Erfassung körperlicher Aktivität bei Patienten mit Rheumatoider Arthritis und die Auswirkungen einer Bewegungsintervention auf Krankheitsaktivität und Lebensqualität
Year: 2021
Type: dissertation
Abstract: Objectives In this work, the results of the PhysActRA study are presented. The aim of the study was to demonstrate that performing moderate exercise intervention has a positive effect on the disease activity and physical and psychological well-being of patients with rheumatoid arthritis. It should also be shown that the effects on health status can be measured by subjective and objective survey methods and that recommendations on the level of physical activity can be derived from their results. Design & Methods Over a study period of 12 weeks, the physical activity of 40 patients diagnosed with rheumatoid arthritis who had low disease activity or remission based on DAS28 was determined (IPAQ, SenseWear Wristband). In addition, the effects of moderate movement intervention on quality of life, functionality (HAQ, SF-36) and disease activity (DAS28 and biomarkers [ESR, CRP, RF, anti-CCP, anti-MCV]) were investigated using an intervention and control group. Observation & Results The results of this study have only been able to substantiate the previous research consensus on the benefits of physical activity, as neither quality of life (HAQ, SF-36) nor disease activity (DAS28 and biomarkers [ESR, CRP, RF, anti-CCP, anti-MCV]) improved significantly in the intervention group. At the very least, however, no deterioration could be observed as a result of the intervention. Nevertheless, important lessons have been learned in terms of further studies: patient training and motivation must be an integral part of study protocol to ensure the correct implementation of the intervention and to achieve the integration of physical activity into everyday life. External and patient-related influences must always be taken into account. A movement diary is an ideal supplement to collect individual daily and movement profiles including the social and spatial component of each individual subject and possible complications. This provides a good overview of patient data, which is often missing from the literature. The analysis of the movement diary also suggested that patients with mild and moderate pain can be most positively influenced by moderate movement intervention.Physical activity should, however, be classified more precisely and the documentation of the intervention should be queried. The intervention task must take into account the different perceptions of intensity. This should best be ranked on a uniform scale by subjects in terms of their respective activities. The PhysActRA study showed that activity sensors such as the SenseWear Wristband provide relatively precise and differentiated information on physiological and energy-related parameters of subjects, but where careful interpretation must always be carried out. Using this data, more differentiated study populations can be formed in combination with the IPAQ, which differ by activity profile and intervention task (intensity, duration). In spite of the small patient clientele, there were large differences in activity levels and interpretation of the intervention task, which must be taken into account in the future. Conclusions Based on this data, subsequent studies can standardize and optimize the study design with a view to concretizing the recommendations on the duration and intensity of physical activity in rheumatoid arthritis. In larger study collectives, patients should be differentiated according to their pre-existing level of activity to ensure the measurability of changes by means of activity sensors. The correct implementation of the intervention could be better verified in a clinically controlled framework, with a lower transferability to everyday life and practice and this would be difficult to achieve even during a similarly long or even longer study period. Instead, it seems more sensible to define the respective intervention more precisely and to encourage the subjects to document their implementation in concrete terms with time and duration, in order to ensure the comparison with an activity sensor. With the help of these findings, more specific recommendations on the duration and intensity of physical activity in rheumatoid arthritis can finally be developed in larger, increasingly standardized study collectives, precisely by combining the various parameters and measuring instruments. The long-term goal is a positive influence on the therapy regimen of rheumatoid arthritis in the sense of a reduction in the medication to be taken while increasing physical activity. The PhysActRA study therefore provides important contributions consistent with the recommendations and objectives of the EULAR and WHO to increasingly integrate physical activity for the benefit of health and quality of life into the daily lives of patients with rheumatoid arthritis.
Author: Leberle, Iulia
Language: German
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W6981582348