PhD Perspectives: Reducing sedentary behaviour in rheumatoid arthritis

My name is Florentia Kitas, and I am a PhD student at the University of Birmingham’s School of Sport, Exercise and Rehabilitation Sciences. Originally from Greece, I have a Bachelor’s in Psychology and a Master’s in Mental Health Studies, which have equipped me with a deep understanding of human behaviour and the psychological complexity of living with chronic illness. It was this foundation that naturally drew me toward my current research, which focuses on reducing sedentary behaviour in people with rheumatoid arthritis.

Sitting less, feeling better: What my research is about

I am developing an intervention to reduce sedentary behaviour in people with rheumatoid arthritis (RA).

We know that physical activity can help reduce inflammation and improve health outcomes for people with RA. We also know that spending long periods sitting down is associated with an increased risk of cardiovascular disease and mortality.

However, taking part in moderate-to-vigorous physical activity can be both objectively and subjectively challenging for people with RA, particularly during flare-ups or for those with limited physical function, chronic pain, or fatigue.

Reducing sedentary behaviour may therefore offer a more acceptable and feasible way to promote movement and improve health in this population.

For lifestyle interventions to be effective, they must be informed by the needs and preferences of those who will use them. My research aims to understand the experiences, perspectives and day-to-day realities of people living with RA, helping identify the barriers and opportunities that influence sedentary behaviour and informing the design of an intervention that is both practical and meaningful.

More than exercise: Why this research matters

For many people living with rheumatoid arthritis, pain and fatigue can make traditional exercise difficult. Reducing the amount of time spent sitting may offer a more realistic and achievable way to improve both psychological and physical health and wellbeing.

Lower levels of sedentary behaviour are linked to reduced systemic inflammation, which may result in fewer flares and less joint pain. Reducing sedentary time can also alleviate fatigue, one of the most debilitating and undertreated symptoms of RA, as well as improve mood and reduce anxiety and depression.

Further benefits include preserved muscle mass and joint mobility, slowing the functional decline that leads to disability, and reduced cardiovascular risk.

Importantly, sitting less is not simply the same as exercising more. These are distinct behaviours with different underlying mechanisms and effects on health. Despite this, sedentary behaviour remains relatively underexplored in rheumatoid arthritis.

By building evidence in this area, my research could help support the inclusion of sedentary behaviour reduction within routine RA management and inform future physiotherapy and occupational therapy approaches, beyond traditional exercise prescription.

Understanding the barriers: My research approach

Given the scarcity of sedentary behaviour interventions specifically designed for people with RA, my PhD follows a systematic, staged approach.

I began with a systematic review compiling existing evidence on sedentary behaviour interventions in RA, with a focus on behaviour change techniques and digital delivery methods.

This was followed by a qualitative study exploring the lived experiences of sedentary behaviour among people with RA, examining psychosocial, cultural, and identity-related factors that influence how and why people spend time sitting.

By building on these findings, I informed the development of a cross-sectional, survey-based study examining how factors such as personality traits, self-determined motivation, RA symptoms and mental wellbeing are associated with sedentary behaviour and physical activity.

Additionally, I have been part of an ecological momentary assessment (EMA) study – a research method that repeatedly collects real-time data on a person’s behaviours and emotions, as they occur in their daily life. The study aims to develop a digital health intervention to help people living with rheumatoid arthritis increase their daily physical activity. This will be done through designing a mobile health app – the MISSION-RA app – which links with a popular physical activity tracker, the Fitbit. The MISSION-RA app will be designed specifically for, and by, people living with rheumatoid arthritis. Artificial intelligence will be used within the app to provide personalised support, based on a person’s activity patterns and self-reported symptoms such as pain, fatigue and mobility.

The final stage of my PhD will involve a co-design workshop with key stakeholders to develop the intervention that directly addresses the barriers and facilitators identified throughout my research.

Breaking the cycle of pain and inactivity

The idea that sitting less is a distinct, separable behaviour with its own biological effects – rather than simply the absence of exercise – is still relatively new and poorly understood in RA, and it is exciting to be working at the frontier of that distinction.

What motivates me most is the prospect of identifying the cognitive and motivational processes that underpin this behaviour, beyond commonly reported physical outcomes. Understanding these could help us develop more effective interventions and improve patient outcomes.

The intersection of behavioural science, pain psychology, and physiology makes this a genuinely complex and compelling problem.

People with RA often sit because they are in pain, yet inactivity likely worsens the very inflammation driving that pain. Designing an intervention that helps break that cycle is both challenging and deeply motivating.

Finally, given that people with RA tend to be more sedentary than the general population, the potential for meaningful change is considerable.

Growing as a researcher: My experience as a BRC PhD student

My PhD, funded by the NIHR Biomedical Research Centre (BRC): Birmingham, has provided an exceptional environment in which to grow as a researcher.

My collaboration with the National Rheumatoid Arthritis Society has been among the most personally enriching aspects of my PhD, grounding my research in the real lived experiences of people with RA and deepening my commitment to producing work that is both scientifically rigorous and genuinely meaningful.

The BRC’s collaborative links with University Hospitals Birmingham, and specifically the Queen Elizabeth Hospital, have also been central to my work, enabling me to recruit RA patients for an accelerometry study within a richly clinical environment.

Thanks to the BRC’s workforce development support, I have completed courses in incorporating patient-reported outcome measures in clinical trials and in qualitative data analysis using NVivo, building a complementary set of quantitative and qualitative skills.

Alongside this, I have published one article in BMC Rheumatology and have a second manuscript under review in Rheumatology Advances in Practice. I have presented my work at postgraduate research days and have presented a poster at the Building Capacity in Behavioural Research Conference.

Throughout my PhD, I have benefited enormously from the expert supervision of Dr Sally Fenton and Professor Jet van Zanten, whose combined expertise in behavioural science, physical activity, and rheumatology has provided both intellectual rigour and genuine encouragement.

Looking ahead

While my longer-term career path remains an evolving question, my PhD has positioned me at a compelling intersection of physical health, behaviour change, and chronic illness management.

My background in mental health has never felt distant from this work – if anything, it has deepened my appreciation for the psychological complexity of living with RA, where pain, fatigue, and self-efficacy are as central to the patient experience as the disease biology itself.

This has sparked a growing interest in integrating psychological support more meaningfully into chronic illness management – for instance, exploring how approaches such as cognitive behavioural therapy, acceptance and commitment therapy, or motivational interviewing might complement behavioural interventions like sedentary behaviour reduction to address both the physical and emotional burden of RA.

I am particularly drawn to questions around how people with chronic conditions sustain health behaviours over time in the face of fluctuating symptoms, low mood, and uncertainty – a challenge that sits squarely at the intersection of my mental health background and my current research, and one I hope to pursue within an academic setting.