Physical activity, sedentary behaviour, and health outcomes in Rheumatoid Arthritis

Brady, Sophia ORCID: 0000-0003-4297-261X (2022). Physical activity, sedentary behaviour, and health outcomes in Rheumatoid Arthritis. University of Birmingham. Ph.D.

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Abstract

Rheumatoid Arthritis (RA) is a chronic autoimmune disease characterised by high-grade local and systemic inflammation. People with RA experience a multitude of symptoms, such as chronic pain, fatigue, poor mental health and psychological wellbeing and disability, which impact their overall quality of life. People with RA typically engage in low levels of physical activity (PA) and spend long periods of time in sedentary behaviours (SB). Research suggests that increasing PA and reducing SB may improve outcomes in RA. However, this research is limited by the use of non-validated or reliable measurement methods of PA, SB, and health outcomes. In addition, studies rarely assess the different dimensions and elements of PA and SB, and their relative and independent relationships with health in people with RA.

The overarching aim of this research was therefore to develop the understanding of the role of PA and SB for health in RA, through building on existing research in this domain. Specifically, the aim of this thesis was to contribute novel data examining the links between different dimensions of PA and SB with RA outcomes considered to be important by both patients and health professionals.

Initiatives such as Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT), have created core outcome sets of patient- and clinician-important symptoms experienced by people with RA. This thesis focuses on the links between PA and SB with the following OMERACT outcomes: pain, disease activity, functional ability, fatigue, depression, anxiety, subjective vitality, and quality of life.

First, the quality of the current evidence regarding lifestyle PA and SB interventions in people with RA was explored in a systematic review and meta-analysis (Chapter 2). In subsequent methodological chapters (Chapters 3 and 4), the reliability and validity of quantitative sensory testing (QST) modalities and reliability of different ActiGraph accelerometer model and placement site specific cut-points were investigated. The results of these methodological chapters were to inform the design and methods of a longitudinal study, to be conducted as Chapter 5 of this thesis. The aim of this study was to explore the relationships between ActiGraph-measured PA and activPAL™-measured SB with OMERACT health outcomes in people with RA.

However, due to the COVID-19 pandemic, the study to be conducted as part of Chapter 5 was unable to proceed. As a consequence, Chapter 6 comprised an online survey investigating the cross-sectional associations between different dimensions of self-reported of PA and SB with OMERACT health outcomes in people with RA during the COVID-19 pandemic.

Overall, thesis findings demonstrated individual links exist between lifestyle PA, non-exercise light intensity PA (LPA), walking, exercise, and sedentary time with core OMERACT patient- and clinician-important outcomes. More specifically, existing lifestyle PA and SB interventions are effective at increasing PA, reducing SB, and improving OMERACT outcomes in people with RA. Furthermore, methodological chapters suggested that QST, the ActiGraph GT9X and activPAL™ are reliable and valid assessments of pain, free-living PA, and SB, respectively. In addition, thesis findings also reported that non-exercise LPA, and walking in particular, demonstrated significant positive associations with OMERACT indicators of mental health and psychological wellbeing during the COVID-19 pandemic. These dimensions of PA should therefore be recommended to people with RA to improve mental health and psychological wellbeing, particularly during future pandemics.

To conclude, this thesis provides novel evidence regarding the complex and distinct relationships between different dimensions and elements of PA and SB with core OMERACT health outcomes in people with RA, particularly during the unique worldwide event of the COVID-19 pandemic.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):

Supervisor(s)	Email	ORCID
Fenton, Sally	UNSPECIFIED	UNSPECIFIED
Veldhuijzen van Zanten, Jet	UNSPECIFIED	UNSPECIFIED
Duda, Joan L. (Joan Lynne)	UNSPECIFIED	UNSPECIFIED
Kitas, George	UNSPECIFIED	UNSPECIFIED
Walsh, David	UNSPECIFIED	UNSPECIFIED
Metsios, George	UNSPECIFIED	UNSPECIFIED