Physical activity and health perception in inflammatory joint disease : a physiotherapy perspective

Ankylosing spondylitis (AS) and rheumatoid arthritis (RA) are inflammatory joint diseases, both leading to disability and reduced health. Physical activity is a powerful health measure and physiotherapists have an important role in its initiation and implementation among patients with inflammatory joint disease. However, more knowledge is needed of the characteristics of those patients in most need of support and the efficiency of physical activity interventions. The aims of the work presented in this thesis were to identify predictors of physical activity and general health perception, to evaluate the outcome of a physical activity intervention, and to gain deeper understanding of physical activity intensity in patients with inflammatory joint disease.

Fifty patients with AS were recruited to Study I, which had a retrospective design. Patients were assessed twice with a median interval between assessments of 24 months (15-37). In Study II, a multicentre, prospective study, 102 patients with RA participated. Patients were assessed twice with a one-year interval between assessments. In Study III, a multicentre, randomized controlled intervention, 228 patients with early RA were recruited, 94 to an intervention group (IG) and 134 to a control group (CG). The intervention aimed at implementing healthy physical activity and was compared to ordinary treatment. In Study IV, an interview study, 19 patients with RA were strategically chosen to participate. Demographics, measures of disease activity, functioning, disability and health were collected in Studies I-III. Semi-structured interviews were conducted in Study IV.

In Study I, work, self-reported disease activity, activity limitation and general health perception predicted general health perception. Diagnosis duration, civil status, exercise, disease activity, activity limitation and general health perception predicted exercise. In Study II, physical activity, lower extremity function, pain, activity limitation and general health perception predicted general health perception. Physical activity was the only predictor of physical activity. In Study III, the results after intervention were better for the IG than the CG regarding general health perception, lower-extremity function and grip force. Disease activity remained stable and the percentages of participants on different types of medication were comparable between the IG and the CG. In Study IV, four different understandings of how to determine physical activity intensity were identified. They were described as focus on alterations of bodily features , will-power and awareness , performing activity , and the consequences of disease .

Some characteristics of patients with AS and RA at risk of poor general health perception and physical inactivity were identified. A structured intervention to promote healthy physical activity had beneficial effects in patients with early RA, while patients understanding of physical activity intensity was found to partly diverge from those underlying commonly used assessments. Data were collected and the intervention was performed by ordinary physiotherapists in their daily clinical environment. Thus, the transferability of the present results should be high, and if implemented the findings should constitute a valuable contribution to improvement of the patients health.

List of scientific papers

I. Brodin N, Opava CH (2007). "Predicting general health perception and exercise habits in ankylosing spondylitis." Adv Physiother 9: 23-30.
https://doi.org/10.1080/14038190601090901

II. Eurenius E, Brodin N, Lindblad S, Opava CH; PARA Study Group (2007). "Predicting physical activity and general health perception among patients with rheumatoid arthritis." J Rheumatol 34(1): 10-5.
https://doi.org/000243467300004

III. Brodin N, Eurenius E, Jensen I, Nisell R, Opava C H, and the PARA study group (2008). "Coaching patients with early rheumatoid arthritis to healthy physical activity: A multicenter, randomized, controlled study." Arthritis Rheum. [Accepted]
https://pubmed.ncbi.nlm.nih.gov/18311770

IV. Brodin N, Swärdh E, Biguet G, Opava CH (2008). "Understanding the intensity of physical activity - an interview study among individuals with rheumatoid arthritis." [Submitted]