# High-intensity exercise improves multidimensional fatigue and health-related quality of life in rheumatoid arthritis: a randomized controlled study PMID: 40968365 Journal: Arthritis research & therapy Published: 2025-09-18 Authors: 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. ## Population - 87 adults with rheumatoid arthritis, stable antirheumatic treatment, and low-to-moderate disease activity or remission. - Sample size: 87 - Age: Mean 48 years, SD 9.66; eligibility 20-60 years. - Sex: 84% female. - Fitness level: Not regularly performing high-intensity cardiorespiratory exercise; baseline VO2max about 26 ml/min/kg. - Health status: Rheumatoid arthritis with disease duration greater than 1 year and stable antirheumatic treatment. ## Methodology - Secondary analysis of an assessor-blinded, two-arm, multicentre randomized controlled trial. - 12-week intervention with assessments at baseline, 3 months, 6 months, and 12 months. - Rheumatology outpatient recruitment from hospitals in western Sweden; intervention supervised by experienced rheumatology physiotherapists. - Randomized and controlled study design. ## Protocol - Supervised HIIT plus strength exercise. - Modality: 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. - Sets or repetitions: HIIT repetition count not specified; strength 2-3 sets of 8-10 repetitions. - Intensity: 90-95% HRmax for HIIT bouts; 70% HRmax for lower-intensity periods; 70-80% 1RM for strength. - Frequency: Two supervised sessions per week plus encouraged third non-supervised cardiorespiratory session. - Program length: 12 weeks. - Progression: Individually tailored and modified based on capacity, ability, symptoms, and health. - Physical activity counseling and home exercise. - Modality: Moderate-intensity physical activity counseling plus home strengthening and balance exercises. - Intensity: Encouraged moderate intensity activity at least 150 minutes per week. - Program length: 12 weeks with standard outpatient care during the study period. ## Outcomes ### Multidimensional fatigue Status: improved 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). ### Health-related quality of life Status: improved 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. ### Sleep, anxiety, depression, pain, and disease activity at 3 months Status: no clear change 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. ### Safety and disease activity Status: mixed 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. ## Practical 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 And Adherence - 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. ## Original Sources - [PubMed](https://pubmed.ncbi.nlm.nih.gov/40968365/) (pubmed) - [DOI](https://doi.org/10.1186/s13075-025-03643-3) (doi) - [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447605/) (full text) ## Agent Guidance Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.