Rheumatoid Arthritis (RA) related joint pain, muscle weakness, dyslipidemia, endothelial dysfunction, and cardiopulmonary involvement place persons with RA at increased risk of physical inactivity and its negative health effects. RA is associated with excess cardiovascular risk exacerbated by physical deconditioning. While advances have been made in the pharmacologic management of RA, interventions to promote physical activity for RA patients are lacking. Evidence-based research strongly supports the use of physical activity and exercise to enhance function and reduce RA associated disability without detrimental effects on joint integrity. However, this medical evidence has not translated into improvements in physical activity. Data indicate that RA patients exhibit suboptimal physical activity participation rates. Critically needed at this time is research that will elucidate the reasons why patients with RA are not engaging in physical activity despite its published benefits. Specifically, we aim to examine factors associated with RA patients'physical activity and exercise patterns in order to inform future exercise interventions. To address this need, we propose to study a prospective cohort of 1089 RA patients enrolled in a large arthritis center's RA registry which contains immunologic and clinical assessments as well as patient-centered outcomes in RA. We will also enroll a subset of 30 patients from University of Alabama who will be randomly sampled for the qualitative component (AIM 3). The research team is experienced in use of this registry and in the conduct of RA related studies. The purposes of this study are: 1) to examine the relationship between physical activity participation and disease activity (patterns of flares and remissions);2) to characterize prognostic factors associated with physical activity participation and 3) to identify profiles ("archetypes") of RA patients who successfully engage in physical activity and those who do not. We will explore and validate these profiles with rheumatologists and patients to develop protocols to guide counseling behaviors. Understanding the relationship between disease activity such as flares and remissions, and physical activity participation among people with RA will enable practitioners to better educate and promote patients'health and well-being through increased physical activity. This proposal's strengths are the significance of the topic of physical activity in RA, integration of theory based quantitative and qualitative approaches to addressing the issue, and the leveraging of a unique registry that enables key data acquisition and provider participation. The PI and team have worked together and have the requisite expertise in the measures and methods to ensure successful attainment of their aims. Findings will inform the development of a future intervention trial that tailors exercise and physical activity recommendations to RA patients according to their characteristics and disease activity and tests an RA exercise/activity protocol for outcome effects. PUBLIC HEALTH RELEVANCE: Project Narrative: This study will describe the characteristics of patients with rheumatoid arthritis (RA) who successfully engage in physical activity and those who do not. This information will be used to develop personally tailored physical activity counseling to promote health and reduce cardiovascular risk of patients with RA.