RESUMEN

The importance of sufficient moderate-to-vigorous physical activity as a key component of a healthy lifestyle is well established, as are the health risks associated with high levels of sedentary behaviour. However, many people with RA do not undertake sufficient physical activity and are highly sedentary. To start addressing this, it is important to be able to carry out an adequate assessment of the physical activity levels of individual people in order that adequate steps can be taken to promote and improve healthy lifestyles. Different methods are available to measure different aspects of physical activity in different settings. In controlled laboratory environments, respiratory gas analysis can measure the energy expenditure of different activities accurately. In free-living environments, the doubly labelled water method is the gold standard for identifying total energy expenditure over a prolonged period of time (>10 days). To assess patterns of physical activity and sedentary behaviour in daily life, objective methods with body-worn activity monitors using accelerometry are superior to self-reported questionnaire- or diary-based methods.

RESUMEN

BACKGROUND: Physical activity has been shown to be of great benefit to people with an inflammatory joint disease (IJD), however people with an IJD have been shown to be very inactive compared to the general population. The aims of this study were to explore 1) whether the transition from a National Health Service (NHS)-run exercise programme into exercising in the community could be achieved successfully; and 2) the barriers and facilitators during the transition period. METHODS: This study adopted a complementary mixed-methods study design including a qualitative approach using focus groups and a prospective cohort study. Descriptive statistics were used to summarise the cohort study data. All variables were assessed for normality of distribution using the Sharpiro-Wilk test. Paired t-tests or Wilcoxon tests were undertaken for two consecutive assessment timepoints; one-way repeated measures ANOVAs or Friedman's tests for three consecutive assessment timepoints. Micro-interlocutor analysis was used to analyse the focus group data. Areas of congruence and incongruence were explored by confirming the statistical results against the qualitative results. The adapted ecological model of the determinants of physical activity was then used as a framework to describe the findings. RESULTS: A successful transition was defined as still exercising in the community 6-months post discharge from the NHS-run Inflammatory Arthritis Exercise Programme. This was self-reported to be 90% of the cohort. An individual barrier to physical activity in people with an IJD was found to be the unpredictable nature of their condition. Other barriers and facilitators found were similar to those found in the general population such as recreation facilities, locations, transportation and cost. Other facilitators were similar to those found in people living with other chronic long-term conditions such as the importance of peer support. CONCLUSIONS: 90% of the cohort data were defined as a successful transition. People with an IJD have similar barriers and facilitators to exercise as the general population and those living with other chronic long-term conditions. A barrier which appears to be unique to this population group is that of the unpredictable nature of their condition which needs to be considered whenever tailoring any intervention.

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RESUMEN

OBJECTIVE: To determine whether patients with inflammatory joint disease (IJD) meet current guidelines on physical activity, and to determine which factors influence physical activity levels and sedentary behavior (SB) in patients with IJD. METHODS: This was a cross-sectional study of 137 patients with a medical diagnosis of an IJD prior to commencing an NHS-run inflammatory arthritis exercise program. Physical activity and SB were measured objectively using a thigh-worn physical activity monitor for 7 consecutive days. Activity levels were subdivided into low physical activity (LPA) and moderate-to-vigorous physical activity (MVPA). First, activity levels were analyzed against current guidelines of 150 minutes of MVPA per week. Second, time spent in SB, LPA, and MVPA was analyzed against possible determinants. RESULTS: In total, 29% of patients with IJD met current physical activity guidelines. Patients on average spent 10 hours per day in SB. Poor physical fitness measured by the 6-minute walk test was the only significant predictor (P = 0.019) of high SB (R2  = 4.7%). Attending an exercise facility in the community (P = 0.034) and low role limitations due to physical health (P = 0.008) predicted high levels of LPA, following a backward multiple regression (R2  = 8.0%). Low role limitations due to emotional problems (P = 0.031), higher physical fitness (P = 0.002), and healthier exercise attitudes and beliefs (P = 0.021) predicted meeting current physical activity guidelines, following a backward conditional logistic regression, explaining between 22.2% and 31.7% of variance. CONCLUSION: Patients with IJD are inactive and spent much time in SB. Good general health predicts high activity levels. No disease-specific factors were found to determine SB, LPA, or MVPA.

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