Tailored Behavioral Intervention Promotes Physical Activity in RA

An individually tailored behavioral approach may be beneficial in promoting long-term physical activity and health in patients with rheumatoid arthritis (RA), according to study results published in Arthritis Care & Research.

Researchers sought to examine the intervention’s efficacy after 18 months following a 4-month, individually tailored behavioral intervention aimed at reducing sedentary behaviors in patients with RA.

Participants were identified using the DANBIO database for a single-center, 2-arm, observer-blinded randomized controlled trial conducted between March 2013 and August 2014. Patients were randomly assigned 1:1 to either an intervention or control group (n=75 for both). The 4-month intervention included 3 individual motivational counseling sessions and 0 to 5 individual text messages per week, aimed at increasing light-intensity physical activity.

Investigators in the current study analyzed 22-month outcomes for 92% of the original cohort. A majority of participants were women (81%) with a mean age of 59.6±11.7 years (range 24-83). Participants spent an average of 9.3±1.9 hours sitting or lying down, which was 1 more hour of daily sitting time compared with controls (9.8 vs 8.8 hours).

In the intervention group, daily sitting time decreased by an average of 1.10 hours per day, compared with a 1.32 hours per day increase in the control group. The between-group difference was statistically significant in favor of the intervention group (-2.43 hours/day; 95% CI, -2.99 to -1.86). Postintervention, the reduction in sitting time was “slightly attenuated” at 6 and 18 months in the intervention group; sitting time increased at both time points in control group patients. Investigators found that the intervention group replaced their daily sitting time with increased standing and increased stepping time for a between-group difference of 0.93 hours per day (0.33 hours/day at 18-month follow-up). Additionally, 57% of patients in the intervention group reduced their daily sitting time by at least 50 minutes, compared with 9% of those in the control group.

Participants in the intervention group also significantly decreased self-reported daily sitting time during both work and leisure time compared with the control group. Self-reported fatigue, pain, health-related quality of life, physical function, and general self-efficacy was also improved in this group.

Changes in total cholesterol, triglycerides, and estimated average glucose were “statistically significant in favor of the intervention group,” according to researchers.

One study limitation included the inability to blind participants. However, the researchers noted that based on the individualized approach, scrutiny of attendance, and independent primary outcome measures, between-group contamination was unlikely.

“The[se] results may have important implications for clinical practice and physical activity recommendations for patients with RA,” the researchers concluded.

Reference

Thomsen T, Aadahl M, Beyer N, et al. Sustained long-term efficacy of motivational counseling and text message reminders on daily sitting time in patients with rheumatoid arthritis? Long-term follow-up of a randomized, parallel-group trial [published online September 10, 2019]. Arthritis Care Res. doi: 10.1002/acr.24060