Sustained Long‐Term Efficacy of Motivational Counseling and Text Message Reminders on Daily Sitting Time in Patients With Rheumatoid Arthritis: Long‐Term Follow‐up of a Randomized, Parallel‐Group Trial

Objective To evaluate the 18‐month postintervention efficacy following a 4‐month individually tailored behavioral intervention on daily sitting time in patients with rheumatoid arthritis (RA). Methods In an observer‐blinded randomized trial, 150 RA patients were included. During 4 months, the intervention group (n = 75) received 3 motivational counseling sessions and tailored text messages aimed at increasing light‐intensity physical activity through reduction of sedentary behavior. The control group (n = 75) maintained their usual lifestyle. The primary outcome was change from baseline to 18 months postintervention in objectively measured daily sitting time (using ActivPAL). Secondary outcomes included changes in clinical patient‐reported outcomes and cardiometabolic biomarkers. A mixed‐effect repeated measures analysis of covariance model in the intent‐to‐treat population was applied. Results At 22 months follow‐up from baseline, 12 participants were lost to follow‐up. Compared to baseline, sitting time in the intervention group decreased 1.10 hours/day, whereas it increased by 1.32 hours/day in the control group, a between‐group difference of –2.43 hours/day (95% confidence interval [95% CI] –2.99, –1.86; P < 0.0001) favoring the intervention group. For most secondary outcomes, between‐group differences favored the intervention: visual analog scale (VAS) pain –15.51 mm (95% CI –23.42, –7.60), VAS fatigue –12.30 mm (95% CI –20.71, –3.88), physical function –0.39 Health Assessment Questionnaire units (95% CI –0.53, –0.26), total cholesterol –0.86 mmoles/liter (95% CI –1.03, –0.68), triglycerides –0.26 mmoles/liter (95% CI –0.43, –0.09), and average glucose –1.15 mmoles/liter (95% CI –1.39, –0.91). Conclusion The 4‐month postintervention results showed that patients in the intervention reduced their daily sitting time and improved patient‐reported outcomes and total cholesterol levels compared to the control group. Eighteen months after intervention, patients in the intervention group were still significantly less sedentary than controls. Findings suggest that a behavioral approach is beneficial for promoting long‐term physical activity and health in patients with RA.