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Physical Activity and Therapy May Decrease Fatigue in People with Rheumatoid Arthritis

Joint pain is the hallmark symptom of rheumatoid arthritis (RA) but many who have RA also know that fatigue can be just as frustrating and debilitating. The inflammatory condition that causes RA itself can cause fatigue but there are other factors that can wear you down. Stress of dealing with a chronic disease and pain can be wearing and fatigue itself can worsen pain creating a constant cycle. Managing fatigue can be an important part to breaking the cycle and managing RA's impact on your day to day life. Medications can help manage inflammation process but the medications themselves can also contribute to fatigue.

Researchers wanted to find treatment options other than medications to help provide fatigue relief. The study, published in the Cochrane Database of Systematic Reviews, found that regular physical activity and psychosocial therapy helped decrease fatigue.

About the Study    TOP

The systematic review included 24 randomized trials that assessed non-medication interventions for fatigue in 2,882 adults with RA. Six of the trials with 388 participants assessed physical activity interventions including pool exercise, yoga, strength training, indoor cycling, low impact aerobics, or tai chi. The review found that compared to controls, physical activity was associated with decreased fatigue.

Psychosocial therapies were assessed in 13 trials with 1,579 people. These therapies may include talk therapy focused on behavior change, group education, and lifestyle changes. The review found that these therapies were also associated with a with a decrease in fatigue compared to controls.

There was not enough quality evidence to assess the benefits of other interventions including herbal medicine, omega-3 fatty acid supplementation, Mediterranean diet, or reflexology.

How Does This Affect You?    TOP

Systematic reviews are considered one of the most reliable forms of research because they create a large pool of participants. Studies with large pools of participants increase the reliability of the outcome but, the review is only as reliable as the studies that are included. There were some problems with the studies included in the physical activity and psychosocial review that would decrease the reliability of the review. The other factors that were studied only had 1 trial each so it was not possible to pool the data for more reliable results. Overall, the results of this trials are similar to the results of other research that supports physical activity and psychosocial interventions to help manage chronic health conditions and improve general health.

There are many factors that can contribute to RA fatigue. Effectively managing fatigue and other RA symptoms may require a combination of medical and lifestyle changes. Communicate with your doctor about your RA symptoms to make any necessary treatment changes but consider lifestyle changes like regular physical activity or changes in thought process to help you manage symptoms and the effect of RA on your life. Explore different exercise options and psychosocial interventions to find one that works best for you and remember that inactivity and stress can actually make your symptoms worse.


American College of Rheumatology
Arthritis Foundation


Cramp F, Hewlett S, Almeida C, et al. Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev. 2013 Aug 23;8:CD008322.
Last reviewed October 2013 by Michael Woods, MD
Last Updated: 10/15/2013

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