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Evaluation of factors affecting the levels of physical activity in patients with rheumatoid arthritis: a cross-sectional study

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Abstract

Relatively little is known about what motivates or prevents patients with rheumatoid arthritis (RA) from adopting physically active lifestyles. This study aimed to evaluate the levels of physical activity and to identify the factors affecting a physically active lifestyle among Korean patients with RA. In this cross-sectional study, data were collected from a rheumatology outpatient clinic of a university-affiliated hospital in South Korea. The levels of physical activity were self-reported using the International Physical Activity Questionnaire. Participants who engaged in more than 600 metabolic equivalent task-minutes/week of physical activity and moderate activity or walking at least three times per week were considered physically active in this study. Structured questionnaires were used to assess perceived barriers and self-efficacy for exercise. Of 345 patients with RA included in this study, about 22% of patients were classified as physically active. Factors associated with a physically active lifestyle were good physical function (odds ratio [OR] = 0.56; 95% confidence interval [CI]: 0.36–0.87) and high levels of exercise self-efficacy (OR = 1.36; 95% CI: 1.20–1.54). Common barriers identified were fatigue, interference with other responsibilities, and a lack of time. Participants showed the lowest self-efficacy for exercise when they had pain and were busy with other activities. The level of physical function and exercise self-efficacy were predictors of physical activity. Individualized physical activity programs tailored to personal abilities and barriers and increasing exercise self-efficacy are needed to facilitate engagement of physical activity in Korean patients with RA.

Key Points

• Factors associated with a physically active lifestyle were good physical function and high levels of exercise self-efficacy.

• The levels of exercise self-efficacy in Korean patients with RA are low compared to those in other populations.

• Frequently encountered barriers in the subjects were being too tired, interference with other responsibilities, and lack of time.

• Individualized physical activity programs tailored to personal abilities and barriers and increasing exercise self-efficacy are needed to facilitate engagement of physical activity in Korean patients with RA.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Gabriel SE, Crowson CS, Kremers HM et al (2003) Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years. Arthritis Rheum 48:54–58

    Article  PubMed  Google Scholar 

  2. Solomon DH, Karlson EW, Rimm EB et al (2003) Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation 107:1303–1307

    Article  PubMed  Google Scholar 

  3. van Halm VP, Peters MJ, Voskuyl AE et al (2009) Rheumatoid arthritis versus diabetes as a risk factor for cardiovascular disease: a cross-sectional study, the CARRE investigation. Ann Rheum Dis 68:1395–1400

    Article  PubMed  Google Scholar 

  4. Peters MJ, van Halm VP, Voskuyl AE et al (2009) Does rheumatoid arthritis equal diabetes mellitus as an independent risk factor for cardiovascular disease? A prospective study. Arthritis Rheum 61:1571–1579

    Article  PubMed  Google Scholar 

  5. Peters MJ, Symmons DP, McCarey D et al (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69:325–331

    Article  CAS  PubMed  Google Scholar 

  6. Knittle KP, De Gucht V, Hurkmans EJ et al (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. 63:1613–1619

    Article  Google Scholar 

  7. de Jong Z, Munneke M, Zwinderman AH et al (2004) Long term high intensity exercise and damage of small joints in rheumatoid arthritis. Ann Rheum Dis 63:1399–1405

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lee EO, Kim JI, Davis AH, Kim I (2006) Effects of regular exercise on pain, fatigue, and disability in patients with rheumatoid arthritis. Fam Community Health 29:320–327

    Article  PubMed  Google Scholar 

  9. Stavropoulos-Kalinoglou A, Metsios GS, van Zanten JJV, Nightingale P, Kitas GD, Koutedakis Y (2013) Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis. Ann Rheum Dis 72:1819–1825

    Article  CAS  PubMed  Google Scholar 

  10. Metsios GS, Stavropoulos-Kalinoglou A, van Zanten JJV et al (2014) Individualised exercise improves endothelial function in patients with rheumatoid arthritis. Ann Rheum Dis 73:748–751

    Article  PubMed  Google Scholar 

  11. Cornelissen VA, Fagard RH, Coeckelberghs E, Vanhees L (2011) Impact of resistance training on blood pressure and other cardiovascular risk factors: a meta-analysis of randomized, controlled trials. Hypertension 58:950–958

    Article  CAS  PubMed  Google Scholar 

  12. Tierney M, Fraser A, Kennedy N (2012) Physical activity in rheumatoid arthritis: a systematic review. J Phys Act Health 9:1036–1048

    Article  PubMed  Google Scholar 

  13. Trost SG, Owen N, Bauman AE, Sallis JF, Brown W (2002) Correlates of adults’ participation in physical activity: review and update. Med Sci Sports Exerc 34:1996–2001

    Article  PubMed  Google Scholar 

  14. Im EO, Chang SJ, Ko Y, Chee W, Stuifbergen A, Walker L (2012) A national internet survey on midlife women’s attitudes toward physical activity. Nurs Res 61:342–352

    Article  PubMed  Google Scholar 

  15. Iversen MD, Frits M, von Heideken J, Cui J, Weinblatt M, Shadick NA (2017) Physical activity and correlates of physical activity participation over three years in adults with rheumatoid arthritis. Arthritis Care Res. 69:1535–1545

    Article  CAS  Google Scholar 

  16. Veldhuijzen van Zanten JJ, Rouse PC, Hale ED et al (2015) Perceived barriers, facilitators and benefits for regular physical activity and exercise in patients with rheumatoid arthritis: a review of the literature. Sports Med 45:1401–1412

    Article  PubMed  PubMed Central  Google Scholar 

  17. Demmelmaier I, Bergman P, Nordgren B, Jensen I, Opava CH (2013) Current and maintained health-enhancing physical activity in rheumatoid arthritis: a cross-sectional study. Arthritis Care Res. 65:1166–1176

    Article  Google Scholar 

  18. Huffman KM, Pieper C, Hall K, St Clair E, Kraus WE (2015) Self-efficacy for exercise, more than disease-related factors, is associated with objectively assessed exercise time and sedentary behaviour in rheumatoid arthritis. Scand J Rheumatol 44:106–110

    Article  CAS  PubMed  Google Scholar 

  19. Lip GY, Luscombe C, McCarry M, Malik I, Beevers G (1996) Ethnic differences in public health awareness, health perceptions and physical exercise: implications for heart disease prevention. Ethn Health 1:47–53

    Article  CAS  PubMed  Google Scholar 

  20. Craig CL, Marshall AL, Sjöström M et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381–1395

    Article  PubMed  Google Scholar 

  21. Myers J (2003) Exercise and cardiovascular health. Circulation 107:e2–e5

    Article  PubMed  Google Scholar 

  22. Office of Disease Prevention and Health Promotion (2018) Physical activity guidelines for Americans. http://www.health.gov/paguidelines/guidelines/default.aspx . Accessed 21 Nobember 2018

    Google Scholar 

  23. Nelson ME, Rejeski WJ, Blair SN et al (2007) Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 116:1094

    Article  PubMed  Google Scholar 

  24. Oh JY, Yang YJ, Kim BS, Kang JH (2007) Validity and reliability of Korean version of international physical activity questionnaire (IPAQ) short form. J Korean Acad Fam Med 28:532–541

    Google Scholar 

  25. Resnick B, Palmer MH, Jenkins LS, Spellbring AM (2000) Path analysis of efficacy expectations and exercise behaviour in older adults. J Adv Nurs 31:1309–1315

    Article  CAS  PubMed  Google Scholar 

  26. Stuifbergen AK, Becker HA (1994) Predictors of health-promoting lifestyles in persons with disabilities. Res Nurs Health 17:3–13

    Article  CAS  PubMed  Google Scholar 

  27. Shin SC, Kim MK, Yun KS et al (1991) The center for epidemiologic studies-depression scale: its use in Korea. J Korean Neuropsychiatr Assoc 30:752–767

    Google Scholar 

  28. Pincus T, Swearingen C, Wolfe F (1999) Toward a multidimensional health assessment questionnaire (MDHAQ): assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. Arthritis Rheum 42:2220–2230

    Article  CAS  PubMed  Google Scholar 

  29. Lee SS, Park MJ, Yoon HJ, Park YW, Park IH, Park KS (2006) Evaluating the Korean version of the multidimensional health assessment questionnaire in patients with rheumatoid arthritis. Clin Rheumatol 25:353–357

    Article  PubMed  Google Scholar 

  30. Sung YK, Cho SK, Choi CB, Bae SC (2013) Prevalence and incidence of rheumatoid arthritis in South Korea. Rheumatol Int 33:1525–1532

    Article  PubMed  Google Scholar 

  31. National Health Insurance Service (2018) Health reports. https://www.nhis.or.kr/bbs7/boards/B0039/16193 . Accessed 12 October 2018

    Google Scholar 

  32. Sokka T, Häkkinen A, Kautiainen H et al (2008) Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Rheum 59:42–50

    Article  PubMed  Google Scholar 

  33. Gyurcsik NC, Brawley LR, Spink KS, Brittain DR, Fuller DL, Chad K (2009) Physical activity in women with arthritis: examining perceived barriers and self-regulatory efficacy to cope. Arthritis Rheum 61:1087–1094

    Article  PubMed  Google Scholar 

  34. Der Ananian C, Wilcox S, Saunders R, Watkins K, Evans A (2006) Factors that influence exercise among adults with arthritis in three activity levels. Prev Chronic Dis 3:A81

    Google Scholar 

  35. Callahan LF, Mielenz T, Freburger J et al (2008) A randomized controlled trial of the people with arthritis can exercise program: symptoms, function, physical activity, and psychosocial outcomes. Arthritis Rheum 59:92–101

    Article  PubMed  Google Scholar 

  36. Lemmey AB, Marcora SM, Chester K, Wilson S, Casanova F, Maddison PJ (2009) Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. Arthritis Rheum 61:1726–1734

    Article  PubMed  Google Scholar 

  37. Lee HY, Hale CA (2011) Effects of tai chi exercise and auricular acupressure in patients with rheumatoid arthritis. J Muscle Joint Health 18:103–112

    Article  Google Scholar 

  38. Nessen T, Demmelmaier I, Nordgren B, Opava CH (2015) The Swedish exercise self-efficacy scale (ESES-S): reliability and validity in a rheumatoid arthritis population. Disabil Rehabil 37:2130–2134

    Article  PubMed  PubMed Central  Google Scholar 

  39. Boo S, Oh H, Froelicher ES, Suh CH (2017) Knowledge and perception of cardiovascular disease risk among patients with rheumatoid arthritis. PLoS One 12:e0176291

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Wilmot EG, Edwardson CL, Achana FA et al (2012) Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia 55:2895–2905

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We express our sincere gratitude to all participants. We also thank Yanghee Koo, Hyojung Kim, Hyunjeong Byeon, and Jieun Choi for their assistance and support with data collection.

Funding

This work was supported by a grant from the National Research Foundation of Korea (NRF) funded by the Korea government (Ministry of Science and ICT & Future Planning) (no. 2017R1C1B1010892).

Author information

Authors and Affiliations

  1. Department of Rheumatology, Ajou University School of Medicine, Suwon, South Korea

    Chang-Hee Suh & Ju-Yang Jung

  2. College of Nursing, Gachon University, Seongnam, South Korea

    Hyunjin Oh

  3. Research Institute of Nursing Science, Ajou University College of Nursing, 206 Worldcup-ro, Yeongtong-gu, Suwon, 16499, South Korea

    Sunjoo Boo

Authors
  1. Chang-Hee Suh
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  2. Ju-Yang Jung
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  3. Hyunjin Oh
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  4. Sunjoo Boo
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Contributions

Conceptualization: CHS, JYJ, SB.

Data curation: CHS, JYJ, SB.

Formal analysis: SB.

Funding acquisition: SB.

Investigation: CHS, SB.

Project administration: SB.

Resources: CHS, SB.

Supervision: CHS, SB.

Writing of the original draft: CHS, HO, SB.

Writing and/or reviewing and editing: CHS, JYJ, HO, SB.

Corresponding author

Correspondence to Sunjoo Boo.

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Conflict of interest

The authors have no conflicts of interest to disclose, have full control of all primary data, and agree to allow the journal to review their data, if requested.

Ethical standards

The study protocol and consent form were reviewed and approved by the ethics committee of Ajou University Medical Center in compliance with the Declaration of Helsinki (AJIRB-SBR-SUR-17-122). All study participants provided written informed consent prior to their inclusion in the study.

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Suh, CH., Jung, JY., Oh, H. et al. Evaluation of factors affecting the levels of physical activity in patients with rheumatoid arthritis: a cross-sectional study. Clin Rheumatol 38, 2483–2491 (2019). https://doi.org/10.1007/s10067-019-04559-5

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  • DOI: https://doi.org/10.1007/s10067-019-04559-5

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