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The effect of exercise on sleep and fatigue in rheumatoid arthritis: a randomized controlled study
Laura Durcan1, Fiona Wilson2, Gaye Cunnane2
1From the Department of Rheumatology, St. James's Hospital; the Department of Physiotherapy, Trinity College, Dublin, Ireland.L. Durcan, MD, MB, Bch, BAO, Specialist Registrar in Rheumatology, Department of Rheumatology, St. James's Hospital; F. Wilson, PhD, Assistant Professor and Chartered Physiotherapist, Department of Physiotherapy, Trinity College; G. Cunnane, PhD, Clinical Professor, Trinity College Dublin, Consultant Rheumatologist, St. James's Hospital. laurajanedurcan@hotmail.com.
Objective:
Sleep disturbance and chronic fatigue are common in rheumatoid arthritis (RA) and contribute to disability, symptomatology, and healthcare use. It has long been recognized in other populations that exercise can improve sleep and diminish fatigue. The effect of exercise on sleep quality and fatigue in RA has not been evaluated.
Methods:
Ours is a randomized controlled study in RA to determine the effect of an exercise program on sleep quality and fatigue. These were measured using the Pittsburgh Sleep Quality Index and the Fatigue Severity Scale. Patients were randomized to either a 12-week, home-based exercise intervention or usual care. The exercise program consisted of specific exercises to target individual deficiencies identified using the Health Assessment Questionnaire (HAQ) with cardiovascular work as per the guidelines. The intervention group was evaluated on a 3-week basis. Full evaluation was carried out at baseline and at 12 weeks.
Results:
Forty patients were randomized to the intervention with 38 controls. In the exercise intervention group, there was a statistically significant improvement in HAQ (p = 0.00), pain (p = 0.05), stiffness (p = 0.05), sleep quality (p = 0.04), and fatigue (p = 0.04). In our control group, there was a statistically significant improvement demonstrated in their overall perceptions of the benefits of exercise, but none of the other variables.
Conclusion:
Our study demonstrates that an exercise program resulted in significant improvement in sleep quality and fatigue. This is particularly interesting given the importance of fatigue as an outcome measure in RA and gives us yet another reason to prescribe exercise in this population.
