Land-Based Aerobic Exercise May Reduce Fatigue in Rheumatoid Arthritis

Supervised, land-based aerobic exercise, such as cycling, running, and circuit training, may reduce fatigue in patients with rheumatoid arthritis (RA), according to a study published in Arthritis Care & Research.¹

Patients with RA commonly report fatigue, with a prevalence between 41% and 80%.^2-7 Although a previous meta-analysis of 5 randomized controlled trials demonstrated that exercise may improve fatigue in adults with RA,⁸ these results are not easily interpreted by clinicians.¹

Therefore, to determine the practically relevant effects of exercise on fatigue in adults with RA, researchers used data from that study to calculate 9 effect sizes, using the minimal important differences approach. These studies included up to 298 participants per study with training modalities that included cycling, running, and circuit training 2 to 3 times per week for more than 15 minutes per session, ranging in length from 4 to 104 weeks.

They found that supervised, land-based aerobic exercise resulted in statistically significant reductions in self-reported fatigue among patients with RA (P =.006). However, because of the minimal important difference effect size and recommended cut points,⁹ they found that it may be unlikely for a large number of patients with RA to achieve clinically relevant reductions in fatigue. Importantly, the researchers also found that land-based aerobic exercise did not increase self-reported fatigue in adults with RA. This is notable because of the numerous other benefits that can result from exercise in patients with chronic conditions.^10,11

“In conclusion, the results of the current study suggest that land-based aerobic exercise is associated with statistically significant reductions in fatigue,” stated the authors, although additional studies are needed to confirm these findings in patients with RA who report elevated levels of fatigue.¹

References

1. Kelley GA, Kelley KS, Callahan LF. Aerobic exercise and fatigue in rheumatoid arthritis participants: a meta‐analysis using the minimal important difference approach [published online April 2, 2018]. Arthritis Care Res. doi:10.1002/acr.23570
2. Chen MK. The epidemiology of self-perceived fatigue among adults. Prev Med. 1986;15(1):74-81.
3. Overman CL, Kool MB, Da Silva JAP, Geenen R. The prevalence of severe fatigue in rheumatic diseases: an international study. Clin Rheumatol. 2016;35:409-415.
4. Belza BL. Comparison of self-reported fatigue in rheumatoid arthritis and controls. J Rheumatol. 1995;22(4):639-643.
5. Belza BL, Henke CJ, Yelin EH, Epstein WV, Gilliss CL. Correlates of fatigue in older adults with rheumatoid arthritis. Nurs Res. 1993;42(2):93-99.
6. Wolfe F, Hawley DJ, Wilson K. The prevalence and meaning of fatigue in rheumatic disease. J Rheumatol. 1996;23(8):1407-17.
7. Pinals RS, Masi AT, Larsen RA. Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis Rheum. 1981;24(10):1308-1315.
8. Rongen-van Dartel SA, Repping-Wuts H, Flendrie M, et al. Effect of aerobic exercise training on fatigue in rheumatoid arthritis: A meta-analysis. Arthritis Care Res. 2015;67(8):1054-1062.
9. Johnston BC, Thorlund K, Schunemann HJ, et al. Improving the interpretation of quality of life evidence in meta-analyses: the application of minimal important difference units. Health Qual Life Outcomes. 2010;8:116.
10. Pedersen BK, Saltin B. Evidence for prescribing exercise as therapy in chronic disease. Scand J Med Sci Sports. 2006;16(s1):3-63.
11. Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25 Suppl 3:1-72.