Comparison of energy expenditure from lifestyle physical activities between patients with rheumatoid arthritis and healthy controls

Objective Low energy expenditure is a risk for cardiovascular morbidity. The goals of this study were to compare energy expenditure between patients with rheumatoid arthritis (RA) and healthy controls. Methods A total of 121 RA patients and 120 healthy controls in New York City completed the Paffenbarger Physical Activity and Exercise Index at time of enrollment (1999–2000) and 1 year later to measure energy expenditure from walking, climbing stairs, and exercise/sports. Analyses were adjusted for age, sex, education, pain, social support, and depressive symptoms and were compared with recommended thresholds of energy expenditure. Results Participants' mean age was 49 years, and 87% were women. Patients with RA expended fewer kilocalories per week than controls (mean ± SD 1,474 ± 1,198 versus 1,958 ± 1,940, P = 0.003), with most of this difference from less walking as opposed to high-intensity activities. Although similar percents of RA patients and controls met national recommendations for total weekly energy expenditure (56% versus 64% for the lower [≥1,000 kilocalories per week] threshold; P = 0.14, and 41% versus 48% for the higher [≥1,400 kilocalories per week] threshold; P = 0.17), fewer RA patients met the recommendations (≥700 kilocalories per week) for walking (32% versus 48%; P = 0.01). The strongest predictor of more energy expenditure at 1 year for both groups was more energy expenditure at enrollment. Conclusion Most of the difference in energy expenditure between RA patients and healthy controls was due to less walking. Given that walking is an effective and relatively safe lifestyle activity, increasing walking should be a priority to improve cardiovascular risk in RA.