The Sustained Physical Activity Role in Overcoming Fatigue in Patients with Rheumatoid Arthritis

Abstract

Lack of knowledge about the causes of fatigue often leads to ignoring this symptom in rheumatoid arthritis (RA). The severity of fatiguein patients with RA can be significantly reduced by actively using non-pharmacological treatment strategies.Aim. To evaluate the effectiveness of aerobic exercise (walking) to reduce fatigue in RA patients during long-term follow-up.Material and methods. The study involved 102 patients with RA (women 100%; average age 54.38 ± 11.3 years; disease duration9.5[5;15] years; DAS28-ESR activity 2.85[2.32;3.06] points; fatigue on the VAS scale ≥50), who completed the stage of sanatoriumtreatment in full (21 days) and provided data on aerobic physical activity (steps quantity per day) and fatigue scores on the BritishRheumatoid Arthritis Fatigue Scale – Numerical Rating Scale (BRAF-NRS V2). RA patients were divided into two groups according totheir level of physical activity: group I (n=53) with a sedentary lifestyle (less than 5–6 thousand steps/day) and group II (n=49) witha recommended (mobile) lifestyle (more than 7–8 thousand steps/day). Assessment of RA patients’ adherence to physical activity wascarried out 2 months after return from the sanatorium, and the dynamics of BRAF-NRS fatigue indexes were recorded.Results and discussion. Seventy-six people (74.5%) agreed to participate in the final survey: 32 patients from a group I and 44 patientsfrom a group II. Commitment to daily aerobic activity (more than 5,000 steps per day) was maintained by 34% of participants in thegroup I and 59% in the group II (p=0.033). The majority of respondents (51.3%) decreased the physical activity level and significantlyreduced the time for aerobic exercise after returning from the sanatorium, citing a lack of incentives and time. 47% of the groupI patients (15/32) felt able to devote more attention to physical activity, but only 25% confirmed a strong belief that they would dedicateat least 30 minutes to aerobic exercise 5 times a week over the next three months. In the group II, 48% of patients (p=0.044) reportedmaintaining or even increasing the corresponding physical activity level, confirming the effectiveness of individual physical activityprograms formed during the sanatorium treatment and then integrated into daily life. Two months after returning from the sanatorium,group II patients showed lower fatigue scores on all BRAF-NRS scales: NRS-severity (p=0.04), NRS-effect (p=0.005), and NRS-overcoming(p=0.034). The analysis of variance revealed a decrease in the level of fatigue in the medium term (up to 2 months) regardless of thelevel of physical activity of the patients, but in RA patients committed to an active lifestyle and regular aerobic physical activity (groupII), the positive changes were most pronounced (p<0.001).Conclusion. The positive effect of aerobic exercise (walking) on reducing fatigue is significantly negated even in the med-term, ifpatients do not continue to lead an active lifestyle. After completion of the sanatorium stage of treatment (with selection of optimaldose and frequency of physical activity), RA patients should be further encouraged to do daily aerobic exercises and be supported tocontinue rehabilitation programs in the community in order to achieve a better effect in the long term.

Keywords

• rheumatoid arthritis
• fatigue
• aerobic exercises
• health resort treatment