quality protein and fatty acids, physical exercise, and antiinflammatory medications. Selective androgen receptor modulators and anti-myostatin antibodies are being evaluated as potential stimulators of muscle anabolism.

Correlates of sedentary behaviour and light physical activity in people living with rheumatoid arthritis: protocol for a longitudinal study

BACKGROUND

Sedentary behaviour (SB) is associated with adverse health outcomes in the general population. Replacing sedentary time with light intensity physical activity (LPA) has been linked with improvements in all-cause and cardiovascular disease mortality in adults. People with Rheumatoid Arthritis (RA) typically spend long periods of time sedentary, but the health consequences of 'too much sitting', and possible benefits of LPA, have not been fully explored in this population. Moreover, little is known regarding the determinants of these behaviours among people living with RA, and such knowledge is required for the development of effective behavioural interventions.

AIMS

To examine longitudinal relationships between: 1) objectively-assessed SB/LPA with health outcomes in RA, 2) hypothesised determinants of SB/LPA with objectively-assessed SB/LPA in RA.

METHODS

This longitudinal study will secure assessments at baseline (Time 1) and 6-month follow-up (Time 2) from RA patients. At both time points, physical assessments will be undertaken, and questionnaires administered to measure physical (e.g., percentage body fat, disease activity, physical function, pain) and psychological (e.g., depression, anxiety, vitality) health outcomes. Additional questionnaires will be administered to establish hypothesised determinants (i.e., psychosocial, individual differences, and physical environmental). Participants will wear the ActiGraph GT3X accelerometer and activPAL3μTM for 7 days to objectively measure SB and LPA.

DISCUSSION

Findings will elucidate the health correlates of SB in RA, as well as the relevance of interventions targeting reductions in SB by promoting LPA. Results will also assist in identifying intervention targets (i.e., determinants), with the potential to encourage SB change in RA.

Sedentary behaviour in rheumatoid arthritis: definition, measurement and implications for health

RA is a chronic autoimmune disease characterized by high grade-inflammation, and associated with elevated cardiovascular risk, rheumatoid-cachexia and functional impairment. Sedentary behaviour (SB) is linked to heightened inflammation, and is highly pervasive in RA, likely as a result of compromised physical function and persistent fatigue. This high sedentarity may exacerbate the inflammatory process in RA, and hold relevance for disease-related outcomes. The aim of this narrative review is to provide an overview of the definition, measurement and health relevance of SB in the context of RA. Contradictions are highlighted with regard to the manner in which SB is operationalized, and the significance of SB for disease outcomes in RA is outlined. The advantages and disadvantages of SB measurement approaches are also discussed. Against this background, we summarize studies that have reported SB and its health correlates in RA, and propose directions for future research.

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

Rheumatoid arthritis is a systemic autoimmune disease characterized by excess morbidity and mortality from cardiovascular disease. Mechanisms linking rheumatoid arthritis and cardiovascular disease include shared inflammatory mediators, post-translational modifications of peptides/proteins and subsequent immune responses, alterations in the composition and function of lipoproteins, increased oxidative stress, and endothelial dysfunction. Despite a growing understanding of these mechanisms and their complex interplay with conventional cardiovascular risk factors, optimal approaches of risk stratification, prevention, and treatment in the context of rheumatoid arthritis remain unknown. A multifaceted approach to reduce the burden posed by cardiovascular disease requires optimal management of traditional risk factors in addition to those intrinsic to rheumatoid arthritis such as increased disease activity. Treatments for rheumatoid arthritis seem to exert differential effects on cardiovascular risk as well as the mechanisms linking these conditions. More research is needed to establish whether preferential rheumatoid arthritis therapies exist in terms of prevention of cardiovascular disease. Ultimately, understanding the unique mechanisms for cardiovascular disease in rheumatoid arthritis will aid in risk stratification and the identification of novel targets for meaningful reduction of cardiovascular risk in this patient population.

Physical activity and sedentary behavior in patients with systemic lupus erythematosus and rheumatoid arthritis

Objective

Patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD). As sedentary behavior and lack of physical activity are known cardiovascular risk factors, we compared habitual activity between SLE patients, RA patients, and healthy control participants.

Patients and methods

For this cross-sectional study, RA and SLE patients were recruited from rheumatology clinics at an academic medical center from April 2013 to December 2014. Healthy control participants were recruited through local advertising during the same time period. Habitual activity was measured using a triaxial accelerometer worn during waking hours for 7 consecutive days. Minutes per day of sedentary, light, and moderate–vigorous physical activity (MVPA) were recorded and compared between SLE, RA, and healthy participants using ANOVA.

Results

There were 59 participants included in the analysis: 20 SLE patients, 19 RA patients, and 20 healthy controls. Disease activity was quiescent in both the SLE and RA groups. All three groups demonstrated high sedentary behavior (mean ± SD sedentary time for all participants: 10.1±1.3 hours/day; 76.4% total wear time). There were no significant differences between SLE, RA, and healthy participants in time spent in sedentary behavior (p=0.80) or light activity (p=0.17). Total MVPA (mean ± SD, minutes/day) was significantly lower in SLE (34.5±22.7; p<0.001) and RA (41.5±21.3; p=0.005) patients compared to controls (64.9±22.4).

Conclusion

SLE and RA patients demonstrate suboptimal MVPA despite well-controlled disease. Given their increased CVD risk, effective interventions are required to improve habitual physical activity levels in both populations.

Developing Fine-Grained Actigraphies for Rheumatoid Arthritis Patients from a Single Accelerometer Using Machine Learning

In addition to routine clinical examination, unobtrusive and physical monitoring of Rheumatoid Arthritis (RA) patients provides an important source of information to enable understanding the impact of the disease on quality of life. Besides an increase in sedentary behaviour, pain in RA can negatively impact simple physical activities such as getting out of bed and standing up from a chair. The objective of this work is to develop a method that can generate fine-grained actigraphies to capture the impact of the disease on the daily activities of patients. A processing methodology is presented to automatically tag activity accelerometer data from a cohort of moderate-to-severe RA patients. A study of procesing methods based on machine learning and deep learning is provided. Thirty subjects, 10 RA patients and 20 healthy control subjects, were recruited in the study. A single tri-axial accelerometer was attached to the position of the fifth lumbar vertebra (L5) of each subject with a tag prediction granularity of 3 s. The proposed method is capable of handling unbalanced datasets from tagged data while accounting for long-duration activities such as sitting and lying, as well as short transitions such as sit-to-stand or lying-to-sit. The methodology also includes a novel mechanism for automatically applying a threshold to predictions by their confidence levels, in addition to a logical filter to correct for infeasible sequences of activities. Performance tests showed that the method was able to achieve around 95% accuracy and 81% F-score. The produced actigraphies can be helpful to generate objective RA disease-specific markers of patient mobility in-between clinical site visits.

Pain rather than self-reported sedentary time explains variation in perceived health and activity limitation in persons with rheumatoid arthritis: a cross sectional study in Sweden

To investigate (1) the amount of self-reported time spent sedentary among a large cohort of persons with rheumatoid arthritis (RA), and (2) the contribution of sedentary time to explain perceived health and activity limitation in RA beyond that of previously known correlates. This cross-sectional study used data from a postal questionnaire and the Swedish Rheumatology Quality registers (SRQ). The International Physical Activity Questionnaire was used to assess sedentary time (sitting) and moderate, vigorous and walking activity (MVPA). Sociodemographics, pain, fatigue, fear-avoidance beliefs, anxiety/depression, disease duration, MVPA and sedentary time were included in multiple regression models with perceived health (Visual Analogue Scale 0-100) and activity limitation (Stanford Health Assessment Questionnaire) as dependent variables.

RESULTS

In all 3152 (59%) of 5391 persons identified as eligible from the SRQ, responded to the questionnaire. 2819 individuals with complete data on all study variables were analysed. Mean time (SD) spent sedentary was 257 (213) minutes per day. Sedentary time did not contribute significantly to explain perceived health and only minimally to explain activity limitation. Instead, variation was mainly explained by pain; for perceived health (Beta = 0.780, p < 0.001) and for activity limitation (Beta = 0.445, p < 0.001).The results indicate a non-significant role of sedentary time and a need for increased focus on pain in the management of RA. Future studies should use prospective designs and objective assessment methods to further investigate the associations between sedentary time and health outcomes in persons with RA.

Physical inactivity and sedentary behavior: Overlooked risk factors in autoimmune rheumatic diseases?

This review aims to (1) summarize the estimates of physical inactivity and sedentary behavior in autoimmune rheumatic diseases; (2) describe the relationship between physical (in)activity levels and disease-related outcomes; (3) contextualize the estimates and impact of physical inactivity and sedentary behavior in autoimmune diseases compared to other rheumatic diseases and chronic conditions; and (4) discuss scientific perspectives around this theme and potential clinical interventions to attenuate these preventable risk factors. We compiled evidence to show that estimates of physical inactivity and sedentary behavior in autoimmune rheumatic diseases are generally comparable to other rheumatic diseases as well as to other chronic conditions (e.g., type 2 diabetes, cardiovascular diseases, and obesity), in which a lack of physical activity and excess of sedentary behavior are well-known predictors of morbimortality. In addition, we also showed evidence that both physical inactivity and sedentary behavior may be associated with poor health-related outcomes (e.g., worse disease symptoms and low functionality) in autoimmune rheumatic diseases. Thus, putting into practice interventions to make the patients "sit less and move more", particularly light-intensity activities and/or breaking-up sedentary time, is a simple and prudent therapeutic approach to minimize physical inactivity and sedentary behavior, which are overlooked yet modifiable risk factors in the field of autoimmune rheumatic diseases.

Sedentary behaviour is associated with increased long-term cardiovascular risk in patients with rheumatoid arthritis independently of moderate-to-vigorous physical activity

BACKGROUND

Rheumatoid Arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). The physical dysfunction symptomatic of RA means people living with this disease spend large periods of the day sedentary, which may further elevate their risk of CVD. The primary aim of this study was to investigate relationships between objectively assessed sedentary behaviour patterns and light physical activity (LPA) with 10-year risk of CVD. Secondary aims were to explore the role of sedentary behaviour patterns and LPA for individual CVD risk factors and functional disability in RA. The extent to which associations were independent of moderate-to-vigorous physical activity (MVPA) engagement was also examined.

METHODS

Baseline data from a subsample of participants recruited to the Physical Activity in Rheumatoid Arthritis (PARA) study were used to answer current research questions. Sixty-one patients with RA (mean age (± SD) = 54.92 ± 12.39 years) provided a fasted blood sample and underwent physical assessments to evaluate factors associated with their cardiovascular health. Sedentary behaviour patterns (sedentary time, sedentary bouts, sedentary breaks), LPA and MVPA were measured via 7-days of accelerometry. Ten-year CVD risk was computed (Q-risk-score2), and functional disability determined via questionnaire.

RESULTS

Regressions revealed significant positive associations between sedentary time and the number of sedentary bouts per day ≥20 min with 10-year CVD risk, with the reverse true for LPA participation. Associations were independent of MVPA engagement.

CONCLUSIONS

Promoting LPA participation and restricting sedentary bouts to <20 min may attenuate long-term CVD risk in RA, independent of MVPA engagement.

TRIAL REGISTRATION

ISRCTN04121489 (retrospectively registered 19/10/2012).