The Effect of Exercise on Sleep and Fatigue in Rheumatoid Arthritis: A Randomized Controlled Study Effects of exercise on fatigue, aerobic fitness, and disease activity measures in persons with rheumatoid arthritis. Yoga for the management of pain and sleep in rheumatoid arthritis: a pilot randomized controlled trial The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritis Predictors of exercise and effects of exercise on symptoms, function, aerobic fitness, and disease outcomes of rheumatoid arthritis. Determining the minimal clinically important differences in activity, fatigue, and sleep quality in patients with rheumatoid arthritis. Responsiveness of patient reported outcomes including fatigue, sleep quality, activity limitation, and quality of life following treatment with abatacept for rheumatoid arthritis The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Association of physical activity and human sleep disorders. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Functional and physiological effects of yoga in women with rheumatoid arthritis: a pilot study. A randomized controlled trial of the effect of exercise on sleep. Endogenous pain modulation in response to exercise in patients with rheumatoid arthritis, patients with chronic fatigue syndrome and comorbid fibromyalgia, and healthy controls: a double-blind randomized controlled trial. Development and delivery of an exercise intervention for rheumatoid arthritis: strengthening and stretching for rheumatoid arthritis of the hand (SARAH) trial. Using internet technology to deliver a home-based physical activity intervention for patients with rheumatoid arthritis: A randomized controlled trial. EFFECTS OF A MODIFIED DANCE-BASED EXERCISE ON CARDIORESPIRATORY FITNESS, PSYCHOLOGICAL STATE AND HEALTH STATUS OF PERSONS WITH RHEUMATOID ARTHRITIS Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored.
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 population s 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 r and omized 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 r and omized 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 Question naire ( 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 r and omized 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 result ed 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 The effects of 12 weeks of low-impact aerobic exercise on fatigue , aerobic fitness , and disease activity were examined in a quasi-experimental time series study of 25 adults with rheumatoid arthritis ( RA ) . Measures were obtained preintervention , midtreatment ( after 6 weeks of exercise ) , end of treatment ( after 12 weeks of exercise ) , and at a 15-week follow-up . ANOVAS for repeated measures showed that those subjects who participated more frequently reported decreased fatigue , while those who participated less frequently reported an increase in fatigue . All subjects , on average , showed increased aerobic fitness and increased right and left h and grip strength , decreased pain , and decreased walk time . There were no significant increases in joint count or sedimentation rate . Significant improvements in measures at the 15-week follow-up also were found . Findings indicate that persons with RA who participate in appropriate exercises may lessen fatigue levels and experience other positive effects without worsening their arthritis OBJECTIVE The aim of the present study was to determine the feasibility of a relaxation-based yoga intervention for rheumatoid arthritis , design ed and reported in accordance with Delphi recommendations for yoga interventions for musculoskeletal conditions . METHODS Participants were recruited from a hospital data base , and r and omized to either eight weekly 75-min yoga classes  or a usual care control .  Feasibility was determined by recruitment rates , retention , protocol adherence , participant satisfaction and adverse events . Secondary physical and psychosocial outcomes were assessed using self-reported question naires at baseline ( week 0 ) , week 9 ( primary time point ) and week 12 ( follow-up ) . RESULTS Over a 3-month period , 26 participants with mild pain , mild to moderate functional disability and moderate disease activity were recruited into the study ( 25 % recruitment rate ) . Retention rates were 100 % for yoga participants and 92 % for usual care participants at both weeks 9 and 12 . Protocol adherence and participant satisfaction were high . Yoga participants attended a median of seven classes ; additionally , seven of the yoga participants ( 54 % ) reported continuing yoga at home during the follow-up period . No serious adverse events were related to the study . Secondary outcomes showed no group effects of yoga compared with usual care . CONCLUSIONS A relaxation-based yoga programme was found to be feasible and safe for participants with rheumatoid arthritis-related pain and functional disability . Adverse events were minor , and not unexpected from an intervention including physical components . This pilot provides a framework for larger intervention studies , and supports further exploration of yoga as a complex intervention to assist with the management of rheumatoid arthritis Summary Pain and depression were related to sleep disturbance in rheumatoid arthritis . Depression partly mediated the relationship between pain and sleep . ABSTRACT The objective of this article is to assess the contribution of disease activity , pain , and psychological factors to self‐reported sleep disturbance in patients with rheumatoid arthritis ( RA ) , and to evaluate whether depression mediates the effects of pain on sleep disturbance . The sample included 106 patients with confirmed RA who participated in an assessment of their disease activity , pain , psychological functioning , and sleep disturbance  during a baseline evaluation prior to participating in a prospect i ve study  to help them manage their RA . Self‐ measures included the Rapid Assessment of Disease Activity in Rheumatology , the SF‐36 Pain Scale , the Helplessness and Internality Subscales of the Arthritis Helplessness Index , the Active and Passive Pain Coping Scales of the Pain Management Inventory , the Center for Epidemiological Studies Depression Scale , and the Pittsburgh Sleep Quality Index .  Hierarchical multiple regression analysis confirmed that higher income , pain , internality , and depression contributed independently to higher sleep disturbance . A mediational analysis demonstrated that depression acted as a significant mechanism through which pain contributed to sleep disturbance . Cross‐sectional findings indicate that pain and depression play significant roles in self‐reported sleep disturbance among patients with RA . The data suggest the importance of interventions that  target pain and depression  to improve sleep in this medical condition OBJECTIVE To determine the effects of participation in a low-impact aerobic exercise program on fatigue , pain , and depression ; to examine whether intervention groups compared with a control group differed on functional ( grip strength and walk time ) and disease activity ( total joint count , erythrocyte sedimentation rate , and C-reactive protein ) measures and aerobic fitness at the end of the intervention ; and to test which factors predicted exercise participation . METHODS A convenience sample of 220 adults with rheumatoid arthritis ( RA ) , ages 40 - 70 , was r and omized to 1 of 3 groups : class exercise , home exercise using a videotape , and control group . Measures were obtained at baseline ( T1 ) , after 6 weeks of exercise ( T2 ) , and after 12 weeks of exercise ( T3 ) . RESULTS Using structural equation modeling , overall symptoms ( latent variable for pain , fatigue , and depression ) decreased significantly at T3 ( P < 0.04 ) for the class exercise group compared with the control group . There were significant interaction effects of time and group for the functional measures of walk time and grip strength : the treatment groups improved more than the control group ( P < or= 0.005 ) . There were no significant increases in measures of disease activity . Fatigue and perceptions of benefits and barriers to exercise affected participants ' amount of exercise , supporting previous research . CONCLUSION This study supported the positive effects of exercise on walk time and grip strength , and demonstrated that fatigue and perceived benefits /barriers to exercise influenced exercise participation . Furthermore , overall symptoms of fatigue , pain , and depression were positively influenced in this selective group of patients with RA ages 40 - 70 years OBJECTIVE To determine the minimal clinical ly important differences ( MCID ) in the patient-reported outcomes of activity ( 0 - 30 , number of days of limitation ) , fatigue ( 0 = none , 100 = complete ) , and sleep quality ( 0 = no problems , 100 = worst case ) for patients with rheumatoid arthritis ( RA ) . METHODS Two r and omized controlled trials comparing abatacept to placebo  in RA patients were considered : ATTAIN ( n = 391 ) and AIM ( n = 652 ) . An internal anchor-based approach was used to derive the MCID using the Health Assessment Question naire , patient global assessment , and pain as anchors . Minimal important change in activity , fatigue , and sleep were determined by estimating mean changes in these outcomes in patients showing change in a narrow range about the MCID of the internal anchor . Correlation analysis was used to determine the consistency of the changes in the outcomes and anchors , and a Delphi process was used to determine the final MCID values . RESULTS For the 2 trials , consistent patterns of change for activity , fatigue , and sleep and the internal anchors were found with correlations in the range of 0.5 , 0.7 , and 0.4 , respectively . The mean changes for activity , fatigue , and sleep in a narrow range about the MCID of the 3 internal anchors corresponding to the 2 trials were : 3.4 to 4.3 for activity ; 6.7 to 17.0 for fatigue ; and 4.1 to 7.3 for sleep . Following the Delphi process the MCID determined were 4 for activity , 10 for fatigue , and 6 for sleep . CONCLUSION These MCID for activity limitation , fatigue , and sleep problems can be used in design ing clinical trials and providing benchmarks in assessing patient improvement Objective : To evaluate the responsiveness of patient reported outcomes ( PROs ) , including fatigue , sleep , activity limitation , and quality of life , in patients with rheumatoid arthritis ( RA ) . Methods : Data were considered from a r and omised controlled trial comparing  abatacept ( n = 258 )  with placebo ( n = 133 ) on a background of DMARD treatment in RA patients who were inadequate responders to anti-TNF therapy ( ATTAIN study ) . PROs assessed included SF-36 , activity limitation , fatigue , and sleep . For each outcome the treatment difference , relative per cent improvement , st and ardised response mean ( SRM ) , and relative efficiency for assessing an outcome ’s ability to detect a treatment effect relative to tender joint count ( TJC ) were calculated . A relative efficiency > 1 suggests a measure that is more efficient than TJC in detecting treatment effect . Results : Moderate to large SRMs ( ⩾0.6 ) were observed for the PRO measures . In particular , SRMs ( 95 % confidence interval ) were : physician global , 0.72 ( 0.51 to 0.94 ) ; HAQ , 0.63 ( 0.42 to 0.85 ) ; SF-36 physical component score , 0.62 ( 0.40 to 0.83 ) ; SF-36 bodily pain , 0.68 ( 0.46 to 0.90 ) ; and fatigue , 0.59 ( 0.38 to 0.81 ) . Relative efficiencies for physician global ( 1.6 ) , SF-36 bodily pain domain ( 1.4 ) , pain intensity ( 1.4 ) , HAQ ( 1.2 ) , SF-36 physical component score ( 1.2 ) , fatigue ( 1.1 ) , and patient global assessment ( 1.04 ) were all more responsive than TJC . The SF-36 mental component score ( 0.3 ) , swollen joint count ( 0.6 ) , activity limitation ( 0.8 ) , sleep ( 0.7 ) , and C reactive protein ( 0.9 ) were less responsive . Conclusions : Using PROs for evaluating treatments for RA can detect improvements and will identify changes that are important to patients . In general , physical assessment s are more responsive to an effective treatment than mental assessment STUDY OBJECTIVES To evaluate the efficacy of a 12-week exercise training program for reducing  obstructive sleep apnea ( OSA ) severity  and improving sleep quality , and to explore possible mechanisms by which exercise may reduce OSA severity . DESIGN R and omized controlled trial . SETTING Clinical exercise physiology center , sleep laboratory . PARTICIPANTS Forty-three sedentary and overweight/obese adults aged 18 - 55 years with at least moderate-severity untreated OSA ( screening apnea-hypopnea index [ AHI ] ≥ 15 ) . INTERVENTIONS Participants r and omized to exercise training ( n = 27 ) met 4 times/week for 12 weeks and performed 150 min/week of moderate-intensity aerobic activity , followed by resistance training twice/week . Participants r and omized to a stretching control ( n = 16 ) met twice weekly for 12 weeks to perform low-intensity exercises design ed to increase whole-body flexibility . MEASUREMENTS AND RESULTS OSA severity was assessed with one night of laboratory polysomnography ( PSG ) before and following the 12-week intervention . Measures of sleep quality included PSG , actigraphy ( 7 - 10 days ) , and the Pittsburgh Sleep Quality Index . Compared with stretching , exercise result ed in a significant AHI reduction  ( exercise : 32.2 ± 5.6 to 24.6 ± 4.4 , stretching : 24.4 ± 5.6 to 28.9 ± 6.4 ; P < 0.01 ) as well as significant changes in oxygen desaturation index ( ODI ; P = 0.03 ) and stage N3 sleep ( P = 0.03 ) . Reductions in AHI and ODI were achieved without a significant decrease in body weight . Improvements in actigraphic sleep and subjective sleep quality were also noted following exercise compared with stretching . CONCLUSIONS Exercise training had moderate treatment efficacy for the reduction of AHI in sedentary overweight/obese adults , which suggests that exercise may be beneficial for the management of OSA beyond simply facilitating weight loss . TRIAL REGISTRATION Clinical trials.gov identification number NCT00956423 BACKGROUND It is generally believed that exercise exerts a beneficial effect on the quality of sleep . However , most studies regarding exercise and sleep have been concerned with the influence of exercise on sleep architecture and efficiency , and not on its effects in the prevention and treatment of sleep disorders . Moreover , epidemiological evidence of the benefits of exercise on sleep are limited . OBJECTIVE To investigate the influence of moderate exercise or physical activity on self-reported sleep disorders among a r and omly selected population of adults . SUBJECTS AND METHODS Study subjects were participants in the Tucson Epidemiological Study of Obstructive Airways Disease who in the 12th survey completed health question naires that included several questions on physical exercise and sleep disorders . Sleep disorders were classified as disorders in maintaining sleep , excessive daily sleepiness , nightmares , and any sleep disorder . Six questions regarding exercise and physical activity were asked . Analyses were performed using multivariate logistic regression models with selected measures of sleep disorders as dependent variables and measures of  exercise  and physical activity as the independent or predictor variables . RESULTS There were 319 men and 403 women included in the analyses . The results showed that more women than men reported participating in a regular exercise program and having sleep symptoms of disorders in maintaining sleep and nightmares and that more men than women did regular vigorous activity and walking at a brisk pace for more than 6 blocks per day . Both men and women had significantly reduced risk of disorders in maintaining sleep associated with regular activity at least once a week , participating regularly in an exercise program , and walking at a normal pace for more than 6 blocks per day . Reduced risk of any sleep disorder was associated with regular activity at least once a week , and for men , walking at a brisk pace for more than 6 blocks . Among women increases in age also reduced the risk of nightmares . CONCLUSIONS These data provide additional evidence that a program of regular exercise may be a useful therapeutic modality in the treatment of patients with sleep disorders A group of 120 patients with rheumatoid arthritis or osteoarthritis volunteered to be subjects for this study of aerobic versus nonaerobic exercise . Patients were stratified by diagnosis and r and omized into an exercise program of aerobic walking , aerobic aquatics , or nonaerobic range of motion ( controls ) . The retention rate for the 12-week program was 83 % . Exercise tolerance , disease-related measures , and self-reported health status were assessed . The aquatics and walking exercise groups showed significant improvement over the control group in aerobic capacity , 50-foot walking time , depression , anxiety , and physical activity after the 12-week exercise program . There were no significant between-group group differences in the change scores for flexibility , number of clinical ly active joints , duration of morning stiffness , or grip strength . Our findings document the feasibility and efficacy of conditioning exercise for people who have rheumatoid arthritis or osteoarthritis CONTEXT Stress , both psychological and physiological , has been implicated as having a role in the onset and exacerbations of rheumatoid arthritis ( RA ) . OBJECTIVE This study investigated whether neuroendocrine and physical function in women with RA can be altered through a yoga intervention . DESIGN Exercise intervention . SETTING University research conducted at a medical clinic . PARTICIPANTS Sixteen independently living , postmenopausal women with an RA classification of I , II , or III according to the American College of Rheumatology functional classification system served as either participants or controls . INTERVENTION The study group participated in three 75-minute yoga classes a week over a 10-week period . MAIN OUTCOME MEASURES At baseline and on completion of the 10-week intervention , diurnal cortisol patterns and resting heart rate were measured . Balance was measured using the Berg Balance Test . Participants completed the Health Assessment Question naire ( HIQ ) , a visual analog pain scale , and the Beck Depression Inventory . RESULTS Yoga result ed in a significantly decreased HAQ disability index , decreased perception of pain and depression , and improved balance .  Yoga did not result in a significant change in awakening or diurnal cortisol patterns ( P = .12 ) We tested the hypothesis that exercise would improve subjective sleep quality and activity in depressed elders . A 10-week r and omized controlled trial was utilized . Participants consisted of a volunteer sample , aged > 60 with a diagnosis of major or minor depression or dysthymia . A total of 32 subjects aged 60 - 84 years with a mean age of 71.3 + /- 1.2 years was used . Intervention consisted of a supervised weight-training program three times a week or an attention-control group . Main outcome measures were Pittsburgh Subjective Sleep Quality Index ( PSQI ) , Likert Scale of Subjective Sleep Quality and Quantity . Paffenbarger Activity Index . Geriatric Depression Scale ( GDS ) . Beck Depression Inventory ( BDI ) , Hamilton Rating Scale of Depression ( HRSD ) , and the Medical Outcomes Survey Short Form 36 ( SF-36 ) . Results showed that exercise significantly improved all subjective sleep- quality and depression measures . Depression measures were reduced by approximately twice that of controls . Habitual activity was not significantly increased by exercise .  Quality of life subscales significantly improved . In a forward stepwise multiple regression , percent improvement in GDS and percent increase in strength remained significant predictors of the improvement in total PSQI score ( r = 0.71 , p = 0.0002 ) . In conclusion , weight lifting exercise was effective in improving subjective sleep quality , depression , strength , and quality of life without significantly changing habitual activity OBJECTIVE Temporal summation ( TS ) of pain , conditioned pain modulation ( CPM ) , and exercise-induced analgesia ( EIA ) are often investigated in chronic pain population s as an indicator for enhanced pain facilitation and impaired endogenous pain inhibition , respectively , but interactions are not yet clear both in healthy controls and in chronic pain patients . Therefore , the present double-blind r and omized placebo-controlled study evaluates pains cores , TS , and CPM in response to exercise in healthy controls , patients with chronic fatigue syndrome and comorbid fibromyalgia ( CFS/FM ) , and patients with rheumatoid arthritis ( RA ) , both under placebo and paracetamol condition . METHODS Fifty-three female volunteers - of which 19 patients with CFS/FM , 16 patients with RA , and 18 healthy controls - underwent a submaximal exercise test on a bicycle ergometer on 2 different occasions ( paracetamol vs. placebo ) , with an interval of 7 days . Before and after exercise , participants rated pain intensity during TS and CPM . RESULTS Patients with rheumatoid arthritis showed decreased TS after exercise , both after paracetamol and placebo ( P < 0.05 ) . In patients with CFS/FM , results were less univocal . A nonsignificant decrease in TS was only observed after taking paracetamol .  CPM responses to exercise are inconclusive , but seem to worsen after exercise . No adverse effects were seen . CONCLUSION This study evaluates pain scores , TS , and CPM in response to submaximal exercise in 2 different chronic pain population s and healthy controls . In patients with RA , exercise had positive effects on TS , suggesting normal EIA . In patients with CFS/FM , these positive effects were only observed after paracetamol and results were inconsistent This paper describes the development and implementation of a h and exercise intervention for rheumatoid arthritis ( RA ) as part of a large multi-centred r and omised controlled trial in a U.K. National Health Service ( NHS ) setting . Participants are eligible if diagnosed with RA according to American College of Rheumatology criteria , have a history of disease activity , functional deficit or impairment in the h and and /or wrist , and have been on a stable medication regime for at least 3 months . The intervention development was informed by the current evidence base , published guidelines , clinician and expert opinion , and a pilot study . The exercise programme targets known , potentially modifiable physical impairments of the h and with 5 exercise sessions and a home exercise component over a 12 week period . The intervention will be provided to 240 participants along with usual care . A further 240 will receive usual care only as part of the control arm . Specific details of the treatments delivered are described . [ IS RCT N no : 89936343 ] OBJECTIVE To compare the effectiveness of 2 Internet-based physical activity interventions for patients with rheumatoid arthritis ( RA ) . METHODS A total of 160 physically inactive patients with RA who had a computer with Internet access were r and omly assigned to an Internet-based physical activity program with individual guidance , a bicycle ergometer , and group contacts ( individualized training [ IT ] group ; n = 82 ) or to an Internet-based program providing only general information on exercises and physical activity ( general training [ GT ] group ; n = 78 ) . Outcome measures included quantity of physical activity ( question naire and activity monitor ) , functional ability , quality of life , and disease activity ( baseline , 3 , 6 , 9 , and 12 months ) . RESULTS The proportion of physically active patients was significantly greater in the IT than in the GT group at 6 ( 38 % versus 22 % ) and 9 months ( 35 % versus 11 % ; both P < 0.05 ) regarding a moderate intensity level for 30 minutes in succession on at least 5 days a week , and at 6 ( 35 % versus 13 % ) , 9 ( 40 % versus 14 % ) , and 12 months ( 34 % versus 10 % ; all P < 0.005 ) regarding a vigorous intensity level for 20 minutes in succession on at least 3 days a week . In general , there were no statistically significant differences regarding changes in physical activity as measured with an activity monitor , functional ability , quality of life , or disease activity . CONCLUSION An Internet-based physical activity intervention with individually tailored supervision , exercise equipment , and group contacts is more effective with respect to the proportion of patients who report meeting physical activity recommendations than an Internet-based program without these additional elements in patients with RA . No differences were found regarding the total amount of physical activity measured with an activity monitor ABSTRACT Cardiorespiratory function and exercise tolerance appear very limited in persons with rheumatoid arthritis ( RA ) . Many studies have demonstrated that aerobic exercise training is beneficial to prevent physical deconditioning without inducing adverse effects on an individual 's joints and general health . The present study was conducted to demonstrate that a dance-based exercise program is a safe and efficient activity to improve physical fitness and psychological state in persons with RA . A group of 19 persons ( mean age , 49.3 ± 13 yr ) participated in a  12-wk exercise program  ( twice weekly ) , whereas 10 persons ( mean age , 49.4 ± 12 yr ) served as controls . Health status , use of medication , joint pain and swelling , physical fitness , activity of daily living and psychological state were assessed at baseline , after the 12-wk training program and 6 mo after the end of the program . Exercise training induced a mean improvement of 13 % in aerobic power , with the highest values reaching 40 % . No significant changes were observed in joint status , even though the count of painful joints tended to decrease in the exercise group . Positive changes in depression , anxiety , fatigue and tension were observed after the 12-wk exercise program . These findings provide some evidence s in favor of aerobic exercise in individuals with RA . Furthermore , it is of primary interest to note that a weight-bearing activity with limited ground impacts do not provoke short-term adverse effects on joint status . Further studies , however , are required to determine the long-term effect of weight-bearing exercise on the health status of individuals with RA OBJECTIVE Fatigue is commonly reported by patients with rheumatoid arthritis ( RA ) but is rarely a treatment target . The aim of this study was to explore the concept of fatigue as experienced by patients with RA . METHODS Fifteen patients with RA and fatigue ( > or = 7 on a 10-cm visual analog scale ) were individually interviewed and asked about the description , cause , consequence , and management of fatigue . Transcripts were systematic ally analyzed by 2 research ers independently , relevant phrases were coded , and earlier transcripts were checked for the emerging codes . A r and om sample of analyses were independently review ed . A total of 191 codes arising from the data were grouped into 46 categories and overarching themes . RESULTS Vivid descriptions reflect 2 types of fatigue : severe weariness and dramatic overwhelming fatigue . RA fatigue is different from normal tiredness because it is extreme , often not earned , and unresolving . Participants described physical , cognitive , and emotional components and attributed fatigue to inflammation , working the joints harder , and unrefreshing sleep . Participants described far-reaching effects on physical activities , emotions , relationships , and social and family roles . Participants used self-management strategies but with limited success . Most did not discuss fatigue with clinicians but when they did , they felt it was dismissed . Participants held negative views on the management of fatigue . CONCLUSION The data show that RA fatigue is important , intrusive , and overwhelming , and patients struggle to manage it alone . These data on the complexity of fatigue experiences will help clinicians design measures , interventions , and self-managment guidance
This review could find no consistent or conclusive evidence on whether exercise impacts on sleep in people who have rheumatoid arthritis , therefore no firm conclusions can be made .
However , there is some indication that exercise may have positive benefits on sleep in people who have rheumatoid arthritis .
To systematic ally search for the availability of evidence for exercise impacting on sleep for people who have rheumatoid arthritis .