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Rheumatology International

, Volume 38, Issue 5, pp 845–853 | Cite as

Sleep and physical activity: a cross-sectional objective profile of people with rheumatoid arthritis

  • Sean McKenna
  • Marie Tierney
  • Aoife O’Neill
  • Alexander Fraser
  • Norelee Kennedy
Observational Research

Abstract

Regular physical activity (PA) is important for people with rheumatoid arthritis (RA). Poor sleep is a common complaint among people with RA, which may have an influence on their PA levels. There is a lack of objective information regarding total sleep time (TST) and PA duration in this population. A cross-sectional study design was used. SenseWear Pro3 Armband(R)TM is used to measure TST and total PA duration. Four valid days, with 95% wear time necessary for inclusion in final results. Disease activity and function were measured using the DAS-28, HAQ and VAS. Data analysis carried out using SPSS v22. Seventy-five (75) participants completed monitoring period, with 51 (68%) meeting modified PA duration guidelines. Data with 95% wear time over a minimum of 4 days were available for 32 recorded participants, with a mean TST of 5.7 (SD_1.11) hours per night and a median 1.25 (IQR_1.88) hours of daily PA. TST had a positive significant relationship with PA (p = 0.018); PA demonstrated a negative significant relationship with functional limitations (p = 0.009) and correlated with lower CRP levels; CRP levels had in turn a significant relationship to global health (p = 0.034). Total sleep time was low for people with RA. People with RA who are more physically active have longer TST. These findings provide an objective profile of TST and PA duration in people with RA and suggest a relationship between increased PA duration and longer TST. Further research is needed to confirm these novel findings.

Keywords

Inflammatory arthritis Pain Exercise Sleep Physiotherapy Accelerometer 

Notes

Funding

Sean McKenna (SMcK) reports a competitive postgraduate scholarship awarded by the Irish Research Council (IRC) (GOIPG/2016/58).

Compliance with ethical standards

Conflict of interest

SMcK & MT report separate Irish Research Council Grants and all other authors declare no conflicts of interest.

References

  1. 1.
    Firestein GS (2005) Immunologic mechanisms in the pathogenesis of rheumatoid arthritis. JCR J Clin Rheumatol 11:S39–S44CrossRefGoogle Scholar
  2. 2.
    Rongen-van Dartel SAA, Repping-Wuts H, Flendrie M, Bleijenberg G, Metsios GS, van den Hout WB, van den Ende CHM, Neuberger G, Reid A, van Riel P (2015) Effect of aerobic exercise training on fatigue in rheumatoid arthritis: a meta-analysis. Arthritis Care Res 67:1054–1062CrossRefGoogle Scholar
  3. 3.
    Løppenthin K, Esbensen BA, Østergaard M, Jennum P, Tolver A, Aadahl M, Thomsen T, Midtgaard J (2015) Physical activity and the association with fatigue and sleep in Danish patients with rheumatoid arthritis. Rheumatol Int 35:1655–1664CrossRefPubMedGoogle Scholar
  4. 4.
    McKenna SG, Kennedy N (2016) OP0294-HPR sleep quality, sleep disturbances and physical activity: a national survey of irish people who have inflammatory arthritis. Ann Rheum Dis 75:169-Google Scholar
  5. 5.
    Eurenius E, Brodin N, Lindblad S, Opava CH, Group PS (2007) Predicting physical activity and general health perception among patients with rheumatoid arthritis. J Rheumatol 34:10–15PubMedGoogle Scholar
  6. 6.
    Tierney M, Fraser A, Kennedy N (2012) Physical activity in rheumatoid arthritis: a systematic review. J Phys Act Health 9(7):1036–1048CrossRefPubMedGoogle Scholar
  7. 7.
    Flemons WW, Buysse D, Redline S, Oack A, Strohl K, Wheatley J, Young T, Douglas N, Levy P, McNicolas W (1999) Sleep-related breathing disorders in adults. Sleep 22:667–689CrossRefGoogle Scholar
  8. 8.
    Lucassen PJ, Meerlo P, Naylor AS, Van Dam AM, Dayer AG, Fuchs E, Oomen CA, Czeh B (2010) Regulation of adult neurogenesis by stress, sleep disruption, exercise and inflammation: implications for depression and antidepressant action. Eur Neuropsychopharmacol 20:1–17CrossRefPubMedGoogle Scholar
  9. 9.
    Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, Van den Ende EC (2009) Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev 9:CD006853Google Scholar
  10. 10.
    Knittle KP, De Gucht V, Hurkmans EJ, Vlieland TPM, Peeters AJ, Ronday HK, Maes S (2011) Effect of self-efficacy and physical activity goal achievement on arthritis pain and quality of life in patients with rheumatoid arthritis. Arthritis Care Res 63:1613–1619CrossRefGoogle Scholar
  11. 11.
    Nicassio PM, Ormseth SR, Kay M, Custodio M, Irwin MR, Olmstead R, Weisman MH (2012) The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritis. Pain 153:107–112CrossRefPubMedGoogle Scholar
  12. 12.
    Cramp F, Hewlett S, Almeida C, Kirwan JR, Choy EH, Chalder T et al (2013) Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev 8:CD008322Google Scholar
  13. 13.
    Yang P-Y, Ho K-H, Chen H-C, Chien M-Y (2012) Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. J Physiother 58:157–163CrossRefPubMedGoogle Scholar
  14. 14.
    Courneya KS, Segal RJ, Mackey JR, Gelmon K, Friedenreich CM, Yasui Y, Reid RD, Jespersen D, Cook D, Proulx C (2014) Effects of exercise dose and type on sleep quality in breast cancer patients receiving chemotherapy: a multicenter randomized trial. Breast Cancer Res Treat 144:361–369CrossRefPubMedGoogle Scholar
  15. 15.
    Bansil P, Kuklina EV, Merritt RK, Yoon PW (2011) Associations between sleep disorders, sleep duration, quality of sleep, and hypertension: results from the National Health and Nutrition Examination Survey, 2005 to 2008. J Clin Hypertens 13:739–743CrossRefGoogle Scholar
  16. 16.
    Ogdie A, Yu Y, Haynes K, Love TJ, Maliha S, Jiang Y, Troxel AB, Hennessy S, Kimmel SE, Margolis DJ (2015) Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis 74:326–332CrossRefPubMedGoogle Scholar
  17. 17.
    Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak C (2003) The role of actigraphy in the study of sleep and circadian rhythms. Am Acad Sleep Med Rev Pap Sleep 26:342–392Google Scholar
  18. 18.
    Sunseri M, Liden CB, Farringdon J, Pelletier R, Safier S, Stivoric J, Teller A, SureshVishnubhatla M (2009) The SenseWear? Armband as a sleep detection device. BodyMedia internal white paper Healthy MDD Sleep duration min Sleep Quality Score, pp 1–9Google Scholar
  19. 19.
    Alsaadi SM, McAuley JH, Hush JM, Bartlett DJ, McKeough ZM et al (2014) Assessing sleep disturbance in low back pain: the validity of portable instruments. PLoS ONE 9(4):e95824.  https://doi.org/10.1371/journal.pone.0095824 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Berntsen S, Hageberg R, Aandstad A, Mowinckel P, Anderssen SA, Carlsen KH, Andersen LB (2010) Validity of physical activity monitors in adults participating in free living activities. Br J Sports Med 44(9):657–664CrossRefPubMedGoogle Scholar
  21. 21.
    Van Remoortel H, Giavedoni S, Raste Y, Burtin C, Louvaris Z, Gimeno-Santos E, Langer D, Glendenning A, Hopkinson NS, Vogiatzis I (2012) Validity of activity monitors in health and chronic disease: a systematic review. Int J Behav Nutr Phys Act 9:84CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Tierney M, Fraser A, Purtill H, Kennedy N (2013) Study to determine the criterion validity of the SenseWear Armband as a measure of physical activity in people with rheumatoid arthritis. Arthritis Care Res 65:888–895CrossRefGoogle Scholar
  23. 23.
    Mackey DC, Manini TM, Schoeller DA, Koster A, Glynn NW, Goodpaster BH, Satterfield S, Newman AB, Harris TB, Cummings SR (2011) Validation of an armband to measure daily energy expenditure in older adults. J Gerontol Ser A Biomed Sci Med Sci 66:1108–1113CrossRefGoogle Scholar
  24. 24.
    Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Strobe I (2014) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 12:1495–1499CrossRefGoogle Scholar
  25. 25.
    Fries JF, Ramey DR (1997) "Arthritis specific” global health analog scales assess” generic” health related quality-of-life in patients with rheumatoid arthritis. J Rheumatol 24:1697–1702PubMedGoogle Scholar
  26. 26.
    Wolfe F, Kleinheksel SM, Cathey MA, Hawley DJ, Spitz PW, Fries JF (1988) The clinical value of the Stanford Health Assessment Questionnaire Functional Disability Index in patients with rheumatoid arthritis. J Rheumatol 15:1480–1488PubMedGoogle Scholar
  27. 27.
    Liden CB, Wolowicz M, Stivoric J, Teller A, Kasabach C, Vishnubhatla S, Pelletier R, Farringdon J, Boehmke S (2002) Characterization and implications of the sensors incorporated into the SenseWear armband for energy expenditure and activity detection. Bodymedia Inc. White Papers: 1, 7Google Scholar
  28. 28.
    Corder K, Ekelund U, Steele RM, Wareham NJ, Brage S (2008) Assessment of physical activity in youth. J Appl Physiol 105:977–987CrossRefPubMedGoogle Scholar
  29. 29.
    Almeida GJM, Wasko MCM, Jeong K, Moore CG, Piva SR (2011) Physical activity measured by the SenseWear Armband in women with rheumatoid arthritis. Phys Ther 91:1367–1376CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Ott RL, Longnecker MT (2015) An introduction to statistical methods and data analysis. Nelson Education, TorontoGoogle Scholar
  31. 31.
    Tabachnick BG, Fidell LS (2007) Using multivariate statistics. Allyn & Bacon/Pearson Education, BostonGoogle Scholar
  32. 32.
    McKenna S, Donnelly A, Fraser A, Kennedy N (2017) Sleep and physical activity: a survey of people with inflammatory arthritis and their engagement by health professionals in rheumatology in Ireland. Disabil Rehabil. 2017:1–7CrossRefGoogle Scholar
  33. 33.
    Katz P, Margaretten M, Trupin L, Schmajuk G, Yazdany J, Yelin E (2016) Role of sleep disturbance, depression, obesity, and physical inactivity in fatigue in rheumatoid arthritis. Arthritis Care Res 68:81–90CrossRefGoogle Scholar
  34. 34.
    Løppenthin K, Esbensen BA, Jennum P, Østergaard M, Tolver A, Thomsen T, Midtgaard J (2015) Sleep quality and correlates of poor sleep in patients with rheumatoid arthritis. Clin Rheumatol 34:2029–2039CrossRefPubMedGoogle Scholar
  35. 35.
    Fenton SAM, van Zanten JJCSV., Kitas GD, Duda JL, Rouse PC, Yu C-a, Metsios GS (2017) Sedentary behaviour is associated with increased long-term cardiovascular risk in patients with rheumatoid arthritis independently of moderate-to-vigorous physical activity. BMC Musculoskelet Disord 18:131CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Vitiello MV, Larsen LH, Moe KE (2004) Age-related sleep change: gender and estrogen effects on the subjective–objective sleep quality relationships of healthy, noncomplaining older men and women. J Psychosom Res 56:503–510CrossRefPubMedGoogle Scholar
  37. 37.
    Campbell SS, Gillin JC, Kripke DF, Erikson P, Clopton P (1989) Gender differences in the circadian temperature rhythms of healthy elderly subjects: relationships to sleep quality. Sleep 12:529–536PubMedGoogle Scholar
  38. 38.
    Zhang B, Wing Y-K (2006) Sex differences in insomnia: a meta-analysis. Sleep 29:85–93CrossRefPubMedGoogle Scholar
  39. 39.
    Brosseau L, Wells GA, Tugwell P, Egan M, Dubouloz C-J, Casimiro L, Robinson VA, Pelland L, McGowan J, Bell M (2004) Ottawa Panel evidence-based clinical practice guidelines for therapeutic exercises in the management of rheumatoid arthritis in adults. Phys Ther 84:934–972Google Scholar
  40. 40.
    McKenna S, Kelly G, Kennedy N (2014) FRI0585-HPR A survey of Irish physiotherapists’ current practice in promoting physical activity in rheumatoid arthritis. Ann Rheum Dis 73:1206–1207Google Scholar
  41. 41.
    McKenna SG, Brodin N, Nordgren B, Esbensen BA, Swinnen T, Hammer NM, Willemijns S, Kennedy N (2016) THU0650-HPR physical activity and aerobic capacity assessment-a survey among health professionals in Sweden, Ireland and Denmark. Ann Rheum Dis 75:1274Google Scholar
  42. 42.
    Larkin L, Kennedy N, Gallagher S (2015) Promoting physical activity in rheumatoid arthritis: a narrative review of behaviour change theories. Disabil Rehabil 37:2359–2366CrossRefPubMedGoogle Scholar
  43. 43.
    Sokka T, Häkkinen A, Kautiainen H, Maillefert JF, Toloza S, Calvo-Alen J, Oding R, Liveborn M, Huisman M, Alten R (2008) Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Care Res 59:42–50CrossRefGoogle Scholar
  44. 44.
    Thomsen T, Beyer N, Aadahl M, Hetland ML, Løppenthin K, Midtgaard J, Esbensen BA (2015) Sedentary behaviour in patients with rheumatoid arthritis: a qualitative study. Int J Qual Stud Health Well Being 10(1):28578CrossRefPubMedGoogle Scholar
  45. 45.
    McKenna S, Donnelly A, Fraser A, Comber L, Kennedy N (2017) Does exercise impact on sleep for people who have rheumatoid arthritis? A systematic review. Rheumatol Int 2017:1–12Google Scholar
  46. 46.
    McBeth J, Prescott G, Scotland G, Lovell K, Keeley P, Hannaford P, McNamee P, Symmons DPM, Woby S, Gkazinou C (2012) Cognitive behavior therapy, exercise, or both for treating chronic widespread pain. Arch Intern Med 172:48–57CrossRefPubMedGoogle Scholar
  47. 47.
    Beasley M, Prescott GJ, Scotland G, McBeth J, Lovell K, Keeley P, Hannaford PC, Symmons DPM, MacDonald RIR, Woby S (2015) Patient-reported improvements in health are maintained 2 years after completing a short course of cognitive behaviour therapy, exercise or both treatments for chronic widespread pain: long-term results from the MUSICIAN randomised controlled trial. RMD Open 1:e000026CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Youngstedt SD (2005) Effects of exercise on sleep. Clin Sports Med 24:355–365CrossRefPubMedGoogle Scholar
  49. 49.
    Hekler EB, Buman MP, Haskell WL, Conway TL, Cain KL, Sallis JF, Saelens BE, Frank LD, Kerr J, King AC (2012) Reliability and validity of CHAMPS self-reported sedentary-to-vigorous intensity physical activity in older adults. J Phys Act Health 9:225–236CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Allied Health, Discipline of PhysiotherapyUniversity of LimerickLimerickIreland
  2. 2.Discipline of General PracticeNational University of GalwayGalwayIreland
  3. 3.Department of Mathematics and StatisticsUniversity of LimerickLimerickIreland
  4. 4.Department of RheumatologyUniversity Hospitals LimerickLimerickIreland
  5. 5.Health Research Institute (HRI), UL Hospitals Clinical Research Unit (CRU)University of LimerickLimerickIreland

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