Background/Purpose:

Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular disease (CVD) with subsequent morbidity and mortality¹. It is well known that prolonged sedentary behaviour (SB) and reduced physical activity (PA) are risk factors for CVD. The purpose of this study was to examine the independent relationships between SB, very light (VLPA), light (LPA), and moderate to vigorous (MVPA) and 10-year CVD risk in a subsample of people with RA using the Framingham risk score (FRS), an accurate and widely used tool to assess 10 year CVD risk.²

Methods:

A subsample of individuals diagnosed with RA was extracted from the 2003–2006 National Health and Nutrition Examination Survey (NHANES) database, a population-representative US sample. Actigraphy, a uniaxial accelerometer ActiGraph 7164, was used to derive SB and PA volume and pattern. Raw actigraphy data were categorized into SB, VLPA, LPA, and MVPA expressed as mean minutes per day. Pattern variables, including number of breaks in sedentary time, length of sedentary time, and active bouts were calculated. Functional limitation was assessed by self-reported questionnaire. The 10-year CVD risk was determined based on the FRS. Descriptive statistics and multiple linear regression models were used in the analysis using Stata software version 14.

Results:

A total of 273 individuals with RA were included in the analysis. Mean age of participants was 62.7 ±13 years; 143 (52.4%) were women, and 167 (61.6%) had functional limitations. Participants spent an average of 9 hours/day in SB, 4 hours/day in VLPA, 1 hour/day in LPA, 23 minutes/day in MVPA.

Based on the FRS which considers age, sex, cholesterol (HDL-D and total), systolic blood pressure, diabetes and smoking, 35% of participants had higher than 20% 10 year CVD risk; 29% had 10-20% risk; and 36% had less than 10% risk.

Greater sedentary time (p= 0.019) and average length of sedentary bout (p<0.001) were associated with higher 10-year of CVD risk in patients with RA. Greater daily VLPA (p<0.001), LPA (p=0.001), MVPA (p=0.021), and total number of sedentary breaks (p<0.001) were negatively associated with 10-year CVD risk. The association between average length of activity bouts and 10-year CVD risk was not significant (p=0.068).

In the fully adjusted regression model (adjusted for wear time, body mass index, and waist circumference) the association between 10-year CVD risk and SB (R²=0.26, p<0.001), VLPA (R²=0.25, p<0.001), LPA (R²=0.24, p=0.003), sedentary bout length (R²=0.24, p=0.002), and breaks in sedentary time (R²=0.23, p=0.026) remained significant.

While functional limitation was directly associated with higher 10-year CVD risk in the unadjusted model (p=0.006), this relationship was attenuated in the fully adjusted model (p=0.045).

Conclusion:

Given the increased cardiovascular risk in people with RA, high sedentary behaviour and low physical activity is concerning. Interventions aimed at decreasing SB and promoting PA may help to reduce long-term CVD risk.

References:

1. Kitas GD et al. Ann Rheum Dis. 2011;70(1):8-14.

2. Maddison R et al. J Sci Med Sport. 2016;19(8):605-610.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/are-sedentary-behavior-and-reduced-physical-activity-associated-with-long-term-cardiovascular-risk-in-individuals-with-rheumatoid-arthritis/