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Moderate-to-high intensity exercise with person-centered guidance influences fatigue in older adults with rheumatoid arthritis

Journal article
Authors Daniel Kucharski
Elvira Lange
A. B. Ross
Sara Svedlund
Caroline Feldthusen
Karin Önnheim
Kaisa Mannerkorpi
Inger Gjertsson
Published in Rheumatology International
Volume 39
Issue 9
Pages 1585-1594
ISSN 0172-8172
Publication year 2019
Published at Institute of Neuroscience and Physiology, Department of Health and Rehabilitation
University of Gothenburg Centre for person-centred care (GPCC)
Institute of Medicine, Department of Rheumatology and Inflammation Research
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 1585-1594
Language en
Keywords Arthritis, Rheumatoid, Patient-centered, Exercise, Fatigue, Depression, Anxiety, Metabolomics, visual analog scales, quality-of-life, resistance exercise, hospital, anxiety, inventory mfi, depression, therapy, validation, age, Rheumatology
Subject categories Rheumatology and Autoimmunity


Fatigue is described as a dominant and disturbing symptom of rheumatoid arthritis (RA) regardless of the advances in pharmacological treatment. Fatigue is also found to correlate with depression. The objective was to evaluate the impact of moderate-to-high intensity, aerobic and resistance exercise with person-centered guidance on fatigue, anxiety and depression, in older adults with RA. Comparisons were made between older adults (> 65 years) with RA taking part in a 20-week moderate-to-high intensity exercise at a gym (n = 36) or in home-based exercise of light intensity (n = 38). Assessments were performed at baseline, at 20 weeks, and at 52 weeks. Outcomes were differences in Multidimensional Fatigue Inventory (MFI-20), Visual Analog Scale Fatigue (VAS fatigue), and Hospital Anxiety and Depression Scale (HADS). Analysis of metabolomics was also performed. The subscales "physical fatigue" and "mental fatigue" in MFI-20 and symptoms of depression using HADS depression scale improved significantly at week 20 in the exercise group compared with the control group. Exercise did not influence global fatigue rated by VAS or subscales "reduced motivation", "reduced activity" and "general fatigue" in MFI-20. No significant change was found on the anxiety index of HADS. The improvements in physical fatigue were associated with changes in the metabolism of lipids, bile acids, the urea cycle and several sugars. Moderate-to-high intensity exercise with person-centered guidance decreased fatigue and improved symptoms of depression and were accompanied by metabolic changes in older adults with RA.

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