OP0263-HPR THE ROLE OF PHYSICAL EXERCISES IN REDUCING CHRONIC FATIGUE IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: A. Aleksandrov, M. Nikitin, V. Aleksandrov, N. Aleksandrova
Journal: Annals of the Rheumatic Diseases (2021)

Background: Physical activity is an important non-pharmacological intervention that has a combination of biological, physical and psycho-social benefits and can positively influence chronic fatigue in patients with rheumatoid arthritis (RA) [1, 2, 3]. Objectives: Evaluation of the effectiveness of the use of aerobic exercise (walking) to reduce fatigue in RA patients. Methods: The study included 111 women with RA (mean age 54.4 ± 11.03 years old, mean duration of illness - 11.9 ± 9.3 years old). The DAS28-ESR indicator in RA patients was 2.84 [2.32; 3.05] points: low disease activity was diagnosed in 61.3% of patients, and remission in 38.7%. The average level of fatigue according to the VAS screening scale was 71.6 ± 8.93 points. Fatigue was assessed using the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS V2). To assess the patient’s tolerance to physical activity, a 6-minute walking distance (6MWD) test was used. A walking test at 50 meters was used to assess the functional state of patients in dynamics. The rehabilitation program (RP) of patients (for 21 days) included morning hygienic gymnastics, dosed walking (daily, duration 30-60 minutes) and walking in the air up to 3-3.5 hours a day. Vigorous movements “through pain” were contraindicated. Results: No association was found between the duration of RA and all of the used numerical fatigue scales (p&gt; 0.05), but there was a weak positive relationship between VAS and NRS-overcoming with age (r = 0.21 and r = 0.28). An association between DAS28-ESR and numerical fatigue scales VAS (r = 0.21), NRS effect (r = 0.25) and NRS - overcoming (r = 0.24) was found, despite the fact that this study did not include patients with moderate and high RA activity. There was a significant correlation between the walking time and the number of steps during the 50-meter test (r = 0.6, p &lt;0.001), as well as an association between the fatigue and the walking time (r = 0.33, p = 0.001 for VAS and r = 0.41, p &lt;0.001 for NRS-severity) and the number of steps (r = 0.39, p &lt;0.001 for VAS; r = 0.47, p &lt;0.001 for NRS-severity; r = 0.44, p &lt;0.001 for NRS-bridging). Table 1. Dynamics of fatigue levels and physical indicators in RA patients Before RP In the end of RP р VAS fatigue level 71,2 ± 9,08 (71,5; 64–78) 70,4 ± 9,15 (70; 64–78) p&gt;0,05 BRAF-NRS: severity 6,83 ± 1,21 (7; 6–8) 6,51 ± 1,18 (7; 6–7) p&lt;0,01 BRAF-NRS: effect 6,24 ± 1,07 (5; 4–6) 5,95 ± 1,08 (6; 5–7) p&lt;0,05 BRAF-NRS: overcoming 5,0 ± 1,7 (7; 6–8) 7,76 ± 1,37 (5; 4–5) p&gt;0,05 50 meter test, number of steps 79,3 ± 8,64 (78; 73–84) 78,91 ± 8,15 (78; 73–83) p&gt;0,05 50-meter test, walking time, seconds 56,7 ± 8,72 (57; 50–63) 55,9 ± 8,59 (56; 51–60) р=0,01 * The data are presented as mean ± standard deviation (median; interquartile range) After the completion of RP (Table), RA patients showed a significant reduction in the aspects of fatigue according to the NRS-severity (Z = 2.98, p = 0.003) and NRS-effect (Z = 2.08, p = 0.037) scales. There was also a decrease in the time spent by patients performing the 50 m walking test (t = 2.63, p = 0.01), but the total number of steps did not change (t = 1.44, p = 0.154). Fatigue and pain are important barriers to physical activity, but it is severe fatigue that reduces physical activity in patients with RA [4]. At the same time, physical activity itself can become a factor in reducing fatigue [5], including by reducing the activity of the disease [6]. Conclusion: The severity of fatigue in RA patients can be reduced by actively using non-pharmacological treatment strategies. Walking is a simple and effective solution to increase physical activity and it has a significant effect on fatigue in RA. References: [1]Rongen-van Dartel SA et al. Arthritis Care Res (Hoboken ). 2015;67:1054–1062. [2]Brosseau L et al. PLoS One. 2014;9(5):e95369. [3]Cherkashina IV et al. Vopr Kurortol Fizioter Lech Fiz Kult . 2016;93(2):13-16. [4]Loppenthin K et al. Rheumatol Int. 2015;35:1655–1664. [5]Cramp F et al. Cochrane Database Syst Rev . 2013;8:CD008322. [6]Sveaas SH et al. Br J Sports Med. 2017;51:1065–1072. Disclosure of Interests: None declared