Physical activity assessment in rheumatoid arthritis: a 120-patient cross-sectional study


Aicha Ben Tekaya
Leila Rouached
Siwar Ben Dhia
Selma Bouden
Rawdha Tekaya
Ines Mahmoud
Olfa Saidane
Leila Abdelmoula


Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease frequently associated with comorbidities such as cardiovascular diseases. RA patients are more prone to physical inactivity than the general population. 

Aim: Our study aimed to evaluate physical activity (PA) in patients with RA and to assess barriers that influence it in RA characteristics.

Methods:  This was a cross sectional study of 120 RA patients. Comorbidities, patients’ characteristics, disease activity, function assessed by Health Assessment Questionnaire (HAQ), severity parameters, and extra-articular manifestations were assessed. PA was evaluated with the Short form of the International Physical Activity Questionnaire (IPAQ-S). Factors influencing PA were analyzed.

Results:  Mean age was 56.1±10.1 years and sex-ratio was 0.14. Screening for comorbidities showed that 30.7% of patients had hypertension, 18.4% had diabetes, and 71.1% were obese or overweight. Moderate to high disease activity was found in 55.6% of patients.  Mean HAQ was 0.9±0.6.

Evaluation of PA revealed that mean continuous IPAQ-S was 4226.02±4703 MET-min per week [0-24276]. Physical activity level (categorical IPAQ-S) was low in 24.2% of patients, moderate in 30.8%, and high in 45%.

Continuous IPAQ-S was negatively correlated with age (r=-0.18,p=0.045), age of disease onset (r=-0.18,p=0.049), and HAQ (r=-0.25,p=0.01). Besides, categorical IPAQ-S was significantly associated with the presence of hypertension (p=0.03) and gout (p=0.02).

Concerning RA parameters, categorical IPAQ-S was significantly associated with HAQ (p=0.03).

Conclusion: Our study showed that PA in RA patients can provide significant improvement in terms of quality of life and function. In RA, regular PA should be part of disease management.


Rheumatoid arthritis, physical activity, disease activity



  1. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep Wash DC 1974. 1985;100(2):126–31.
  2. Hill J, Harrison J, Christian D, et al. The prevalence of comorbidity in rheumatoid arthritis: a systematic review and meta-analysis. Br J Community Nurs. 2022 May 2;27(5):232–41.
  3. Almeida OP, Khan KM, Hankey GJ, Yeap BB, Golledge J, Flicker L. 150 minutes of vigorous physical activity per week predicts survival and successful ageing: a population-based 11-year longitudinal study of 12 201 older Australian men. Br J Sports Med. 2014 Feb;48(3):220–5.
  4. Orrow G, Kinmonth AL, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012 Mar 26;344:e1389.
  5. Evenson KR, Wen F, Herring AH. Associations of Accelerometry-Assessed and Self-Reported Physical Activity and Sedentary Behavior With All-Cause and Cardiovascular Mortality Among US Adults. Am J Epidemiol. 2016 Nov 1;184(9):621–32.
  6. Peters MJL, Symmons DPM, McCarey D, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2010 Feb;69(2):325–31.
  7. van der Heijde DM, van ’t Hof MA, van Riel PL, et al. Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis. 1990 Nov;49(11):916–20.
  8. Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–45.
  9. Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): a systematic review. Int J Behav Nutr Phys Act. 2011 Oct 21;8:115.
  10. IPAQ scoring protocol - International Physical Activity Questionnaire [Internet]. [cited 2023 Jun 25]. Available from:
  11. Metsios GS, Stavropoulos-Kalinoglou A, Treharne GJ, et al. Disease activity and low physical activity associate with number of hospital admissions and length of hospitalisation in patients with rheumatoid arthritis. Arthritis Res Ther. 2011 Jun 29;13(3):R108.
  12. Hernández-Hernández V, Ferraz-Amaro I, Díaz-González F. Influence of disease activity on the physical activity of rheumatoid arthritis patients. Rheumatol Oxf Engl. 2014 Apr;53(4):722–31.
  13. Craig CL, Marshall AL, Sjöström M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003 Aug;35(8):1381–95.
  14. Adams SA, Matthews CE, Ebbeling CB, et al. The effect of social desirability and social approval on self-reports of physical activity. Am J Epidemiol. 2005 Feb 15;161(4):389–98.
  15. Westerterp KR. Assessment of physical activity: a critical appraisal. Eur J Appl Physiol. 2009 Apr;105(6):823–8.
  16. Warren JM, Ekelund U, Besson H, et al. Assessment of physical activity - a review of methodologies with reference to epidemiological research: a report of the exercise physiology section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil Off J Eur Soc Cardiol Work Groups Epidemiol Prev Card Rehabil Exerc Physiol. 2010 Apr;17(2):127–39.
  17. Prioreschi A, Hodkinson B, Tikly M, McVeigh JA. Changes in physical activity measured by accelerometry following initiation of DMARD therapy in rheumatoid arthritis. Rheumatol Oxf Engl. 2014 May;53(5):923–6.
  18. Prioreschi A, Hodkinson B, Avidon I, Tikly M, McVeigh JA. The clinical utility of accelerometry in patients with rheumatoid arthritis. Rheumatol Oxf Engl. 2013 Sep;52(9):1721–7.
  19. Henchoz Y, Bastardot F, Guessous I, et al. Physical activity and energy expenditure in rheumatoid arthritis patients and matched controls. Rheumatol Oxf Engl. 2012 Aug;51(8):1500–7.
  20. de Jong Z, Munneke M, Kroon HM, et al. Long-term follow-up of a high-intensity exercise program in patients with rheumatoid arthritis. Clin Rheumatol. 2009 Jun;28(6):663–71.
  21. Plasqui G. The role of physical activity in rheumatoid arthritis. Physiol Behav. 2008 May 23;94(2):270–5.
  22. van den Ende CH, Breedveld FC, le Cessie S, Dijkmans BA, de Mug AW, Hazes JM. Effect of intensive exercise on patients with active rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis. 2000 Aug;59(8):615–21.
  23. Hernández-Hernández MV, Díaz-González F. Role of physical activity in the management and assessment of rheumatoid arthritis patients. Reumatol Clin. 2017;13(4):214–20.
  24. Stavropoulos-Kalinoglou A, Metsios GS, Veldhuijzen van Zanten JJJCS, Nightingale P, Kitas GD, Koutedakis Y. Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis. Ann Rheum Dis. 2013 Nov;72(11):1819–25.
  25. Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009 May 20;301(19):2024–35.
  26. de Jong Z, Munneke M, Zwinderman AH, et al. Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial. Arthritis Rheum. 2003 Sep;48(9):2415–24.
  27. Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, Schoones J, Van den Ende ECHM. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev. 2009 Oct 7;2009(4):CD006853.
  28. Van Den Ende CH, Vliet Vlieland TP, Munneke M, Hazes JM. Dynamic exercise therapy for rheumatoid arthritis. Cochrane Database Syst Rev. 2000;(2):CD000322.
  29. Kabbaj SE, Rkain H, Benslama I, et al. Physical Activity and Rheumatoid Arthritis: Results from QUEST-RA Moroccan Study. Ann Rheum Dis. 2013 Jun 1;72(Suppl 3):A607–A607.
  30. Sandberg MEC, Wedrén S, Klareskog L, et al. Patients with regular physical activity before onset of rheumatoid arthritis present with milder disease. Ann Rheum Dis. 2014 Aug;73(8):1541–4.
  31. Bann D, Kuh D, Wills AK, et al. Physical activity across adulthood in relation to fat and lean body mass in early old age: findings from the Medical Research Council National Survey of Health and Development, 1946-2010. Am J Epidemiol. 2014 May 15;179(10):1197–207.
  32. Panagiotakos DB, Pitsavos C, Chrysohoou C, et al. Effect of leisure time physical activity on blood lipid levels: the ATTICA study. Coron Artery Dis. 2003 Dec;14(8):533–9.
  33. Stavropoulos-Kalinoglou A, Metsios GS, Smith JP, et al. What predicts obesity in patients with rheumatoid arthritis? An investigation of the interactions between lifestyle and inflammation. Int J Obes 2005. 2010 Feb;34(2):295–301.
  34. Elkan AC, Håkansson N, Frostegård J, Hafström I. Low level of physical activity in women with rheumatoid arthritis is associated with cardiovascular risk factors but not with body fat mass--a cross sectional study. BMC Musculoskelet Disord. 2011 Jan 14;12:13.
  35. Metsios GS, Stavropoulos-Kalinoglou A, Panoulas VF, et al. Association of physical inactivity with increased cardiovascular risk in patients with rheumatoid arthritis. Eur J Cardiovasc Prev Rehabil Off J Eur Soc Cardiol Work Groups Epidemiol Prev Card Rehabil Exerc Physiol. 2009 Apr;16(2):188–94.
  36. Moschou D, Krikelis M, Georgakopoulos C, et al. Sarcopenia in Rheumatoid arthritis. A narrative review. J Frailty Sarcopenia Falls. 2023 Mar 1;8(1):44–52.