1962 - Association Between Disease Activity, Attitudes Toward Exercise and Exercise in Patients with Rheumatoid Arthritis

Mei-Chun Wu1, Roberta Glass2, Nancy Maher2, Nancy Shadick3, Maura D. Iversen4. 1MGH Institute of Health Professions, Boston, MA; 2Brigham & Women's Hospital, Boston, MA; 3Brigham & Women's Hospital, Harvard Medical School, Boston, MA; 4MGH Institute of Health Professions, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
Presentation Number: 1962

Purpose: Little is known about attitudes and beliefs toward exercise in patients with active rheumatoid arthritis (RA) and how attitudes impact exercise behavior. Our goals were to: 1) describe attitudes toward exercise in patients with minimally, moderately and highly active RA, 2) determine whether attitudes influence exercise differently in patients with various disease activity. Methods: This cross-sectional study used data from patients enrolled in an RA registry. Patients completed questions about exercise attitude and beliefs (EAQ), exercise behavior, an arthritis self-efficacy scale (ASES) and the SF-36 Mental Health Inventory (MHI-5). Disease activity was measured by the Disease Activity Score (DAS-28) and the Physician’s Global Assessment (PGA). Patients were stratified into 3 groups based on DAS-28 scores. A t-test and Kruskal-Wallis test assessed differences between groups in EAQ scores and time spent exercising. Logistic regression identified predictors of exercise behavior. Results: One hundred eleven patients participated (78% female, 94% Caucasian, mean age 57, average disease duration 15 years). The only significant demographic difference between groups was education level (χ2 =3.9; p=0.05). Patients with mildly active RA were more likely to have the college education. Mean disease activity was low (DAS-28 = 3.17; PGA = 3.2). The internal consistency of the EAQ was excellent (alpha = 0.91). Patients had positive attitudes and beliefs toward exercise (mean EAQ = 74.9; SD = 15), were confident in their ability to manage their disease (mean ASES = 73.7; SD = 19.7) and 79 patients (71%) had no mood disorder (MHI-5). Patients reported stretching (50%) and walking (65%) as their predominant exercise behavior. Grouped by disease activity, 57 patients (51%) had minimally active disease, 42 (38%) had moderately active and 12 (11%) had highly active disease. On average, patients with minimally active RA performed more exercise (median=60 minutes) than those with moderately and highly active RA (median 54 minutes ; p=0.017). There was no significant difference in EAQ scores between disease activity levels (p=0.3). Positive attitudes and beliefs toward exercise (OR=3.1; p=0.02) and mild disease activity (OR=3.0; p=0.02) were significant predictors of exercise activity; patients were 3 times more likely to exercise if they had positive attitudes and beliefs toward exercise or had mildly active disease. Conclusions: Patients with minimally active RA exercised more compared to patients with moderate and highly active RA. The mode of exercise chosen matched established recommendations. Disease activity level did not influence patients’ attitudes and beliefs toward exercise. Exercise activity was influenced by patients’ attitudes and beliefs toward exercise and by disease activity level.

 M. Wu, None.