NEW evidence from a randomized controlled study suggests that high-intensity exercise may offer sustained benefits for fatigue and quality of life in people with rheumatoid arthritis (RA), addressing one of the most persistent and debilitating symptoms of the disease.
Fatigue affects a large proportion of people with RA and often persists even when inflammation is well controlled. While physical activity is widely recommended, uncertainty remains around the optimal type and intensity of exercise needed to achieve meaningful improvements. This multicenter trial aimed to evaluate whether a structured programme combining high-intensity interval training (HIIT) and strength exercise could improve fatigue and related outcomes compared with standard physical activity advice.
Testing High-Intensity Exercise in RA
The study enrolled 87 adults with RA, with a mean age of 48 years, the majority of whom were women. Participants were randomly assigned to either an intervention group that undertook supervised HIIT and strength training for 12 weeks, or a control group that received counselling on general physical activity recommendations.
Outcomes were assessed at baseline and at 3, 6, and 12 months using validated patient-reported measures, including the Multidimensional Fatigue Inventory, sleep quality, mood, pain, and global health-related quality of life. Disease activity was monitored using DAS28-ESR.
Sustained Improvements in Fatigue and Quality of Life
At 3 months, participants in the high-intensity exercise group experienced significantly greater improvements across multiple fatigue domains compared with controls, including general fatigue, physical fatigue, reduced activity, and reduced motivation. Improvements were also observed in overall health-related quality of life.
These benefits persisted at 6 months, with continued significant differences between groups across the same fatigue domains and global health scores. Notably, at 12 months follow-up, improvements in physical fatigue, depressive mood, pain, and global health-related quality of life remained evident in the intervention group, indicating long-term effects beyond the supervised training period.
Importantly, improvements occurred without worsening disease activity, supporting the safety of higher-intensity exercise in this population.
Implications for RA Management
The findings challenge lingering concerns that high-intensity exercise may be poorly tolerated or unsafe in RA. Instead, the results suggest that structured, supervised programmes incorporating HIIT and strength training can deliver meaningful and durable benefits for fatigue, mood, pain, and quality of life.
The authors conclude that high-intensity exercise should be considered a valuable adjunct to pharmacological treatment in RA, particularly for patients struggling with persistent fatigue. By demonstrating benefits that last up to a year, the study supports a shift toward more targeted exercise prescriptions rather than generic activity advice in routine RA care.
