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Original research
Diurnal patterns of sedentary time in rheumatoid arthritis: associations with cardiovascular disease risk
  1. Sally A M Fenton1,2,
  2. Nikos Ntoumanis3,
  3. Joan L Duda1,
  4. George S Metsios2,4,
  5. Peter C Rouse5,
  6. Chen-an Yu6,
  7. George D Kitas1,2 and
  8. Jet J C S Veldhuijzen van Zanten1,2
  1. 1School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  2. 2Russells Hall Hospital, Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
  3. 3Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, Perth, Australia
  4. 4Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
  5. 5Department for Health, University of Bath, Bath, UK
  6. 6Institute of Sport, University of Chichester, Chichester, UK
  1. Correspondence to Sally AM Fenton;s.a.m.fenton{at}


Objectives Research demonstrates that sedentary behaviour may contribute towards cardiovascular disease (CVD) risk in rheumatoid arthritis (RA). This study explored diurnal patterns of sedentary time and physical activity (PA) in RA and examined associations with long-term CVD risk.

Methods 97 RA patients wore an accelerometer for 7 days to assess sedentary time, light-intensity and moderate-to-vigorous-intensity PA. Estimated 10-year CVD risk was determined via QRISK score. Hourly estimates of sedentary time and PA (min/hour) were computed for valid-wear hours (ie, valid-wear = 60 min/hour of activity data, ≥3 days). Hourly data were averaged across time periods to represent morning (08:00–11:59), afternoon (12:00–17:59) and evening (18:00–22:59) behaviour. Participants providing data for ≥2 complete time periods/day (eg, morning/evening, or morning/afternoon) were used in the main analysis (n = 41). Mixed linear modelling explored the associations between 10-year CVD risk and within-person (time: morning, afternoon, evening) changes in sedentary time and PA.

Results Sedentary time was higher, and light-intensity and moderate-to-vigorous-intensity PA lower in the evening, compared to morning and afternoon. Significant interactions revealed individuals with higher CVD risk were more sedentary and did less light-intensity PA during the afternoon and evening. Findings remained significant after adjustment for disease duration, functional ability and erythrocyte sedimentation rate.

Conclusion Results suggest that the evening time period may offer a significant window of opportunity for interventions to reduce sedentary behaviour in RA and contribute to associated improvements in CVD risk. Due to inverse patterns of engagement, replacing sedentary time with light-intensity PA may offer an effective approach for intervention.

  • Cardiovascular disease
  • psychology
  • rheumatoid arthritis
  • arthritis
  • rheumatoid
  • rehabilitation

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  • Contributors All authors (SAMF, NN, JLD, GSM, PCR, CY, GDK and JJCSVvZ) were involved in forming the concept and research aims and developing the methodology for this study. PCR, CY and SAMF conducted data collections and managed the data. SAMF, JJCSVvZ, and NN were responsible for analysing the data, and JLD, GSM, GDK and PCR provided input throughout the process. SAMF and JJCSVvZ wrote the first draft of this manuscript, with reviews and revision undertaken by all authors. All authors read and approved the final manuscript.

  • Funding This study was funded by the Medical Research Council (UK), National Prevention Research Initiative (NPRI), Phase 3.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

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