'I never thought exercise could help improve my sleep': experiences of people with rheumatoid arthritis on the impact of an 8-week walking-based exercise intervention in improving their sleep

Objective The purpose of this study was to explore the experiences of people with RA of participating in an exercise intervention to improve their sleep.Methods Using a qualitative descriptive design, semi-structured face-to-face interviews were conducted with 12 people with RA who had completed an 8-week walking-based exercise intervention to improve their total sleep time, sleep quality and sleep disturbance. Data were analysed using thematic analysis.Results Four themes were generated: positive impact of exercise on participants' sleep ('I really didn't think any type of exercise would help me sleep better, if I'm honest'); positive experiences of the exercise intervention ('I learnt so much regarding walking that I didn't even think about'); clear mental health benefits ('If you don't sleep well then it will have a knock-on effect to your mental health'); and achieving empowerment and ownership when exercising ('I feel empowered now and confident that I'm not doing harm to myself').Conclusion The findings demonstrated that participants had not expected exercise to improve their sleep. Although there is a growing consensus that exercise will benefit sleep and mitigate some disease symptoms, research is severely lacking in people with RA. What does this mean for patients?A sample of people with rheumatoid arthritis (RA) participated in an 8-week exercise intervention to help improve their sleep. The results of interviewing those who participated demonstrated that they were surprised that exercise could help to improve their sleep quality but found it beneficial and safe. Those who participated in the walking programme found it to be a positive experience, giving them a sense of empowerment, with clear mental health benefits being described. It is acknowledged that people with RA can be less active and engage in lower levels of exercise compared with their healthy counterparts. Participants in this study occasionally engaged in exercise to help manage their symptoms. Participants described positive effects of the walking programme on their mental health, which supports the benefits of exercise in people with RA. Owing to the multifactorial nature of RA and to help mitigate some of its symptoms, engaging in exercise has been widely researched and advised, with our study adding to the existing understanding of the impact of exercise on people with RA. Exercise prescription is a core skill for some health-care professionals (e.g. physiotherapists), who play an important role in educating people with RA on the benefit of increasing their exercise levels in improving their sleep. Therefore, it is essential to explore any negative beliefs regarding the impact of exercise on sleep among these professionals when seeking to promote exercise.