With our 5×50 worldwide exercise flash-mob challenge about to start on Friday 23rd November (see earlier post) we thought we would have a look at evidence related to physical activity and exercise for people with musculoskeletal conditions.

The majority of research on people with RA has focused on the effect of exercise training with benefits reported in functional ability and disease outcomes. However it is assumed that physical activity levels in people with rheumatoid arthritis (RA) may be reduced as a result of symptoms of the disease. It is also known that people with RA are at an increased risk of cardiovascular events and thus maintaining an active lifestyle is especially necessary in this population.

We came across this recently published systematic review of Physical Activity in Rheumatoid Arthritis (RA) by a group of authors from Ireland. The objective was to establish the current evidence base for levels of physical activity in the RA population.

Here’s what they did

They searched electronic databases up until December 2011 for adult populations with RA and of the 136 studies, 120 were excluded. Only 16 studies met the inclusion criteria of measuring and reporting on free living physical activity levels or total/activity related energy expenditure levels for at least 24 hours. Participants must have had a formal diagnosis of rheumatoid arthritis according to the American College of Rheumatology (ACR) criteria. As no randomized controlled trials were included in this review, the authors appraised the studies based on the Newcastle-Ottawa Quality Assessment Scale. However only one author undertook the appraisals.

Here’s what they found

People with RA appear to have lower activity levels than recommended.

The 16 studies involved 1890 participants and study designs were cross-sectional (N = 15) and (n=1) cohort designs.

They found a wide range of outcome measures were reported which prohibited pooling of data. Data were compared with The American College of Sports Medicine (ACSM) recommendation – the accumulation of 30 minutes of moderate-intensity lifestyle physical activity in short segments (10-minute bouts) on most, if not all, days of the week. People with RA appear to have lower activity levels than recommended.

However methodological flaws exist in each of the studies reviewed and therefore these results should be interpreted with caution.

The authors concluded

Physical activity levels among the RA population may be decreased when compared with healthy controls and is lower than the current international recommendations outlined to maintain a healthy lifestyle.

The Musculoskeletal Elf’s view

There were a number of limitations in this review, a single author reviewed all studies which could introduce bias. Furthermore there were methodological issues within the included studies. A number of studies (n = 9) did not use a control group and of those which did, 6 out of 7 studies matched groups for age and gender but mainly used healthy populations.

It is worth reminding ourselves of the accepted definitions by Casperson: physical activity is ‘any bodily movement produced by skeletal muscles that results in energy expenditure,’ whereas exercise is ‘a subset of physical activity that is planned, structured, and repetitive and has as a final or an intermediate objective the improvement or maintenance of physical fitness’.

PS: Don’t forget to sign up for and join the Musculoskeletal Elves Team (on the 5×50 registration website #TheMSK_Elf).

Questions

• Do you routinely seek information from patients with RA about their levels of physical activity?
• Do you prescribe general physical activity for patients with RA?

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