title: Rheumatoid arthritis and spondyloarthropathies: geographical variations in prevalence in France. The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century. Cardiovascular Morbidity and Mortality in Women Diagnosed With Rheumatoid Arthritis Maintenance of physical activity after Internet-based physical activity interventions in patients with rheumatoid arthritis. A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis. A randomized controlled trial of a cognitive behavioural patient education intervention vs a traditional information leaflet to address the cardiovascular aspects of rheumatoid disease. Targeting motivation and self-regulation to increase physical activity among patients with rheumatoid arthritis: a randomised controlled trial The value of a continuous ambulatory activity monitor to quantify the amount and intensity of daily activity in patients with rheumatoid arthritis. Influence of patient education on exercise compliance in rheumatoid arthritis: a prospective 12-month randomized controlled trial. Coaching patients with early rheumatoid arthritis to healthy physical activity: a multicenter, randomized, controlled study. Physical activity coaching of patients with rheumatoid arthritis in everyday practice: a long-term follow-up. Using internet technology to deliver a home-based physical activity intervention for patients with rheumatoid arthritis: A randomized controlled trial. EFFECTS OF A MODIFIED DANCE-BASED EXERCISE ON CARDIORESPIRATORY FITNESS, PSYCHOLOGICAL STATE AND HEALTH STATUS OF PERSONS WITH RHEUMATOID ARTHRITIS A dynamic exercise programme to improve patients' disability in rheumatoid arthritis: a prospective randomized controlled trial.
abstract: OBJECTIVE To determine geographical variation in the prevalence of rheumatoid arthritis ( RA ) and spondyloarthropathies ( SpA ) in France . METHODS The survey sample was drawn from 7 areas of France . Households were r and omly selected using the national telephone directory , and an individual within each household was r and omly chosen by the next-birthday method . All cases of suspected RA and SpA were confirmed by the patient 's rheumatologist or by clinical examination . St and ardized estimates of prevalence were compared between regions and groups of regions . RESULTS In total 15,219 anonymous telephone numbers were selected . An average response rate of 64 % led to a total of 9395 respondents included in the study . The highest regional rates of RA were observed in the south ( range 0.59 - 0.66 % ) , and the lowest in the north ( range 0.14 - 0.24 % ) , with a national rate of 0.31 % ( 95 % CI 0.18 - 0.48 % ) . Regional heterogeneity was observed for SpA , with the highest rates in Bretagne ( 0.47 % ) and the Sud-Est ( 0.53 % ) and a national rate of 0.30 % ( 95 % CI 0.17 - 0.46 % ) . CONCLUSION This study is the largest of its kind conducted in France . It shows inter-regional variations , mainly in RA , with a higher prevalence in the south of the country . The many potential reasons for the heterogeneity observed , including genetic and environmental factors , warrant further research BACKGROUND It is 40 yr since the last age- and sex-specific estimates of the prevalence of rheumatoid arthritis ( RA ) for the UK were published . Since then the classification criteria for RA have been revised and there has been evidence of a fall in the incidence of RA , especially in women . OBJECTIVES To estimate the age- and sex-specific point prevalence of RA ( defined as fulfilment of a modification of the 1987 ACR classification criteria for RA on the day of assessment ) . The estimate was made in the primary care setting in Norfolk , UK . METHODS A stratified r and om sample was drawn from seven age and gender b and s. The 7050 individuals selected were mailed a screening question naire . Positive responders were invited to attend for a clinical examination . The sample was matched against the names in the Norfolk Arthritis Register ( NOAR ) , a register of incident cases of inflammatory polyarthritis which has been in existence since 1990 . RESULTS The overall response rate was 82 % . Sixty-six cases of RA were identified . Extrapolated to the population of the UK , the overall minimum prevalence of RA is 1.16 % in women and 0.44 % in men . A number of incident cases of RA previously notified to NOAR were not identified as cases in the survey because they had entered into treatment-induced remission . In addition , some cases who failed to attend for examination had significant disability . These prevalence figures are therefore an underestimate . CONCLUSIONS The prevalence of RA in women , but not in men , in the UK may have fallen since the 1950s Background —Rheumatoid arthritis may be associated with an increased risk of cardiovascular disease . We compared the incidence rates of myocardial infa rct ion and stroke in subjects with and without rheumatoid arthritis . Methods and Results —A prospect i ve cohort study was conducted among the 114 342 women participating in the Nurses ’ Health Study who were free of cardiovascular disease and rheumatoid arthritis at baseline in 1976 . All self-reported cases of rheumatoid arthritis were confirmed by medical record review . Fatal and nonfatal myocardial infa rct ions and strokes were similarly confirmed . Multivariate pooled logistic regression was used to adjust for potential cardiovascular risk factors . Five hundred twenty-seven incident cases of rheumatoid arthritis and 3622 myocardial infa rct ions and strokes  were confirmed during 2.4 million person-years of follow-up . The adjusted relative risk of myocardial infa rct ion in women with rheumatoid arthritis compared with those without was 2.0 ( 95 % confidence interval [ CI ] , 1.23 to 3.29 ) . For stroke , the adjusted relative risk was 1.48 ( 95 % CI , 0.70 to 3.12 ) . Women who had rheumatoid arthritis for at least 10 years had a risk for myocardial infa rct ion of 3.10 ( 95 % CI , 1.64 to 5.87 ) . Conclusion —In this large prospect i ve cohort of women , participants with rheumatoid arthritis had a significantly increased risk of myocardial infa rct ion but not stroke compared with those without rheumatoid arthritis . If these data are confirmed , aggressive coronary heart disease prevention strategies should be tested for persons with rheumatoid arthritis OBJECTIVES To investigate the maintenance of physical activity 12 months after two 1-year Internet-based physical activity interventions in patients with RA . METHODS This follow-up study was a r and omized comparison of an Internet-based individualized training ( IT ) and a general training ( GT ) programme in sedentary RA patients . Outcome measures included physical activity ( meeting public health recommendations for moderate physical activity , i.e. 30 min for at least 5 days/week ; or vigorous physical activity , i.e. 20 min for at least 3 days/week ) , functional ability and quality of life ( QoL ) . RESULTS Of the 152 RA patients who completed the initial study , 110 ( 72 % ) were available at follow-up . At 24 months , the proportions of patients meeting public health recommendations for moderate intensity physical activity were significantly higher compared with baseline in both the IT and GT groups ( 19 and 24 % , respectively , P < 0.05 ) , whereas the proportions of patients meeting the recommendation for vigorous activity was only significantly higher compared with baseline in the IT group ( P < 0.05 ) but not in the GT group . There were no differences between the IT and GT groups concerning proportions of patients meeting moderate or vigorous physical activity recommendations at 24 months . Apart from a significantly higher RAQoL score in the IT group at 24 months compared with baseline , there were no significant differences within or between the programmes regarding functional ability or QoL. CONCLUSION In RA patients , the effectiveness of both an individualized and a general 1-year Internet-based physical activity programme is sustained with respect to moderate intensity physical activity up to 12 months after the interventions OBJECTIVE To evaluate the impact of a 2-year program of strength training on muscle strength , bone mineral density ( BMD ) , physical function , joint damage , and disease activity in patients with recent-onset ( < 2 years ) rheumatoid arthritis ( RA ) . METHODS In this prospect i ve trial , 70 RA patients were r and omly assigned to perform either strength training ( all major muscle groups of the lower and upper extremities and trunk , with loads of 50 - 70 % of repetition maximum ) or range of motion exercises ( without resistance ) twice a week ; all were encouraged to engage in recreational activities 2 - 3 times a week . All patients completed training diaries  ( evaluated bi-monthly ) and were examined at 6-month intervals . All were treated with medications to achieve disease remission . Maximum strength of the knee extensors , trunk flexors and extensors , and grip strength was measured with dynamometers . BMD was measured at the femoral neck and lumbar spine by dual x-ray densitometry . Disease activity was determined by the Disease Activity Score , the extent of joint damage by the Larsen score , and functional capacity by the Health Assessment Question naire ( HAQ ) ; walking speed was also measured . RESULTS Sixty-two patients ( 31 per group ) completed the study .  Strength training  compliance averaged 1.4 - 1.5 times/week . The maximum strength of all muscle groups examined increased significantly ( 19 - 59 % ) in the strength-training group , with statistically significant improvements in clinical disease activity parameters , HAQ scores , and walking speed . While muscle strength , disease activity parameters , and physical function also improved significantly in the control group , the changes were not as great as those in the strength-training group . BMD in the femoral neck and spine increased by a mean + /- SD of 0.51 + /- 1.64 % and by 1.17 + /- 5.34 % , respectively , in the strength-training group , but decreased by 0.70 + /- 2.25 % and 0.91 + /- 4.07 % in the controls . Femoral neck BMD in the 17 patients with high initial disease activity ( and subsequent use of oral glucocorticoids ) remained constantly at a statistically significantly lower level than that in the other 45 patients . CONCLUSION Regular dynamic strength training combined with endurance-type physical activities improves muscle strength and physical function , but not BMD , in patients with early RA , without detrimental effects on disease activity OBJECTIVES Cardiovascular disease ( CVD ) is responsible for 50 % of the excess mortality for patients with RA . This study aim ed to evaluate a novel 8-week cognitive behavioural patient education intervention design ed to effect behavioural change with regard to modifiable CVD risk factors in people with RA . METHODS This was a non-blinded r and omized controlled trial with a delayed intervention arm . Participants were r and omly assigned to receive the cognitive behavioural education intervention or a control information leaflet at a ratio of 1:1 . The primary outcome measure was patient 's knowledge of CVD in RA ; secondary measures were psychological measures relating to effecting behaviour change , actual behaviour changes and clinical risk factors . Data were collected at baseline , 2 and 6 months . RESULTS A total of 110 participants consented ( 52 in the intervention group and 58 in the control group ) to participate in the study . At 6 months , those in the intervention group had significantly higher knowledge scores ( P < 0.001 ) ; improved behavioural intentions to increase exercise ( P < 0.001 ) , eat a low-fat diet ( P = 0.01 ) and lose weight ( P = 0.06 ) ; and lower mean diastolic blood pressure by 3.7 mmHg , whereas the control group 's mean diastolic blood pressure increased by 0.8 mmHg . There was no difference between the groups on actual behaviours . CONCLUSIONS Patient education has a significant role to play in CVD risk factor modification for patients with RA , and the detailed development of this programme probably contributed to its successful results . It is disappointing that behaviours , as we measured them , did not change . The challenge , as always , is how to translate behavioural intentions into action . Larger studies , powered specifically to look at behavioural changes , are required . Trial registration . National Institute for Health Research , UKCRN 4566 The purpose of this study is to evaluate the effects of targeting both the motivation and action phases of behaviour change in a 5-week intervention to increase physical activity ( PA )  among patients with rheumatoid arthritis ( RA ) not meeting current PA recommendations . In a r and omised controlled trial , a control group — which received a group-based patient education session led by a physical therapist — was compared to a treatment group which received the education session plus a motivational interview from a physical therapist and two self-regulation coaching sessions from a rheumatology nurse . Outcomes included  leisure-time PA , days per week with at least 30 min of moderate-intensity PA , self-efficacy and autonomous motivation ( cognitions which predict PA initiation and maintenance ) , disease activity , functional status , depressive symptoms and fatigue . Effects were assessed using mixed models repeated measures . Of the 78 patients r and omised , 76 and 67 completed the post-treatment and follow-up assessment s , respectively . Significant treatment effects were found for leisure-time PA  ( p = 0.022 ) , active days/week ( p = 0.016 ) , self-efficacy ( p = 0.008 ) and autonomous motivation ( p = 0.001 ) . At post-treatment and 6-months follow-up , significantly more treated patients than controls met current PA recommendations . No significant effects were found for disease activity , functional status , depressive symptoms or fatigue . Combining motivation- and action-focused intervention approaches improved PA-related cognitions and led to improved uptake and maintenance of leisure-time PA . However , further research is necessary to identify ways of helping patients with RA transition to— and maintain — more intensive forms of PA which are more likely to improve disease activity and functional status OBJECTIVE To examine the reliability , validity , and responsiveness of a continuous ambulatory activity monitor in patients with rheumatoid arthritis ( RA ) . METHODS Forty-one patients with RA , participating in a r and omized controlled trial examining the effect of an intensive exercise program  , were assessed by means of the  Dynaport ADL ( activities of daily living ) monitor ( AM ) .  The time spent on activities ( locomotion , st and ing , and active sitting ) during 24 hours and the intensity of trunk movement during these activities were recorded . To determine test-retest reliability 20 patients were reassessed with the AM one week after the first assessment . Construct validity of the AM was determined by comparing the AM results with physical fitness measures ( muscle strength , endurance , joint mobility ) , disease activity , and functional status . As well , 37 patients were assessed 18 months after the first assessment to determine responsiveness . RESULTS All AM measurements showed satisfactory test-retest reliability ( ICC 0.63 - 0.76 ) . AM measures were significantly associated with physical fitness , functional status , and disease activity , indicating construct validity of the AM . The AM could discriminate between patients with improvement and deterioration in physical fitness , indicating sufficient responsiveness of AM variables . CONCLUSION This study shows the value of an ambulatory activity monitor to quantify both the amount and intensity of physical activity of patients with RA during a day in their own environment . The ambulatory activity monitor seems to be a promising instrument for research into rehabilitation of patients with RA OBJECTIVE To determine the effect of education on the exercise habits of patients with rheumatoid arthritis ( RA ) after 6 and 12 months . METHODS We studied 208 out patients recruited between June 2001 and December 2002 . This was a prospect i ve controlled r and omized trial . The active group received a multidisciplinary education program , including training in home-based exercises and guidelines for leisure physical activity ( PA ) . The control group received a booklet added to usual medical care . Compliance with home-based exercises was defined as a practice rate > or= 30 % of the prescribed training . Compliance with leisure PA was defined as > or= 20 % increase in Baecke question naire score . Additional assessment s involved possible predictors of compliance and changes with regard to the compliance . RESULTS At 6-month followup , home-based exercise and leisure PA compliance were significantly higher [ 13.5 % vs 1 % , respectively ( p = 0.001 ) ; and 28.2 % vs 13.8 % ( p = 0.02 ) ] , but were not at 12 months . Predictors of leisure PA compliance at 6 months included participating in the active group ( odds ratio 2.74 , 95 % CI 1.17 to 6.38 ) and previous low leisure PA ( OR 6.01 , 95 % CI 2.47 to 14.61 ) , with decreased fatigue ( FACIT-F mean -2.94 + /- 8.04 vs -0.1 + /- 7.25 for noncompliant subjects ; p = 0.04 ) and improved psychological status ( Arthritis Impact Measurement Scale mean -1.25 + /- 3.12 vs 0.11 + /- 3.39 ; p = 0.03 ) . CONCLUSION Education of patients with RA may increase compliance especially with leisure PA , particularly when it is poor at baseline , but these effects are limited and short-term OBJECTIVE To investigate the effect of a 1-year coaching program for healthy physical activity on perceived health status , body function , and activity limitation in patients with early rheumatoid arthritis . METHODS A total of 228 patients ( 169 women , 59 men , mean age 55 years , mean time since diagnosis 21 months ) were r and omized to 2 groups after assessment s with the EuroQol visual analog scale ( VAS ) , Grippit , Timed-St and s Test , Escola Paulista de Medicina Range of Motion scale , walking in a figure-of-8 , a visual analog scale for pain , the Health Assessment Question naire disability index , a self-reported physical activity question naire , and the Disease Activity Score in 28 joints . All patients were regularly seen by rheumatologists and underwent rehabilitation as prescribed . Those in the intervention group were further individually coached by a physical therapist to reach or maintain healthy physical activity ( > or = 30 minutes , moderately intensive activity , most days of the week ) . RESULTS The retention rates after 1 year were 82 % in the intervention group and 85 % in the control group . The percentages of individuals in the intervention and control groups fulfilling the requirements for healthy physical activity were similar before ( 47 % versus 51 % ; P > 0.05 ) and after ( 54 % versus 44 % ; P > 0.05 ) the intervention . Analyses of outcome variables indicated improvements in the intervention group over the control group in the EuroQol VAS ( P = 0.025 ) and muscle strength ( Timed-St and s Test ; P = 0.000 ) ( Grippit ; P = 0.003 ) , but not in any other variables assessed . CONCLUSION A 1-year coaching program for healthy physical activity result ed in improved perceived health status and muscle strength , but the mechanisms remain unclear , as self-reported physical activity at healthy level did not change OBJECTIVES To investigate the long-term effects on perceived general health , disease activity , pain , activity limitation and cognitive behavioural factors of a one-year coaching programme performed in ordinary physical therapy practice to promote the adoption of health-enhancing physical activity in patients with early rheumatoid arthritis ( RA ) . METHODS A total of 228 patients with early RA , from 10 rheumatology clinics in Sweden , were r and omly assigned to an intervention group ( IG ; n = 94 ) or a control group ( CG ; n = 134 ) . The IG was coached by physical therapists during the first year to adopt health-enhancing levels of physical activity ( 30 minutes/day , moderately intensive , ≥ 4 days/week ) . No coaching was given during the subsequent year between post-intervention and follow-up . Follow-up assessment consisted of a postal question naire on physical activity and of visual analogue scales for ratings of general health perception and pain . The Health Assessment Question naire Disability Index ( HAQ ) and the Disease Activity Score in 28 joints ( DAS 28 ) were collected at regular medical check-ups . RESULTS Sixty-five ( 69 % ) participants in the IG and 92 ( 69 % ) in the CG completed the entire study period by filling in the follow-up question naire on physical activity two years after baseline . The intervention seemed to lack any significant influence on long-term outcome . However , different patterns of change in physical activity behaviour were observed in the two groups . CONCLUSIONS No long-term improvement in perceived general health or other outcomes were found in the follow-up . This may partly be because the intervention lacked several important behavioural elements for physical activity maintenance OBJECTIVE To compare the effectiveness of 2 Internet-based physical activity interventions for patients with rheumatoid arthritis ( RA ) . METHODS A total of 160 physically inactive patients with RA who had a computer with Internet access were r and omly assigned to an Internet-based physical activity program with individual guidance , a bicycle ergometer , and group contacts ( individualized training [ IT ] group ; n = 82 ) or to an Internet-based program providing only general information on exercises and physical activity ( general training [ GT ] group ; n = 78 ) . Outcome measures included quantity of physical activity ( question naire and activity monitor ) , functional ability , quality of life , and disease activity ( baseline , 3 , 6 , 9 , and 12 months ) . RESULTS The proportion of physically active patients was significantly greater in the IT than in the GT group at 6 ( 38 % versus 22 % ) and 9 months ( 35 % versus 11 % ; both P < 0.05 ) regarding a moderate intensity level for 30 minutes in succession on at least 5 days a week , and at 6 ( 35 % versus 13 % ) , 9 ( 40 % versus 14 % ) , and 12 months ( 34 % versus 10 % ; all P < 0.005 ) regarding a vigorous intensity level for 20 minutes in succession on at least 3 days a week . In general , there were no statistically significant differences regarding changes in physical activity as measured with an activity monitor , functional ability , quality of life , or disease activity . CONCLUSION An Internet-based physical activity intervention with individually tailored supervision , exercise equipment , and group contacts is more effective with respect to the proportion of patients who report meeting physical activity recommendations than an Internet-based program without these additional elements in patients with RA . No differences were found regarding the total amount of physical activity measured with an activity monitor ABSTRACT Cardiorespiratory function and exercise tolerance appear very limited in persons with rheumatoid arthritis ( RA ) . Many studies have demonstrated that aerobic exercise training is beneficial to prevent physical deconditioning without inducing adverse effects on an individual 's joints and general health . The present study was conducted to demonstrate that a dance-based exercise program is a safe and efficient activity to improve physical fitness and psychological state in persons with RA . A group of 19 persons ( mean age , 49.3 ± 13 yr ) participated in a  12-wk exercise program  ( twice weekly ) , whereas 10 persons ( mean age , 49.4 ± 12 yr ) served as controls . Health status , use of medication , joint pain and swelling , physical fitness , activity of daily living and psychological state were assessed at baseline , after the 12-wk training program and 6 mo after the end of the program . Exercise training induced a mean improvement of 13 % in aerobic power , with the highest values reaching 40 % . No significant changes were observed in joint status , even though the count of painful joints tended to decrease in the exercise group . Positive changes in depression , anxiety , fatigue and tension were observed after the 12-wk exercise program . These findings provide some evidence s in favor of aerobic exercise in individuals with RA . Furthermore , it is of primary interest to note that a weight-bearing activity with limited ground impacts do not provoke short-term adverse effects on joint status . Further studies , however , are required to determine the long-term effect of weight-bearing exercise on the health status of individuals with RA OBJECTIVE To evaluate the functional , clinical , radiological and quality of life outcomes of a 4-week dynamic exercise programme ( DEP ) in RA . METHODS Patients matched on the principal medico-social parameters were r and omly assigned to either the DEP or the conventional joint rehabilitation group . Primary end point for judging effectiveness was functional status assessed by HAQ . Secondary outcomes included Nottingham Health Profile ( NHP ) , Arthritis Impact Measurement Scale 2-Short Form ( AIMS 2-SF ) and radiological worsening measured by Simple Narrowing Erosion Score ( SENS ) . Clinical evaluation consisted of disease activity score ( DAS 28 ) , cycling aerobic fitness and dexterity . Dexterity was measured using Sequential Occupational Dexterity Assessment ( SODA ) and Duruoz H and Index ( DHI ) . Data were collected at baseline 1 , 6 and 12 months . RESULTS Fifty patients were enrolled .  HAQ improved throughout the length of the trial in the DEP group . This improvement was greater in DEP than in the st and ard joint rehabilitation group at 1 month ( -0.2 vs no variation from baseline , P = 0.04 ) , but not at 6 months ( -0.2 vs -0.1 in control group , P = 0.25 ) or 12 months ( -0.1 vs no variation in control group , P = 0.51 ) . DEP improved NHP ( -23 vs + 7 % in control group , P = 0.01 ) and aerobic fitness ( + 0.3 vs + 0.1 km per 5 min in control group , P = 0.02 ) at 1 month but the progress was not statistically significant thereafter . DEP also improved DHI , SODA , DAS 28 and AIMS 2-SF , although not significantly . CONCLUSION DEP was effective on functional status assessed by HAQ , quality of life and aerobic fitness at 1 month
target: There has been varied success of behaviour change interventions in promoting physical activity behaviour in people who have RA .
background: Research has shown that people who have rheumatoid arthritis ( RA ) do not usually participate in enough physical activity to obtain the benefits of optimal physical activity levels , including quality of life , aerobic fitness and disease-related characteristics .
  Behaviour change theory underpins the promotion of physical activity .
  The aim of this systematic review was to explore behaviour change interventions which targeted physical activity behaviour in people who have RA , focusing on the theory underpinning the interventions and the behaviour change techniques utilised using specific behaviour change taxonomy .