Physical activity, exercise, and sedentary behaviour on fatigue in rheumatoid arthritis

Elmsmari, Saleh M.A. ORCID: 0009-0004-9872-6834 (2025). Physical activity, exercise, and sedentary behaviour on fatigue in rheumatoid arthritis. University of Birmingham. Ph.D.

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Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune joint disease characterised by chronic high-grade systemic inflammation. Individuals with RA experience symptoms like fatigue, pain, inflammation, and joint stiffness, along with wellbeing and psychological challenges that affect their general quality of life. People with RA often have relatively low levels of physical activity (PA) and have relatively high levels of sedentary behaviour (SB).
This aim of this thesis was the explore the associations between PA, exercise, and SB with fatigue in people with RA using different methodological approaches. The thesis includes a review which examined these associations (Chapter 2). A novel aspect of this work was the inclusion of observational, longitudinal, and intervention studies in the same review to get a detailed understanding of the existing literature. The findings from the review showed that observational studies provided more substantial evidence for associations between PA and fatigue, whereas exercise interventions appeared to be more effective in reducing fatigue. Few studies explored the associations between SB and fatigue in RA. The review also found a lack of consistency of measuring fatigue in these studies, with some using validated multidimensional measures of fatigue, whereas others included a unidimensional fatigue measure.
In the subsequent chapters, different methods and assessments were used to measure fatigue. Chapter 3 examined the diurnal variation in PA and SB and its associations with a multidimensional measure of fatigue. The findings indicated
that people with RA tend to be more sedentary and less physically active in the evening compared to the morning and afternoon. In addition, sedentary time, standing and stepping are differentially associated with dimensions of fatigue in RA, with stepping behaviours (time and intensity) demonstrating the most consistent associations across all fatigue dimensions.
Chapter 4 used both a multidimensional measure of fatigue as well as unidimensional assessment which was recorded throughout the day for 1 week to provide an overall measure of fatigue in university students, as well as a device-based measures of PA and SB. It was found that daily PA and sedentary time were not associated with multidimensional aspects of fatigue in this population. Using ecological momentary assessment (EMA) was a suitable method to capture unidimensional fatigue over the course of a week. However, these measures were not associated with PA or sedentary time in this population.
The combined findings of this thesis indicate a plausible role of increasing PA (including exercise) for managing fatigue in RA. However, limited evidence exists for the role of sedentary time. In all cases, more research is required to uncover the complexities of the associations between these movement behaviours and fatigue in RA, particularly when considering the complex and multidimensional nature of the experience of fatigue. EMA-methods employing multidimensional measures of fatigue, alongside device-based assessments of PA and sedentary time, may show some promise, but further development and validation work of fatigue measurement is required prior to implementing such studies in RA.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):