Twenty-four hour physical activity, sedentary behaviour and sleep profiles in adults living with rheumatoid arthritis: a cross-sectional latent class analysis

Abstract

Background: Rheumatoid Arthritis (RA), an autoimmune systemic inflammatory disease, affects more than 17 million people globally. People with RA have higher risk of premature mortality; often experience chronic fatigue, pain and disrupted sleep; and are less physically active and more sedentary than healthy counterparts. It remains unclear how people with RA may balance sleep and awake movement activities over 24-hours, or how differences in 24-hour behaviours may be associated with determinants of health, or alignment with published activity guidelines.

Methods: Cross-sectional exploration of objective measures of 24-hour sleep-wake activities in 203 people with RA. Latent Class Analysis (LCA) derived classes from time, by tertile, in six sleep-awake activities over 24 h. Comparisons of model fit statistics, class separation and interpretability defined best fit for number of classes. Variations in sleep-awake behaviour across classes and association of profile allocation with determinants of health, quality metrics for sleep, sitting and walking and alignment with published guidelines were explored. Multinomial logistic regression identified factors associated with likelihood of profile allocation.

Results: LCA identified 2 to 6 classes and a 4-class model was determined as best fit for 24-hour sleep-awake behaviour profiles. One profile (26%) presented with more balanced 24-hour sleep, sitting and walking behaviours. The other three profiles demonstrated progressively less balanced 24-hour behaviours including: having low (< 7 h), high (> 8 h), or recommended (7-8 h) sleep duration in respective combination with high sitting (> 10 h), limited walking (< 3 h) or both when awake. Age, existing sitting and walking habit strength and fatigue were associated with likelihood of belonging to different profiles. More balanced 24-hour behaviour was aligned with better quality metrics for sleep, sitting and walking and published guidelines.

Discussion: For people living with RA it is important to understand the 'whole person' and their 'whole day' to define who may benefit from support to modify 24-hour sleep-awake behaviours and which behaviours to modify. Supports should be informed by an understanding of personal or health-related factors that could act as barriers or facilitators for behavioural change, including exploring existing habitual sitting and walking behaviours.

Trial registrations: ClinicalTrials.gov ID: NCT02554474 (2015-09-16) and ClinicalTrials.gov ID: NCT03404245 (2018-01-11).

Keywords: 24-hour movement; Latent class analysis; Physical activity; Rheumatoid arthritis; Sedentary behaviour; Sleep.

Fig. 1

Across-profile comparisons: Average time spent in each of six discrete sleep-awake activity categories over 24-hours (1440 min) The images below the figure from left to right represent the following sleep-awake activities: (1) off-body time (unknown activity, likely showering/bathing), (2) lying down asleep, (3) lying down awake (resting), (4) awake non-ambulatory activities (likely sitting or standing still), (5) awake intermittent (lower cadence) walking, and (6) awake purposeful (higher cadence) walking. Average time in each sleep or awake activity category is identified in minutes / day (Y axis), with additional markers embedded in the figure to identify key daily cut- points for time spent sleeping (< 7 and > 8 h), sitting / standing still (< 10 and > 12 h), walking intermittently (lower cadence walking) (< 3 h) and walking purposefully (higher cadence walking) (< 25 min)