Developing a group intervention to manage fatigue in rheumatoid arthritis through modifying physical activity

Victoria E. Salmon*, Sarah Hewlett, Nicola E. Walsh, John R. Kirwan, Maria Morris, Marie Urban, Fiona Cramp

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

3 Citations (Scopus)
211 Downloads (Pure)


Background: Fatigue is a major symptom of rheumatoid arthritis (RA). There is some evidence that physical activity (PA) may be effective in reducing RA fatigue. However, few PA interventions have been designed to manage fatigue and there is limited evidence of end-user input into intervention development. The aim of this research was to co-design an intervention to support self-management of RA fatigue through modifying PA. Methods: A series of studies used mixed methodological approaches to co-design a fatigue management intervention focused on modifying PA based on UK Medical Research Council guidance, and informed by the Behaviour Change Wheel theoretical framework. Development was based on existing evidence, preferences of RA patients and rheumatology healthcare professionals, and practical issues regarding intervention format, content and implementation. Results: The resulting group-based intervention consists of seven sessions delivered by a physiotherapist over 12 weeks. Each session includes an education and discussion session followed by supervised PA chosen by the participant. The intervention is designed to support modification and maintenance of PA as a means of managing fatigue. This is underpinned by evidence-based behaviour change techniques that might support changes in PA behaviour. Intervention delivery is interactive and aims to enhance capability, opportunity and motivation for PA. Conclusion: This study outlines stages in the systematic development of a theory-based intervention designed through consultation with RA patients and healthcare professionals to reduce the impact of RA fatigue. The feasibility of future evaluation of the intervention should now be determined.

Original languageEnglish
Article number194
Number of pages13
JournalBMC Musculoskeletal Disorders
Issue number1
Publication statusPublished - 4 May 2019


  • Co-design
  • Fatigue
  • Intervention development
  • Patient and public involvement
  • Physical activity
  • Rheumatoid arthritis
  • Self-management


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