Background/Purpose: Extensive evidence indicates major benefits of exercise in rheumatoid arthritis¹ and many other rheumatic diseases,² not only for cardiovascular and general fitness, but also for better rheumatologic clinical status. Most reported exercise data are derived from structured research studies rather than from usual care. A multidimensional health assessment questionnaire (MDHAQ) designed for usual care includes a query concerning exercise status for the rheumatologist to analyze possible associations with clinical outcomes. The objective of this study was to compare baseline demographic and clinical data and changes in status over 1 year, in patients classified into 4 categories according to the level of exercise.

Methods: Each patient seen at an academic rheumatology setting completes an MDHAQ at each visit while waiting to see the rheumatologist. The MDHAQ includes scores for physical function, pain, patient global estimate (PATGL), and RAPID3 (Routine Assessment of Patient Index Data), an index of these 3 measures, each scored 0-10; total=0-30. Patients were classified into 4 groups according to exercise 3 times a week at baseline and 1 year: EX at baseline & 1 year later, no EX at baseline but EX 1 yr later, EX at baseline but no 1 yr later and no EX at baseline or 1yr later. Mean baseline data and percentage change from baseline to 1 year were analyzed and compared by analysis of variance (ANOVA), with multivariate adjustment for age, disease duration, education, sex and baseline physical function (MANOVA).

Results: 795 patients, including 221 with RA, were classified into 4 exercise groups: EX at baseline & 1 year later, no EX at baseline but EX 1 yr later, EX at baseline but no 1 yr later and no EX at baseline or 1yr later. Patients doing exercise at baseline were younger with a higher level of education than the NO exercise group (data not shown). Patients reporting no exercise at baseline and exercise 1 year later had greater improvement in scores than those in all other groups. Patients reporting exercise at baseline but not 1 yr later were the only group with poorer status. A potential limitation for our study is that it was unknown if change in exercise status preceded or resulted from change in clinical status. 

	EX at baseline & 1 year later N=268 (33.7%)		No EX at baseline but EX at 1 year N=126 (15.8%)		EX at baseline No EX at 1 year N=77 (9.7%)		No EX at baseline or 1 year later N=324 (40.7%)
	Baseline Mean (SD)	Mean change (%)	Baseline Mean (SD)	Mean change (%)	Baseline Mean (SD)	Mean change (%)	Baseline Mean (SD)	Mean change (%)
MDHAQ-FN (0-10)	1.5 (1.8)	-0.2 (-13.3)	2.3 (2.1)	-0.8 (-34.7)	2.0 (1.9)	0.3 (15.0)	2.7 (2.1)	-0.01 (-0.4)
MDHAQ-PN (0-10)	3.9 (2.9)	-0.5 (-12.8)	5.0 (3.1)	-1.7 (-34.0)	4.4 (2.9)	-0.2 (-4.5)	5.6 (3.0)	-0.8 (-14.3)
PATGL (0-10)	3.6 (2.7)	-0.4 (-11.1)	4.5 (2.8)	-1.8 (-40.0)	4.2 (2.8)	0.2 (4.8)	5.4 (2.7)	-0.8 (-14.8)
RAPID3 (0-30)	9.0 (6.5)	-1.2 (-13.3)	11.8 (7.3)	-4.4 (-37.3)	10.5 (6.3)	0.3 (2.8)	13.7 (6.9)	-1.7 (-12.4)
RADAI (0-48)	7 (9)	-2.1 (-28.0)	10 (10)	-3.9 (-37.9)	10 (8)	0.1 (1.2)	12 (11)	-0.3 (-2.4)
P<0.0001 for all comparisons. Negative change indicates improvement & positive change worsening

Conclusion: Exercise 3 times a week is associated with better clinical status. The best status was seen for patients who report no EX at baseline but performing EX 1yr later while poorest status was seen in patients reporting exercise at baseline but no 1 yr later. Regular exercise may be of therapeutic relevance in the management of rheumatic diseases by reducing pain and improving physical function. This clinically relevant information concerning exercise is available on MDHAQ for routine care settings.

References: 1. Sokka T, Hakkinen A. Clin Exp Rheumatol. 2008; 26(5 Suppl 51):S14-20. 2. Perandini LA, de Sa-Pinto AL, Roschel H, et al. Autoimmunity Rev 2012;12:218-24

---

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-exercise-status-in-routine-care-using-patient-reported-outcomes-initiating-exercise-is-associated-with-better-outcomes-than-no-exercise/