Correlates of physical activity in adults with spondyloarthritis and rheumatoid arthritis: a systematic review

Ingram, Thomas; Sengupta, Raj; Standage, Martyn; Barnett, Rosemarie; Rouse, Peter

doi:10.1007/s00296-022-05142-z

Cited by 9 publications

(5 citation statements)

References 102 publications

(121 reference statements)

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“…A multivariable linear regression analysis was applied to evaluate associates of CRF in our study population (VO 2peak in mL/kg/min as dependent variable). Based on clinical reasoning and literature review on correlates to CRF, the following variables were entered in our full model: age, gender, fat mass (in % of body weight), current use of cigarettes and/or snuff (yes/no), systolic blood pressure, HDL-c, physical activity index, disease activity and self-reported fatigue [35,[38][39][40]. With the significance level set to 0.05, the full model was reduced to the final model by backward elimination of non-significant variables.…”

Section: Discussionmentioning

confidence: 99%

“…Considering the high prevalence of fatigue in IJD [48] and positive correlation to disease activity [49,50], we addressed fatigue as a possible associate of CRF. Although few studies have assessed this relationship, low levels of physical activity correlate with fatigue in patients with IJD [40], and an inactive lifestyle can negatively impact CRF. There was no evidence of an association between fatigue and CRF in our data.…”

Section: Discussionmentioning

confidence: 99%

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Associations between cardiovascular risk factors, disease activity and cardiorespiratory fitness in patients with inflammatory joint disease: a cross-sectional analysis

Nordén

Semb

Dagfinrud

et al. 2023

BMC Sports Sci Med Rehabil

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Background Inflammatory joint diseases (IJD) are accompanied by an increased risk of cardiovascular disease (CVD). Cardiorespiratory fitness (CRF) is a modifiable CVD risk factor and low levels of CRF associate with an elevated CVD risk. This study aimed to investigate the associations between CVD risk factors, disease activity and CRF in patients with IJD and to explore differences between patients with normal versus low levels of CRF. Methods CRF was measured as peak oxygen uptake (VO2peak) with a cardiopulmonary exercise test. Participants were also evaluated for: Body composition, blood pressure, blood lipids, inflammatory markers and disease activity. Patient-reported use of cigarettes/snuff, medication, disease duration, pain, fatigue, CVD history, habitual physical activity and exercise beliefs and self-efficacy were collected by questionnaire. Cross-sectional associations between CVD risk factors, disease-related factors and CRF were analyzed by multiple linear regression. CRF was categorized to normal CRF (VO2peak ≥ 80%) or low CRF (VO2peak < 80%) according to age- and gender-stratified reference data. Differences in demographic, CVD and disease-related factors between patients with normal versus low CRF were explored. Results In 60 Norwegian patients with IJD [34 females, age 59 years (IQR: 52–63)], mean VO2peak was 30.2 (± 6.9) mL/kg/min, corresponding to 83% (± 18) of normative reference values. Age (coefficient: − 0.18 years, p = 0.01) and fat mass (coefficient: − 0.67 %, p < 0.001) were inversely associated with CRF, while physical activity index (coefficient: 0.13 points, p = 0.05) was positively associated with CRF (R2 = 0.66). There were no significant associations between CRF, classical CVD risk factors and disease-related variables. Compared to patients with low CRF (n = 30), patients with normal CRF (n = 30) had higher peak oxygen uptake (+ 9.4 mL/kg/min, p < 0.001), high-density lipoprotein cholesterol (+ 0.5 mmol L−1, p < 0.001), and exercise self-efficacy (+ 6.9, p < 0.01) as well as lower fat mass (− 8.7%, p < 0.001), resting heart rate (− 8.0 beats/min, p < 0.01) and triglycerides (− 0.5 mmol L−1, p < 0.01). Conclusions In this sample of IJD-patients, age, fatmass and physical activity level were associated with CRF. CRF was lower than reference values and patients with normal CRF presented with a more favorable health profile. There is a continued need for exercise interventions to improve CRF in patients with IJD. Trial registration: NCT04922840.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Associations between cardiovascular risk factors, disease activity and cardiorespiratory fitness in patients with inflammatory joint disease: a cross-sectional analysis

Nordén

Semb

Dagfinrud

et al. 2023

BMC Sports Sci Med Rehabil

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“…Both pain and stiffness have been reported as important barriers to PA by RA patients [ 30 ]. Stiffness has been associated with PA habits in one study, whereas the association between pain and PA habits appears to be non-significant in most studies of RA patients [ 31 , 32 ]. In patients with fibromyalgia more pain has been associated with lower fitness [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…Other factors than physical symptoms and negative emotions probably also mediate the relationship between RA and low CRF. Potential mediators might include fatigue, comorbidities, lung function, body composition, inflammation, exercise habits, anxiety, motivation, self-efficacy, coping strategies, and sarcopenia [ 11 , 32 , 43 , 44 ]. We focused on factors that are common both in RA patients and the general population, though generally more prevalent in RA patients.…”

Section: Discussionmentioning

confidence: 99%

The association between rheumatoid arthritis and reduced estimated cardiorespiratory fitness is mediated by physical symptoms and negative emotions: a cross-sectional study

Houge

Videm

2023

Clin Rheumatol

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Objectives Persons with rheumatoid arthritis (RA) have lower cardiorespiratory fitness (CRF) than healthy individuals. We sought to identify variables explaining the association between RA status and reduced CRF. Methods RA patients recruited from two Norwegian hospitals and blood donors recruited as controls filled in questionnaires about physical activity, physical symptoms, and psychological factors. Estimated CRF (eCRF) was calculated from non-exercise models. The relationship between RA status and reduced eCRF was explored with structural equation modelling. The latent variables physical symptoms (based on morning stiffness, joint pain, and pain in neck, back, or hips) and negative emotions (based on Hospital Anxiety and Depression Scale’s Depression score and Cohen’s perceived stress scale) were included as possible mediators between RA status and eCRF in separate and combined models adjusted for age and sex. Results Two-hundred-and-twenty-seven RA patients and 300 controls participated. The patients were older and had lower eCRF than controls (age- and sex-adjusted mean difference: 1.7 mL/kg/min, p=0.002). Both latent variables were significant mediators of the association between RA and reduced eCRF when included in separate models. The latent variables mediated 74% of the total effect of RA on eCRF in the combined model. Standardized coefficients: direct effect of RA -0.024 (p=0.46), indirect effect through physical symptoms -0.034 (p=0.051), and indirect effect through negative emotions -0.034 (p=0.039). Conclusion Both physical symptoms and negative emotions mediated the association between RA and reduced eCRF with similar effect sizes. To successfully increase CRF in RA patients, both physical and psychological factors should be addressed. Key Points• The RA patients in the present study had 1.7 mL/kg/min lower mean estimated cardiorespiratory fitness (CRF) compared to healthy controls.• Mediation analysis demonstrated that physical symptoms and negative emotions mediated 74% of the total negative effect of RA on estimated CRF in a combined, adjusted model.• This suggests that both physical and psychological factors should be addressed when supporting RA patients in improving their CRF.

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“…One factor that has been increasingly acknowledged to contribute to activity intolerance and functioning in the context of chronic pain, and axSpA specifically, is fear avoidance behaviour [ 11 – 14 ]. Despite the prevalence of pain for people living with axSpA, little research has established whether pain-related fear of movement contributes to a reduction in physical function in this population [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Fear of movement and competence frustration mediate the relationship between pain catastrophising and physical function in people living with axSpA: an online cross-sectional survey

Rouse,

Ingram,

Standage

et al. 2024

Rheumatol Int

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The objective of this study is to examine the contribution of pain catastrophising to Axial Spondyloarthritis (axSpA) patient’s physical function and to test the mediating role of fear of movement, and uniquely, the contribution of competence frustration to the fear-avoidance model. Participants (N = 98, 70% female, M age = 45.62, SD 12.16) completed an online survey (December 2020–May 2021) distributed in the United Kingdom via the National Axial Spondyloarthritis Society (n ≈ 3500; NASS, 2019). The PROCESS SPSS macro was used to test three mediation models using percentile bootstrap 95% confidence intervals (PBCI). A significant indirect effect on the relationship between pain and physical function via fear of movement (β = 0.10, 95% PBCI = 0.030–0.183) was observed (Model 1). Model 2 showed the relationship between pain catastrophising and physical function to be significantly mediated by fear of movement (β = 0.16, 95% PBCI = 0.005–0.322). Finally, Model 3 showed a significant indirect effect on the relationship between pain catastrophising and physical function via competence frustration (β = 0.15, 95% PBCI = 0.014–0.309) but not through fear of movement (β = 0.062, 95% PBCI = − 0.134 to 0.248). To our knowledge, this is the first study to examine and demonstrate the unique contribution of competence need frustration to the Fear-avoidance model in people that live with axSpA. Identifying modifiable factors that contribute to disease outcomes such as physical function can improve the care and quality of life for people living with a disease currently without a cure.

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Correlates of physical activity in adults with spondyloarthritis and rheumatoid arthritis: a systematic review

Cited by 9 publications

References 102 publications

Associations between cardiovascular risk factors, disease activity and cardiorespiratory fitness in patients with inflammatory joint disease: a cross-sectional analysis

Associations between cardiovascular risk factors, disease activity and cardiorespiratory fitness in patients with inflammatory joint disease: a cross-sectional analysis

The association between rheumatoid arthritis and reduced estimated cardiorespiratory fitness is mediated by physical symptoms and negative emotions: a cross-sectional study

Fear of movement and competence frustration mediate the relationship between pain catastrophising and physical function in people living with axSpA: an online cross-sectional survey

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