Background Extensive evidence indicates major benefits of exercise in rheumatoid arthritis1 and many rheumatic diseases,2 not only for cardiovascular and general fitness, but also for better rheumatologic clinical status. Most reported exercise data are derived from structured research studies rather than from usual care. A multidimensional health assessment questionnaire (MDHAQ) designed for usual care includes a query concerning exercise status for the rheumatologist to analyze possible associations with clinical outcomes.
Objectives To compare baseline demographic and clinical data, and changes in status over 1 year, in patients classified into 4 categories: a) exercise at both baseline and 1 year later (YES/YES); b) no exercise at baseline and exercise 1 year later (NO/YES); c) exercise at baseline and not 1 year later (YES/NO); d) no exercise at either time point (NO/NO).
Methods Each patient seen at an academic rheumatology setting completes an MDHAQ at each visit while waiting to see the rheumatologist. The MDHAQ includes scores for physical function, pain, patient global estimate (PATGL), and RAPID3 (Routine Assessment of Patient Index Data), an index of these 3 measures, each scored 0-10; total=0-30. Patients were classified into 4 groups according to exercise 3 times a week at baseline and 1 year: YES/YES, NO/YES, YES/NO, NO/NO. Mean baseline data and percentage change from baseline to 1 year were analyzed and compared by analysis of variance (ANOVA), with multivariate adjustment for age, disease duration, education, sex and baseline physical function (MANOVA).
Results YES/YES patients were younger with a higher level of education than the NO/NO exercise group (data not shown). YES/YES patients had best baseline status, which was progressively worse in the NO/YES, YES/NO, and NO/NO groups. Patients in the NO/YES group had substantially greater improvement in scores 1 year later than those in all other groups, including the YES/YES group, while the YES/NO group was the only patient group with poorer status 1 year later.
Conclusions Exercise 3 times a week is associated with better clinical status. Patients who report no exercise at baseline and performing exercise 1 year later have considerably better status, while patients who reported performing exercise at baseline and not 1 year later have poorer status, although it is not known how frequently changes in outcomes resulted from changes in exercise status. Clinically relevant information concerning exercise status is available on MDHAQ in usual care settings.
Sokka T, Hakkinen A. Clin Exp Rheumatol. 2008; 26(5 Suppl 51):S14-20
Perandini LA, de Sa-Pinto AL, Roschel H, et al. Autoimmunity Rev 2012;12:218-24
Disclosure of Interest None declared