Background/Purpose: Health-enhancing physical activity (HEPA), i.e. at least 150 weekly minutes of moderate-intensity and at least twice-weekly muscle-strengthening activities, is recommended for every adult. Long-term studies on HEPA promotion in rheumatoid arthritis (RA) are scarce. Our aim was to describe HEPA levels and explore aspects of adherence and response during the second year of an outsourced two-year intervention in people with RA.

Methods: Two-hundred and twenty individuals not reaching maintained (>6 months) HEPA were included at baseline and 177 of them (81% women, mean age 60 years, mean time from disease onset 12 years) remained at the end of year two of this uncontrolled cohort study¹. Adherence, without support from health care, to circuit training at public gyms and moderately intense daily physical activity was prompted and recorded by weekly short text messages. Bi-weekly physiotherapist-led support group meetings to facilitate behavior change during the first intervention year were replaced during year two with optional peer-support groups. Response variables included current (past week) and maintained (past six months) HEPA, socio-demographics, disease-related and psychosocial factors collected by questionnaires and performance tests of aerobic capacity and muscle function. Perceptions on the HEPA program were assessed with a study-specific questionnaire. Each participant with unchanged/improved values in general health perception (100 mm VAS) and at least two of three performance tests (aerobic capacity, grip srength and timed standing) year was considered a responder to the HEPA program.

Results: Current and maintained HEPA decreased from 82% to 75% (p=0.0141) and from 41% to 27% (p<0.0001), respectively, during the second year. Fifty-four participants were defined as total responders during the second year, while 105 were non-responders. The mean number of reported circuit-training sessions was 41 (SD 35.3) among total responders and 35 (SD 33.4) among non-responders (p=0.2708), the mean number of days with total HEPA were 194 (SD 80.8) and 171 (SD 76.9) respectively (p=0.0828) and the mean registered support group meetings 12 (SD 6.1) and 10 (SD 6.1) respectively (p=0.0943). Strategies for maintenance and relapse prevention learned during the first intervention year were reportedly used by 35% of the participants. Circuit training, daily physical activity and short text message reminders were perceived (scale 1-5) as valuable (=4), while the value of peer support groups was rated somewhat lower (=3).

Conclusion: Although maintained HEPA decreased from the end of the first intervention year, about one fourth of the originally sedentary individuals with RA still sustained their new behavior after two years. It remains unclear whether improvements in health and functioning relates to the HEPA program and its different components.

¹Nordgren B, Fridén C, Demmelmaier I, Bergström G, Lundberg IE, Dufour AB, Opava CH, the PARA Study Group. An outsourced health-enhancing physical activity program for people with rheumatoid arthritis. Exploration of adherence and response. The PARA 2010 study. Rheumatology (Oxford). 2015;54:1065-73

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/an-outsourced-health-enhancing-physical-activity-program-for-people-with-rheumatoid-arthritis-exploration-of-the-maintenance-phase/