Background/Purpose: Fatigue is a major problem for people with RA.  Physical inactivity is an indirect risk factor for fatigue¹. We tested the effect of a simple pedometer-based physical activity intervention to reduce fatigue in people with RA.

Methods: Individuals with rheumatologist-diagnosed RA were recruited from previous studies or rheumatology clinics. Eligibility criteria were:  English- or Spanish-speaking, able to walk, able to return for study visits, at least moderate level of fatigue, and not currently engaged in regular exercise.  Eligible individuals completed baseline questionnaires and received activity-monitoring devices for a one-week baseline step count. After one week, subjects returned and were randomized into one of three groups:  (1) Education only (control), (2) Pedometer and step diary, or (3) Pedometer, step diary, and step targets. Step targets were based on the baseline step counts with the goal of increasing steps by 10% every two weeks. Groups 2 and 3 received phone calls every two weeks to collect step diary information and, for Group 3, to assign new step targets. Follow-up assessments were made at Week 10 (by phone) and Week 21 (in person). The primary outcome was fatigue measured with the PROMIS Fatigue short-form. Changes in the number of steps and in fatigue were tested within each group using paired t-tests and across groups with linear regression using Group 1 (education only) as the reference group.

Results: 359 individuals were approached to participate; 91 refused before screening, 150 were ineligible, and 22 were eligible but refused, leaving 96 participants. Mean ±SD age of participants was 54 ±13 years, 88% were female, and 21% were Spanish-speaking. Mean RA duration was 14 ±13 years.  At baseline, mean RA Disease Activity Index (RADAI) was 4.1 ±1.9, mean HAQ was 1.34 ± 0.65, 59% were currently using glucocorticoids, and 60% were currently receiving biologics. Overall, the median of the average number of daily steps at baseline was 3710 (<5000 is considered “sedentary”) and mean fatigue score was 59.0 ±6.9.  At 21 weeks, both intervention groups had significant increases in mean daily steps compared to the control group (p<.05; table).  Only Group 3 achieved a significant increase in steps as a proportion of baseline.  Both intervention groups had significant and meaningful decreases in fatigue (p<.05, table). Across all groups, decreases in fatigue were correlated with the percentage increase in average daily steps (r = -0.37, p = .005).

Conclusion: A low-resource, pedometer-based physical activity intervention yielded significant increases in physical activity and significant decreases in fatigue among individuals with RA. Results suggest that increasing physical activity by prescribing a pedometer can be effective for reducing fatigue, particularly among individuals with very low activity levels initially.

¹Katz et al. Arthritis Care Res [epub 2015 Mar 16]

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-randomized-controlled-trial-for-a-physical-activity-intervention-for-ra-fatigue/