A Novel, Theory Based Intervention to Promote Engagement in Physical Activity in Early Rheumatoid Arthritis (PEPA-RA): Proof of Concept Study

A novel, theory based intervention to promote engagement in physical activity in early rheumatoid arthritis (PEPA-RA): proof of concept study.

People with rheumatoid arthritis (RA) do less physical activity (PA) than the general population and this is associated with work disability and reduced physical function. High intensity training and supervised exercise can improve physical function in RA, while PA decreases chronic inflammation and reduces pain, all without adversely affecting disease activity. Despite the benefits, patients do not maintain exercise beyond the supervised intervention and benefits are not maintained.

People with RA report a range of barriers to PA and are often reluctant to participate for fear of exacerbating their symptoms. It is therefore essential that they are provided with appropriate support to overcome these barriers soon after diagnosis, in order to optimise PA, minimise inappropriate health beliefs and prevent unnecessary reductions in function. Patients have also expressed a desire for more information relating to exercise.

Physiotherapists are best placed to provide this support as their approach is person-centred, taking into account the individual's health and wellbeing needs and supporting self-management through patient education and the facilitation of behaviour change. Whilst the National Institute for Health and Care Excellence (NICE) guidelines indicate that people with RA should have access to specialist physiotherapy to encourage regular PA this rarely occurs in practice with a third of patients waiting over a year for physiotherapy. The British Society of Rheumatology suggests that conversations regarding health promotion, including PA, need to occur early in the patient pathway and are best delivered via primary care.

To explore the opinions of people with RA in relation to support for PA programmes the investigators carried out focus groups. Based upon these findings, in combination with existing evidence and input from patient research partners, the researchers designed an intervention for delivery in a primary care setting for people with recently diagnosed RA. The focus group participants were in agreement that the intervention should be delivered in an accessible location within their local community. The intervention is informed by a theoretical framework for health behaviour change. The overall purpose of this new intervention is to support long term engagement with PA in order to optimise maintenance of physical function. The researchers plan to investigate the effectiveness of the intervention in a future trial, but initially need to carry out a proof of concept study.