SP0022 Reduction of Sedentary Behaviour in Patients with Rheumatoid Arthritis – Experiences from An Intervention Study
Authors: B.A. Esbensen
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> The everyday life of patients with RA is periodically influenced by increased disease activity (flares) which often leads to severe limitations in physical functioning and potential progressive joint destruction. Intervention studies in patients with RA have documented a positive effect of exercise on pain and physical functioning. However, studies have also demonstrated that exercise and increased activity levels are difficult to maintain over time [1]. Pain has been identified as a main barrier against adaptation and maintenance of a physically active lifestyle in patients with RA [2]. Sedentary behavior (SB) has become increasingly prevalent in modern society. SB has been recognized as a distinct and independent risk factor for cardiovascular morbidity and mortality, independent of moderate or vigorous physical activity during leisure time [3]. Recent research in healthy population has shown that SB can be reduced through behavioral intervention. At present time there exists few intervention studies investigating health effects of reducing SB. Reducing SB rather than solely increasing physical activity may be suitable in patients with RA. <h3>Aim</h3> This presentation focus on some available experiences from an intervention study (Randomized Controlled Trial, RCT) which aimed to investigate the efficacy of an individually tailored, theory-based motivational counseling intervention on reducing daily sitting time in patients with RA. <h3>Methods/Design</h3> In total 150 patients with RA were recruited from a rheumatology outpatient clinic with at least 5 hours of sitting time per day. Block-randomized was to the intervention group (N=75) or the control group (N=75) receiving usual care. The intervention included: 1) Individual motivational counseling (in total 3 sessions) on reducing daily sitting time in combination with 2) Individual Short Text Message Service (SMS) reminders over a 16 week intervention period. Primary outcome was a change in daily sitting time (minutes) from baseline to 16 weeks measured objectively using an ActivPAL® Activity Monitor. Secondary outcomes included fatigue, pain, physical function, health-related quality of life, self-efficacy, costs and cost-effectiveness. Furthermore, anthropometric measures were included as well as measurement of blood pressure and serum lipids. <h3>Results</h3> <h3>Recruitment and sample characteristics</h3> Recruitment process commenced from April 2013 to August 2014. A project manager consecutively screened medical journals of patients with RA regarding criteria about RA diagnosis and HAQ-score &lt;2.5. <h3>Adherence to the intervention</h3> In total, 75 patients with RA completed all three individual Motivational Intervention (MI) sessions. The participants generally responded well to the part about setting goals to reduce daily SB, which is how each motivational session ended. Examples of SMS text messages will be presented. Frequency of SMS-reminders ranged from 1-4 per week and they were mostly sent out in the afternoon. <h3>Experiences of the intervention</h3> Evaluation of the participant experience was undertaken through field notes and a short questionnaire. In general, the intervention was well accepted by the participants because of its9 simple structure with only three required visits to the hospital. <h3>Safety and adverse events</h3> No serious adverse events related to the intervention or assessments were reported during the study intervention period. Minor complaints relating to redness and itching on the thigh after a week of wearing the ActivPAL monitor were reported by participants intermittently. <h3>Conclusion</h3> Our experiences with the intervention are positive and promising for RA patient with sedentary behaviour. We suppose the final results to fully confirm the present expectations. The intervention is feasible, simple, non-invasive and may be implemented at low costs in clinical practice. <h3>References (selected)</h3> Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, EC. VdE. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev. 2009;4: CD006853. Wilcox S, Der Ananian C, Abbott J, Vrazel J, Ramsey C, Sharpe PA, et al. Perceived exercise barriers, enablers, and benefits among exercising and nonexercising adults with arthritis: results from a qualitative study. Arthritis Rheum. 2006;55(4):616-27. Epub 2006/07/29. Kerola AM, Kerola T, Kauppi MJ, Kautiainen H, Virta LJ, Puolakka K ea. Cardiovascular comorbidities antedating the diagnosis of rheumatoid arthritis. Ann Rheum Dis 2013;Nov 1;72(11):1826-9. <h3>Disclosure of Interest</h3> None declared