PMID 40968365

Research
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High-intensity exercise improves multidimensional fatigue and health-related quality of life in rheumatoid arthritis: a randomized controlled study

Bilberg A, Bjersing J, Börjesson M, Sivertsson J, Mannerkorpi K

Question

Does 12 weeks of supervised high-intensity interval training plus strength exercise improve multidimensional fatigue, sleep, mood, pain, and health-related quality of life in people with rheumatoid arthritis compared with counseling on general physical activity recommendations?

Summary

This assessor-blinded multicentre randomized controlled secondary analysis tested a 12-week supervised high-intensity interval cycling plus strength exercise program in adults with rheumatoid arthritis against counseling on general physical activity recommendations. The intervention improved several dimensions of fatigue and health-related quality of life at 3 months, with several fatigue benefits persisting at 6 months and physical fatigue, depression mood, pain, and global health-related quality of life still favoring the intervention at 12 months. Disease activity remained stable, but one participant had irregular heart rate during HIIT and several had musculoskeletal pain that required exercise modification.

Methodology

  • 87 adults with rheumatoid arthritis, stable antirheumatic treatment, and low-to-moderate disease activity or remission.
  • 87 participants.
  • Cycle ergometer HIIT plus large-muscle-group strength training.
  • Work intervals: High-intensity cycling bouts at 90-95% HRmax; duration not specified in this article.
  • Recovery: Lower-intensity periods at 70% HRmax; duration not specified in this article.
  • Intensity: 90-95% HRmax for HIIT bouts; 70% HRmax for lower-intensity periods; 70-80% 1RM for strength.
  • Two supervised sessions per week plus encouraged third non-supervised cardiorespiratory session.
  • 12 weeks.
  • Secondary analysis of an assessor-blinded, two-arm, multicentre randomized controlled trial.
  • General fatigue, Physical fatigue, Health-related quality of life, and Disease activity were tracked.

Outcomes

Multidimensional fatigue

At 3 months, intervention improved MFI-20 general fatigue, physical fatigue, reduced activity, and reduced motivation versus control, with medium to large effect sizes.

Adjusted mean differences: general fatigue -4.0 (95% CI -5.57 to -2.39), physical fatigue -4.9 (95% CI -6.43 to -3.36), reduced activity -2.5 (95% CI -3.84 to -1.20), reduced motivation -1.8 (95% CI -2.97 to -0.62).

Improved

Health-related quality of life

VAS-global favored intervention at 3 months and remained favorable at 6 and 12 months.

3-month adjusted mean difference -12.8 (95% CI -21.3 to -4.3), p=0.0036; 6-month estimate -9.2 (95% CI -17.47 to -0.94), p=0.030; 12-month estimate -13.6 (95% CI -21.61 to -5.54), p=0.0012.

Improved

Sleep, anxiety, depression, pain, and disease activity at 3 months

Most secondary outcomes did not show statistically significant adjusted between-group changes at 3 months, although health-related quality of life improved.

PSQI p=0.052, HADSa p=0.073, HADSd p=0.076, pain p=0.37, DAS28-ESR p=0.059, ESR p=0.51.

No clear change

Safety and disease activity

Disease activity remained stable, but individual symptom events required modifications.

DAS28-ESR showed no statistically significant adjusted 3-month between-group difference; adherence/safety section reported one irregular heart-rate event and multiple musculoskeletal pain modifications.

Mixed

Insights

  • In medically screened rheumatoid arthritis patients, supervised high-intensity cycling combined with strength training can improve fatigue and quality-of-life outcomes without average disease activity worsening.
  • Clinical HIIT programming for rheumatoid arthritis needs screening, heart-rate monitoring, symptom checks, and modification options for pain and rhythm symptoms.
  • This article does not report enough work-rest detail to reproduce the exact HIIT interval prescription.

Limitations

  • Secondary analysis; no power calculation was performed for fatigue outcomes.
  • The intervention combined HIIT, strength training, motivational strategies, physiotherapist feedback, and diary use.
  • Exact HIIT work-rest duration and total session duration were not reported in this article.
  • Participants may have been more motivated than the broader rheumatoid arthritis population.

Safety

  • One participant in the intervention group experienced irregular heart rate during supervised HIIT and continued at moderate intensity after cardiologist consultation and referral for ultrasound cardiography.
  • Four participants experienced temporary increases in musculoskeletal pain during strength exercise, managed with temporary exercise modifications.
  • One participant experienced persistent musculoskeletal pain midway through intervention and completed without the strength component.
  • Two participants received corticosteroid injections followed by temporary exercise modifications.
  • Disease activity remained stable in both groups through 12 months.