School dinners and markers of cardiovascular health and type 2 diabetes in 13-16 year olds: cross sectional study
Authors: P H Whincup, C G Owen, N Sattar, D G Cook
Journal: BMJ (2005)

<h3>Background:</h3> Rheumatoid arthritis (RA) is a chronic, autoimmune inflammatory condition that affects 0.5% of the adult population worldwide (1). Sedentary behavior (SB) is any waking behavior characterized by an energy expenditure of ≤1.5 METs (metabolic equivalent) and a sitting or reclining posture, e.g. computer use (2) and has a negative impact on health in the RA population (3). Sleep is an important health behavior, but sleep quality is an issue for people living with RA (4, 5). Poor sleep quality is associated with low levels of physical activity in RA (4) however the association between SB and sleep in people who have RA has not been examined previously. <h3>Objectives:</h3> The aim of this study was to investigate the relationship between SB and sleep in people who have RA. <h3>Methods:</h3> A cross-sectional study was conducted. Patients were recruited from rheumatology clinics in a large acute public hospital serving a mix of urban and rural populations. Inclusion criteria were diagnosis of RA by a rheumatologist according to the American College of Rheumatology criteria age ≥ 18 and ≤ 80 years; ability to mobilize independently or aided by a stick; and to understand written and spoken English. Demographic data on age, gender, disease duration and medication were recorded. Pain and fatigue were measured by the Visual Analogue Scale (VAS), anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), and sleep quality was assessed using the Pittsburgh Sleep Quality Index. SB was measured using the ActivPAL4™ activity monitor, over a 7-day wear period. Descriptive statistics were calculated to describe participant characteristics. Relationships between clinical characteristics and SB were examined using Pearson’s correlation coefficients and regression analyses. <h3>Results:</h3> N=76 participants enrolled in the study with valid data provided by N=72 participants. Mean age of participants was 61.5years (SD10.6) and the majority 63% (n = 47) were female. Participant mean disease duration was 17.8years (SD10.9). Mean SB time was 533.7 (SD100.1) minutes (8.9 hours per day/59.9% of waking hours). Mean sleep quality score was 7.2 (SD5.0) (Table 1). Correlation analysis and regression analysis found no significant correlation between sleep quality and SB variables. Regression analysis demonstrated positive statistical associations for SB time and body mass index (p-value=0.03846, R<sup>2</sup> = 0.05143), SB time and pain VAS (p-value=0.009261, R<sup>2</sup> = 0.07987), SB time and HADS (p-value = 0.009721, R<sup>2</sup> = 0.08097) and SB time and HADSD (p-value = 0.01932, R<sup>2</sup> = 0.0643). <h3>Conclusion:</h3> We found high levels of sedentary behavior and poor sleep quality in people who have RA, however no statistically significant relationship was found in this study. Future research should further explore the complex associations between sedentary behavior and sleep quality in people who have RA. <h3>References:</h3> [1]Carmona L, et al. Rheumatoid arthritis. <i>Best Pract Res Clin Rheumatol</i> 2010;24:733–745. [2]Anon. Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours”. <i>Appl Physiol Nutr Metab = Physiol Appl Nutr Metab</i> 2012;37:540–542. [3]Fenton, S.A.M. et al. Sedentary behaviour is associated with increased long-term cardiovascular risk in patients with rheumatoid arthritis independently of moderate-to-vigorous physical activity. <i>BMC Musculoskelet Disord</i> 18, 131 (2017). [4]McKenna S, et al. Sleep and physical activity: a cross-sectional objective profile of people with rheumatoid arthritis. <i>Rheumatol Int.</i> 2018 May;38(5):845-853. [5]Grabovac, I., et al. 2018. Sleep quality in patients with rheumatoid arthritis and associations with pain, disability, disease duration, and activity. <i>Journal of clinical medicine</i>, 7(10)336. <h3>Disclosure of Interests:</h3> None declared