Pedometers: The new prescription for rheumatoid arthritis

Rheumatoid arthritis is the most common chronic autoimmune disease that affects the joints. RA has the potential for joint damage and deformity, with loss of function. The cause of RA is unknown. It affects people of all ages, and women more commonly than men. RA causes pain, stiffness and swelling, generally in multiple joints. RA may affect any joint, but the small joints in the hands and feet are most frequently involved. Rheumatoid inflammation may also develop in other organs such as the lungs.

Fatigue is problem for many people with RA. And, this can often lead to them shying away from physical activity, which unfortunately contributes to a cycle of more fatigue and less physical activity. Researchers from the University of California in San Francisco recently looked at one way of breaking this cycle -- the use of pedometers.

"With prior funding from the Rheumatology Research Foundation, I completed a study of the predictors of fatigue in RA. We found that, even after accounting for RA disease activity, obesity, depression, and sleep disturbance were important predictors of RA fatigue, and that physical inactivity was associated with each of those predictors. So, physical inactivity seemed to be the most important target to address," explains lead investigator, Patricia Katz, PhD; professor of Medicine and Health Policy; Division of Rheumatology, Department of Medicine, University of California, San Francisco.

Dr. Katz's team recruited 96 people from previous studies and rheumatology clinics to participate in a study -- also funded by the Rheumatology Research Foundation -- that looked at the effects of increased daily activity on RA-related fatigue. To participate in the study, a person had to be English or Spanish speaking, able to walk (even with a walking aid), able to return for follow up visits, experience at least a moderate level of fatigue, and be sedentary. Of the 96 participants, 88 percent were women with an average age of 54 and who had been diagnosed with RA an average of 14 years. The majority were English speaking; and 59 and 60 percent were on glucocorticoids and biologics, respectively.

At the beginning of the study, each participant filled out a Health Assessment Questionnaire (with the group receiving an average HAQ score of 1.34). They were also asked to report on their level of fatigue, and the group received an average fatigue score of 59 (based on the Patient Reported Outcomes Measurement System, or PROMIS). Finally, they were asked to wear an activity monitoring device for one week to determine their starting level of activity. The median of the average number of steps during that first week was 3,710, which is well below the threshold for a sedentary lifestyle (5,000 steps per day).

After one week, each of the participants was randomly placed into one of three groups. The first group received education on physical activity and no other intervention. Group two received a pedometer and a diary to log their daily steps. Group three received a pedometer, step diary, and a goal of increasing their steps by 10 percent every two weeks.

Groups two and three received calls from study personnel every two weeks to check on progress and collect the number of steps walked. Additionally, during these calls, group three would receive their new step goal for the next two weeks. All of the groups received a follow-up call at 10 weeks and participated in an in-person follow up at 21 weeks.

At 21 weeks, groups two and three had significant increases in their daily steps when compared to group one (which had virtually no change in activity). Group two increased their steps by 87 percent, and group three by 159 percent. "Just having a pedometer and reporting steps seemed to be important," says Dr. Katz. "Combined, both pedometer groups increased average daily steps by 125 percent, and both had significant decreases in fatigue. Of course, having goals seemed to create an even greater increase in steps and decrease in fatigue, but the important shift occurred just from having the pedometer and monitoring steps," explains Dr. Katz, who also notes that groups two and three had an added element of accountability in reporting their steps to study personnel.

While all groups noted their fatigue decreased the more they moved, it was the participants who were the least active at the beginning of the study who noticed the biggest change in fatigue at the end. This finding, explains Dr. Katz, suggests that people who were the least active gained the most from the intervention.

"From a purely logistical point of view, if someone's baseline activity level is 2,000 steps per day, it may be less difficult in terms of time and effort for them to increase their steps per day by 100 percent to 4,000 steps per day over a five-month period," she explains. "This may also move them from being very sedentary to a healthier level of activity. On the other hand, if someone is already covering 5,000 steps per day, it will take more time during the day for them to increase by 100 percent. And, while this increase is likely to have health benefits, the change in health benefits may not be as great when compared to someone moving from sedentary to low activity.

"Overall, this study further confirms the importance of physical activity for people with RA," concludes Dr. Katz, who suggests people with RA add more steps to their day. "Not only does it help to reduce fatigue -- as shown in this study -- it may improve mood, help a patient maintain a healthy weight, improve cardiovascular risk factors, and improve overall functioning."