Sustaining Healthy Physical Activity Levels in People With Inflammatory Arthritis
Authors:   , Bell Kirsty Jane 
Published: June 2024

Background: Physical activity has been shown to be of great benefit to people with an inflammatory arthritis (IA), however people with an IA have been shown to be very inactive compared to the general population. The aims of this study were therefore to 1) identify barriers and facilitators to sustaining healthy physically active behaviour in people with inflammatory arthritis; 2) assess whether people with inflammatory arthritis sustain physical activity levels through recreational exercise in the first 12 months following completion of an NHS exercise therapy program, and which factors affect physical activity levels; 3) describe the course of health and health-related quality of life outcomes from the start of a supervised and NHS-delivered exercise therapy programme through to 12-months post-program completion in people with inflammatory arthritis; and 4) determine whether the course of health and health-related quality of life depend upon physical activity levels in people with inflammatory arthritis. Method: The study was an embedded mixed methods approach with the main component being a prospective cohort study with an embedded qualitative component through focus groups. 137 participants were recruited from referrals into the inflammatory arthritis exercise programme from across NHS Greater Glasgow & Clyde Health Board. Results: At baseline, 29% of people with an IA met current physical activity guidelines and on average spent 10 hours a day in sedentary behaviour (SB). Ninety per cent of the cohort self-reported that they successfully transitioned from a NHS-run Inflammatory Arthritis Exercise Programme onto exercising in the community. However, this was not supported by objective physical activity data as there was no reduction in SB nor an increase in physical activity. A specific barrier to physical activity in people with an IA was found to be the unpredictable nature of their condition. However, no disease specific characteristics were found to be predictors of physical activity. A specific facilitator was having access to physiotherapy led exercise classes however, a predictor of physical activity was that of attending an exercise facility in the community. Other barriers and facilitators were found to be similar to those in the general population such as availability, accessibility and affordability of exercise and recreational facilities linked to locations, transport options and cost. Other facilitators were similar to those found in people living with other chronic long-term conditions such as the importance of peer support. Over the course of the 15-month cohort study, there was little change in physical activity and health-related quality of life within individual participants. Therefore, the majority of variance for time spent in moderate-to-vigorous physical activity (MVPA) and SB over time is between participants as opposed to within participants. A value of 22.4 % of the between participant variance for time spent in MVPA can be explained by BMI, pain, fatigue, HADs, 6-minute walk test and attending a community exercise facility variables; with BMI, the 6-minute walk test and attending a community exercise facility being significant predictors. The higher the BMI, the less time spent in MVPA; the more distance covered in the 6-minute walk test, the more time spent in MVPA; and by attending an exercise facility in the community, the more time spent in MVPA a week. A value of 6.1 % of the between participant variance for time spent in SB can be explained by gender, pain, ASES, HADs, 6-minute walk test and attending a community exercise facility; with gender being a significant predictor. Males spend more time in SB a week. A value of 61.6% of the variance for the physical function domain of the SF-36 can be explained by time spent in MVPA, age, disease duration, DAS-28, fatigue, ASES, SIMD and 6-minute walk test. A value of 43.4% of the variance for the role limitations due to emotional problems domain of the SF-36 can be explained by SB, age, diagnosis, ASES and HADs. Conclusions: Patients with IA are inactive and spent a lot of time in SB. People with an IA have similar barriers and facilitators to exercise as the general population and those living with other chronic long-term conditions. A barrier which appears to be unique to this population group is that of the unpredictable nature of their condition. Predictors of time spent in MVPA are BMI, the 6-minute walk test and attending a community exercise facility. A predictor of SB is gender, with males spending more time in SB. Physical activity and SB appear to determine aspects of health-related quality of life in people with an IA.