Iversen Maura D, Frits Michelle, von Heideken Johan, Cui Jing, Weinblatt Michael, Shadick Nancy A
Northeastern University, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, and Karolinska Institutet, Stockholm, Sweden.
Brigham and Women's Hospital, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2017 Oct;69(10):1535-1545. doi: 10.1002/acr.23156. Epub 2017 Aug 25.
To characterize physical activity participation (moderate-to-vigorous physical activity [MVPA], ≥150 minutes of moderate physical activity or 75 minutes of vigorous physical activity per week), to examine associations between disease activity and MVPA, and to identify MVPA correlates in adults with rheumatoid arthritis (RA) over 3 years.
This study included 573 RA patients (94% white, 83% female, mean age 61 years, mean RA duration 19.5 years) with ≥1 annual registry visit and who completed the physical activity questionnaire. Baseline and annual measures included demographics/medical history, self-efficacy for disease management, quality of life, patient/physician global assessment, physical function, and self-reported physical activity. A logistic repeated-measures model using the generalized estimating equation examined the relationship between disease activity and MVPA.
Average disease activity (from the 3-variable Disease Activity Score in 28 joints using the C-reactive protein level) was mean ± SD 3.1 ± 1.4, 36% were physically inactive, and 29% met MVPA recommendations. There was a negative borderline association with disease activity (odds ratio [OR] 0.89 [95% confidence interval (95% CI) 0.79-1.00]). Correlates of meeting MVPA recommendations, adjusting for disease activity, were being white (OR 2.95 [95% CI 1.29-6.75]), older age (ages >69 years OR 0.58 [95% CI 0.36-0.92]), poor mental health (OR 0.63 [95% CI 0.41-0.95]), poor physical function (OR 0.59 [95% CI 0.34-1.01]), overweight/obese (body mass index [BMI] >25-30 OR 0.69 [95% CI 0.50-0.95], BMI >30-39.9 OR 0.60 [95% CI 0.41-0.88], and BMI ≤40 OR 0.24 [95% CI 0.08-0.74]), and patient global assessment (≥10-20 OR 0.57 [95% CI 0.39-0.83]).
A small proportion of patients met MVPA recommendations despite well-controlled disease. Disease activity was negatively associated with physical activity over time. Physical activity correlates were linked to lifestyle, mental health, and patient perceptions of disease, suggesting physical activity interventions that address patient perspectives may facilitate RA management.
描述体力活动参与情况（中度至剧烈体力活动[MVPA]，每周至少150分钟的中度体力活动或75分钟的剧烈体力活动），研究疾病活动与MVPA之间的关联，并确定3年期间类风湿关节炎（RA）成年患者的MVPA相关因素。
本研究纳入了573例RA患者（94%为白人，83%为女性，平均年龄61岁，平均RA病程19.5年），这些患者每年至少进行一次登记访视并完成了体力活动问卷。基线和年度测量指标包括人口统计学/病史、疾病管理自我效能、生活质量、患者/医生整体评估、身体功能以及自我报告的体力活动。使用广义估计方程的逻辑重复测量模型研究了疾病活动与MVPA之间的关系。
平均疾病活动度（采用28个关节的3变量疾病活动评分，结合C反应蛋白水平）为均值±标准差3.1±1.4，36%的患者体力活动不足，29%的患者达到MVPA建议水平。疾病活动度与之存在负向临界关联（比值比[OR]为0.89[95%置信区间（CI）0.79 - 1.00]）。在调整疾病活动度后，达到MVPA建议水平的相关因素包括白人（OR 2.95[95% CI 1.29 - 6.75]）、年龄较大（年龄>69岁OR 0.58[95% CI 0.36 - 0.92]）、心理健康状况差（OR 0.63[95% CI 0.41 - 0.95]）、身体功能差（OR 0.59[95% CI 0.34 - 1.01]）、超重/肥胖（体重指数[BMI]>25 - 30 OR 0.69[95% CI 0.50 - 0.95]，BMI>30 - 39.9 OR 0.60[95% CI 0.41 - 0.88]，BMI≤40 OR 0.24[95% CI 0.08 - 0.74]）以及患者整体评估（≥等级10 - 20 OR 0.57[95% CI 0.39 - 0.83]）。
尽管疾病得到良好控制，但只有一小部分患者达到MVPA建议水平。随着时间推移，疾病活动度与体力活动呈负相关。体力活动相关因素与生活方式、心理健康以及患者对疾病的认知有关，这表明从患者角度出发的体力活动干预可能有助于RA的管理。
