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Mckenna S.1, Tierney M.2, Fraser A.3, Kennedy N.1,4
1University of Limerick, Department of Clinical Therapies, Limerick, Ireland, 2National University of Galway, Department of General Practice, Galway, Ireland, 3University Hospitals Limerick, Department of Rheumatology, Limerick, Ireland, 4Health Research Institute (HRI), University of Limerick, Limerick, Ireland
Background: Physical activity and exercise is important for people with rheumatoid arthritis (RA). Sleep requirements for adults should be on a spectrum between 7 to 9 hours per night and is an important aspect in maintaining circadian rhythm and homeostasis. Getting 5 hours or less has been associated with cardiovascular problems, diabetes and can be linked to depression, anxiety and poor productivity. Poor sleep is a common complaint among people with RA and consequently has an effect on their quality of life, activity levels, mental and physical health.
Purpose: Addressing sleep quality and disturbances through physical activity/exercise may have an important impact on the quality of life for people with RA. Disrupted or lower levels of sleep have been related to serious outcomes such as an increased risk of morbidities. Sleep disturbances and poor sleep quality are prevalent complaints in people with rheumatic disease and may exacerbate pain in this population, potentially leading to reduced levels of activity.
Methods: People with RA attending the rheumatology outpatient clinics in the University Hospitals Limerick were recruited. Information sheet provided and written consent received before testing. A SenseWear armband was applied to the right upper arm and participants were encouraged to wear same for 24 hours a day for 8 days. Participants were contacted 3 times during the week. Four consecutive valid days with 75% wear time were determined as the measurement period.
Results: Seventy five completed period of monitoring. Fifty three did not achieve required days or wear time therefore, analysis was conducted on 22 participants. Average sleep time was 5.6 (SD 1.46) hours per night, with 1.60 (SD 1.36) hours of daily physical activity. Participants were sedentary for 21.03 (SD1.97) hours per day including sleep time and 14.43 (SD 1.97) excluding sleep time. Sleep time had a significant relationship with lying down (p 0.001) and sedentary time (p=0.029) with sleep time and sedentary time having a moderate, negative relationship (Pearsons correlation coefficient = -0.554), as sedentary time increased, sleeping time decreased (p=0.029). Sedentary time and physical activity had a strong, negative, linear relationship (p 0.001; Pearsons correlation coefficient = -0.793), as physical activity increased, sedentary time decreased.
Conclusion(s): People with RA fall far below the sleep needs spectrum. While participants seem to meet the recommendations of the ACSM physical activity guidelines, the volume of sedentary activity is concerning. Interestingly as sedentary time increased, sleeping time decreased. The literature provides evidence for a positive immune response for exercise in chronic disease however, studies are required to specifically investigate exercises effect on sleep and therefore, the most effective exercise prescription in terms of the FITT principle, the ideal approach to exercise delivery and indeed how compliance can be promoted.
Implications: More research is needed with regards to investigating sleep quality and disturbances in order to promote health and well-being in people with RA. In addition the effects of physical activity interventions on poor sleep needs to be examined to show if it is a positive non-pharmacological treatment approach for the management of poor sleep in patients with RA.
Funding acknowledgements: Two authors report receipt of an Irish Research Council (IRC) scholarship during conduct of study and data analysis.
Topic: Rheumatology
Ethics approval: Approved by University Hospitals Limerick, Ireland Ethics Review board prior to beginning of study.
All authors, affiliations and abstracts have been published as submitted.
