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Sleeplessness Linked to Less Exercise in Patients With Knee OA
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Poor sleep quality is significantly associated with decreased physical activity in patients who have or are at risk for knee osteoarthritis, according to findings published in Arthritis Care and Research.
“This study is important because there are many health benefits of physical activity in patients with or at high risk for knee OA and even small amounts of physical activity can lead to meaningful improvements in health,” Abigail L. Gilbert, MD, MSCI, of the University of North Carolina Thurston Arthritis Research Center, told Healio Rheumatology. “One possible way to help individuals increase physical activity is to identify those with restless sleep and try to improve those patients’ sleep quality.”
To determine the relationship between self-reported sleep quality and objectively-measured physical activity among adult patients with knee OA, the researchers analyzed data from participants in the Osteoarthritis Initiative (OAI). They focused on 2,127 patients with knee OA who were enrolled in an accelerometer ancillary study at the OAI from 2008 to 2010. Among those participants, 1,892 provided complete data.
Gilbert and colleagues analyzed the participants’ physical activity as measured by the accelerometers, as well as clinical data provided in the OAI. In addition, they used multiple regression analysis to determine the patients’ physical activity, grouped by self-reported occurrences of sleeplessness, adjusting for demographic and medical confounders.
According to the researchers, among the 1,892 participants who provided complete data, 16% reported experiencing restless sleep 3 or more days within that past week. Those who reported having 3 to 4 days of restless sleep per week had 11.9% fewer weekly minutes of moderate-to-vigorous physical activity compared with those who were restless just once per week; for participants who reported 5 to 7 days of restless sleep per week, there was 23.7% less activity. Differences persisted after accounting for age, gender, race, BMI, comorbidity, knee OA severity and pain. The researchers also found that differences related to sleeplessness were attenuated by the presence of depression symptoms and low energy.
“There is a significant relationship between restless sleep and physical activity with depression and energy levels serving as possible mediators,” Gilbert said. “It is hard to know if poor sleep leads to low physical activity, or low physical activity leads to restless sleep — I anticipate the relationship goes both ways.”
Gilbert noted that clinicians may need to help patients improve sleep quality to assist in effectively increasing physical activity. She added that increasing physical activity could also help patients’ sleep quality, and stressed the importance of encouraging patients to increase their physical activity, even when they have low energy and feel tired.
“I would encourage physicians to discuss the many health benefits of physical activity in patients with or at high risk for knee OA,” Gilbert said. “Talking about the relationship between restless sleep and physical activity with patients and finding ways to help them focus on both concurrently could help them increase physical activity and improve their health.” – by Jason Laday
Disclosure: Gilbert reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Iris Zink, MSN, RN, ANP-BC, RN-BC
The study from Gilbert and colleagues successfully shows the correlation between physical inactivity, depression and restless sleep. Although several previous studies have concluded similar results, it is important that the direction of the relationship continue to be studied in order to accurately educate patients and improve quality of life.
Exercise has been shown to reduce pain and disability in individuals with osteoarthritis, as noted in by Juhl and colleagues in Arthritis & Rheumatology. As the pain decreases with exercise, sleeping may become more comfortable, thus improving in restful sleep. Knowledge of the direction in this relationship would allow providers to narrow their focus in treatment of either sleep disturbances or physical activity, benefiting care of patients.
Having an increased number of medical conditions and concurrent illnesses have shown to be factors in decreasing patient adherence to short- and long-term treatments, as demonstrated by Kardas and colleagues in Frontiers in Pharmacology. Determining whether restless sleep causes physical inactivity, or more likely a lack of exercise leads to reduced sleep quality and increased risk of depression, would allow providers to work with patients in the treatment of one problem, rather than two, reducing risk of non-adherence and benefitting patient care.
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