Actigraphy-derived physical activity levels and circadian rhythm parameters in patients with psoriatic arthritis: relationship with disease activity, mood, age and BMI

Abstract

Background: Psoriatic arthritis (PsA) is associated with sleep disturbance, depression and a lifetime risk of obesity and cardiovascular disease. To date, there have been no studies investigating the relationship between objectively-measured physical activity (PA) levels and circadian rhythm disturbance with disease activity, daily symptoms and mood in patients with PsA. Objective: This pilot study aimed to investigate the relationship between disease activity, daily symptoms and mood on PA and circadian rhythm in PsA. Design: A prospective cohort study recruiting adults with PsA from rheumatology clinics at a single centre in the UK. Methods: Participants wore an actigraph and recorded their symptoms and mood on a daily basis via a smartphone app for 28 days. Time spent in sedentary, light and moderate-to-vigorous physical activity (MVPA) and parameters reflecting the circadian rhythm of the rest-activity pattern were derived. This included the onset time of the least active 5-h (L5) and most active 10-h (M10) daily consecutive periods and the relative amplitude (RA). The relationship factors between baseline clinical status, daily symptoms, PA and circadian measures were examined using linear mixed effect regression models. Results: Nineteen participants (8/19 female) were included. Participants with active PsA spent 63.87 min (95% CI: 18.5–109.3, p = 0.008) more in inactivity and 30.78 min (95% CI: 0.4–61.1, p = 0.047) less in MVPA per day compared to those in minimal disease activity (MDA). Age, body mass index and disease duration were also associated with PA duration. Participants with worse functional impairment had an M10 onset time 1.94 h (95% CI: 0.05–3.39, p = 0.011) later than those with no reported functional impairment. No differences were detected for L5 onset time or RA. Higher scores for positive mood components such as feeling energetic, cheerful and elated were associated with less time in inactivity and greater time spent in MVPA overall. Conclusion: Our study highlights differences in PA and circadian rest-activity pattern timing based on disease activity, disability and daily mood in PsA. Reduced PA levels in patients with active disease may contribute to the observed increased risk of cardiovascular and metabolic sequelae, with further studies exploring this need.

Analysis of physical activity in psoriatic arthritis: relationship with clinical and analytical parameters and comorbidity—description of the sedentary patient

“…Similar studies have found similar results to ours: McGagh et al confirmed that patients who did not reach the therapeutic goal of minimal disease activity (MAE) were less physically active. The authors did not show the relationship between the different items that make up MAE ( 13 ). In a recent study by Queiro et al using data from the Spanish registry of new-onset PsA, low physical activity was predictive of moderate or high disease activity at 2 years ( 32 ).…”

“…Bivariate correlations were calculated between physical activity and DAPSA (and components), HAQ, FACIT-F, PSAID, BMI, HADS-A, HADS-D, and ISI. The linear regression model was performed with exercise as the dependent variable and as independent variables those that had been significant in the univariate analysis and those that, according to the literature, had influenced physical activity (age, sex, BMI, TJC, VAS pain, HADS-A, HADS-D, FACIT-F, and ISI) ( 13 , 14 , 31 ).…”

“…On the other hand, two groups of patients were established according to the definition of a sedentary lifestyle, and comparisons were made in demographic variables, clinical characteristics, activity, functionality, impact, and comorbidities between both groups of patients. Similarly, a logistic regression model was performed using sedentary lifestyle as the dependent variable and as independent variables those that had been significant in the univariate analysis and those that, according to the literature, had influenced physical activity (age, sex, enthesitis, TJC, SJC, VAS pain, BMI, HADS-A/HADS-D, FACIT-F, and ISI) ( 13 , 14 , 31 ).…”

“…In a recent study, it was confirmed that physical activity, as measured by actigraphy, was related to minimal disease activity, age, body mass index, and disease duration. In addition, better mood was related to physical activity ( 13 ). Similarly, another study found an inverse relationship between physical activity, measured using accelerometry and a physical activity questionnaire, and disease activity ( 14 ).…”

Stability and Volatility of Human Rest-Activity Rhythms: Insights from Very Long Actograms (VLAs)

“…Through large-scale efforts to measure RARs in hundreds-thousands of community-dwelling subjects (e.g., NHANES [National Health and Nutritional Examination Survey], SOL (Study of Latinos), MESA (Multi-ethnic Study of Atherosclerosis) [13][14][15] ], we know how these parameters vary by sex, age, BMI and active employment 13,14,[16][17][18][19] . Cross-sectional case-control studies have also identified RAR abnormalities in a range of chronic illnesses [20][21][22][23][24][25][26][27][28][29] . Within neuropsychiatry, depression has received the greatest emphasis, with multiple studies linking the severity of prevalent depression symptoms to reductions in robustness/routines (low F and IS, high IV), amplitude and a delayed acrophase 12,16,[30][31][32][33] .…”