S McKenna1, L Larkin1, A Fraser2, A Donnelly3, B Appel Esbensen4, N Kennedy5
1University of Limerick, School of Allied Health, Limerick, Ireland, 2University Hospitals Limerick, Department of Rheumatology, Limerick, Ireland, 3University of Limerick, Department of Physical Education and Sport Sciences, Limerick, Ireland, 4Copenhagen Center for Arthritis Research, Rigshospitalet, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark, 5University of Limerick, Office of the Vice President of Research, Limerick, Ireland
Background: The Outcome Measures for Rheumatology Clinical Trials (OMERACT) has identified sleep quality as one of the key outcomes for people with Rheumatoid Arthritis (RA). Poor sleep and reduced total sleep time are common complaints among people with RA. Poor sleep can in turn lead to deterioration in function, reduce physical activity levels and also impact mental health. Although sleep and mental health outcomes have been identified as important, they are frequently not measured in clinical trials. Involving key stakeholders, like people with RA, is important when designing exercise interventions as it allows consideration of particular issues that may influence future intervention delivery. This study involved people with RA who participated in a pilot RCT group exercise class to improve sleep quality.
Purpose: To capture their reality, the purpose of this study was to explore participants experiences of an exercise intervention in improving sleep quality and total sleep time.
Methods: A descriptive qualitative study design of face-to-face semi-structured interviews was employed. The interview schedule explored a number of areas: experience of the intervention; outcome measures used; views regarding the intervention; perceptions regarding exercise and sleep and the impact on sleep. Interviews were transcribed verbatim by a professional transcriber. Inductive thematic analysis was used as an analytical approach. Interview transcripts were read, notes made, and ideas formulated to facilitate coding. The research team searched for patterns, analysed and coded the data, and generated themes and sub-themes. Themes were reviewed by the research team to check if they worked in relation to the coded extracts and the entire data set. The consolidated criteria for reporting qualitative research (COREQ) checklist provided guidance during the reporting of this study.
Results: Twelve females participated with a mean age of 58 (SD 7.4); mean RA diagnosis of 9.9 (SD 7.4) years; moderate to severe disability (HAQ-DI: 1.5 (SD 0.60). Four main themes were generated: 1) Positive impact of exercise on sleep - “I really didn’t think any type of exercise would help me sleep better if I’m honest.”; 2) Positive experiences of exercise intervention to improve sleep -“I learnt so much regarding walking that I didn’t even think about.”; 3) Clear mental health benefits – “If you don’t sleep well then it will have a knock-on effect to your mental health”; 4) Achieving empowerment and ownership when exercising - “I feel empowered now and confident that I’m not doing harm to myself”. The findings demonstrated that participants were clearly surprised that exercise could improve sleep.
Conclusion(s): In a variety of inflammatory conditions exercise is recommended as an effective intervention for the treatment of sleeping disorders. Although there is a growing consensus that exercise will benefit sleep, research is severely lacking in those with RA. This study demonstrates that participants were clearly surprised that exercise could improve their sleep.
Implications: Because of the multifactorial nature of RA, that is, how it negatively affects a person both physically and psychosocially, engaging in exercise may not only improve sleep quality but also mitigate some of its symptoms.
Funding, acknowledgements: Sean McKenna reports a competitive postgraduate scholarship awarded by the Irish Research Council (IRC) (GOIPG/2016/58).
Keywords: Rheumatoid Arthritis, Exercise, Sleep
Topic: Rheumatology
Did this work require ethics approval? Yes
Institution: University Hospital Limerick, Ireland
Committee: Research Ethics Committee
Ethics number: REC ref: 60/17
All authors, affiliations and abstracts have been published as submitted.
