Using a pedometer and keeping track of the steps taken with a diary has significantly increased physical activity and improved fatigue in patients with rheumatoid arthritis (RA), according to a study published in Arthritis Care & Research.
“Even patients who have their RA well controlled still report fairly significant levels of fatigue,” Patricia Katz, PhD, from the University of California, San Francisco, said in an interview with Rheumatology Advisor. “There needs to be some other way to deal with this, because fatigue can be pretty debilitating.”
In one observational study in patients with RA, Dr Katz and colleagues found that “people with higher levels of fatigue were more inactive.” While exercise interventions have been shown to improve fatigue in RA, they typically require specific resources that would make them hard to implement on a larger scale — such as trained staff and classes offering these interventions.
However, pedometers and step-monitoring diaries are easy to use, and data show good patient adherence to these methods. Dr Katz and colleagues, also from the University of California, San Francisco, evaluated whether an exercise intervention — based on pedometer use — could increase physical activity and reduce fatigue in patients with RA.
A total of 96 participants were randomly assigned to (1) pedometer intervention and step-monitoring diary, (2) pedometer intervention and step-monitoring diary plus step targets, or (3) education on how to increase physical activity, serving as the control group. Primary end points were defined as changes in fatigue — as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire — and average weekly steps at week 21 compared with baseline.
Both pedometer groups demonstrated increased average weekly step counts at 21 weeks (with step targets: mean change, +1656; P =.001; without step targets: mean change, +1441; P =.004), while the control group actually exhibited reduced step counts (mean change, −747; P =.14).
At week 21, patients in the pedometer groups also reported significant decreases in fatigue scores (with step targets: −4.8; P =.0002; without step targets: −3.2; P =.02). However, patients in the control group experienced no change in fatigue level (−1.6; P =.26).
Adherence to the study intervention was high, with participants recording steps on nearly 90% of days for the duration of the study.
Summary and Clinical Applicability
While exercise interventions have been shown to reduce fatigue in RA, they are resource-intensive and may be difficult to implement on a large scale. Dr Katz and colleagues found that using a simple pedometer-based intervention — with or without step targets — effectively reduced fatigue in patients with RA.
“We know that medications alone don’t get rid of fatigue, so patients need some other ways to try to reduce it or manage it,” Dr Katz said. “Walking is a simple activity and it’s something that people can do without going to a gym. They don’t need a trainer or a physical therapist. They can just go out and take a walk.”
“The pedometer helps provide a little motivation,” she added. “I think that people generally like to see that they’re improving. But the simplicity of it, I think, is really the beautiful thing. It’s not complicated.”
Limitations and Disclosures
- Participation in the study may have affected adherence to the intervention, and it is unknown whether adherence would remain high in a real-world setting
- Between-group differences in outcomes could not be measured due to small sample size
Dr Katz reports no relevant disclosures.
Katz P, Margaretten M, Gregorich S, Trupin L. Physical activity to reduce fatigue in rheumatoid arthritis: a randomized, controlled trial [published online April 5, 2017]. Arthritis Care Res. doi:10.1002/acr.23230