BRIGHTON, ENGLAND – Although patients with rheumatoid arthritis may be aware that regular exercise is good for them, many are afraid to be physically active for fear of damaging their joints.
Other results of an online survey show that a large percentage of patients with rheumatoid arthritis (RA) are unsure of what exercises they can or should perform, and they feel that health care professionals do not always have adequate knowledge to advise them.
Ms. Rebecca-Jane Law
"Exercise is now a very important component within the management of RA," Ms. Rebecca-Jane Law of the School of Sport, Health, and Exercise Sciences at Bangor (Wales) University said April 12, at the British Society for Rheumatology Annual Conference.
"The benefits of high-intensity exercise in RA include improvements in aerobic capacity, strength, physical function, and psychosocial well-being," she added. Ms. Law noted that the use of exercise is a far cry from when bed-rest and splinting was advised back in the 1960s (Ann. Rheum. Dis. 1963;22:91-9) and that the view that exercise might detrimentally affect disease activity or cause exacerbation had been refuted.
However, despite the known benefits of exercise in RA – which might also potentially include improvement of cardiovascular health and prevention of muscle wasting and osteoporosis – RA patients tend to be less active than is the general population. To determine why this might be, Ms. Law and her associates developed an online questionnaire to survey the perceptions of patients towards exercise.
The 32-item questionnaire was based on previous research involving 18 patients with RA who participated in four focus groups. The discussions focused on two main areas: the effects of exercise on the joints and what affected whether people exercised or not. (Rheumatology 2010;49:2444-51).
A total of 247 patients with RA participated in the subsequent online survey. The mean age of the study cohort was 52 years, the mean disease duration was 9 years, and 88% were female. Physical activity was categorized as being low, medium, or high, with 24.5%, 36.9%, and 38.6% of patients, respectively falling into each of these categories.
Noting that only one-quarter of respondents were classed as having low physical activity, which is perhaps encouraging, Ms. Law commented that all the respondents were members of the U.K. National Rheumatoid Arthritis Society (NRAS), so may have been more proactive in the management of their disease than perhaps others with RA were.
Results showed the validity of the questionnaire and that it could be useful in examining patient perceptions in relation to exercise and joint health.
Most respondents (72%) felt that exercise was helpful for RA, although 44% were worried about causing harm to their joints and 52% saying they did not want to exercise because their joints hurt when they did so.
Under half (42%) said they knew what exercises to do and only 19% felt that health care professionals exhibited the knowledge necessary to advise on exercise.
Multiple guidelines – issued independently by the National Institute for Health and Clinical Excellence, the British Society for Rheumatology and the British Health Professionals in Rheumatology, the American College of Sports Medicine, and the European League Against Rheumatism – recommend that aerobic strengthening and mobility exercises be incorporated into patient care.
However, as these results suggest, not all health care professionals are perhaps familiar with this guidance. Or, if they are, they are not able to demonstrate to patients that they know what exercises should be performed, when, how often, and for how long.
Examining health care professional perceptions toward exercise in RA is a future avenue of research, Ms. Law suggested, as is clarifying exercise recommendations to help patients. The ACSM FITT principle, which covers the frequency, intensity, timing and, type of exercise, might be a useful starting point.
Ms. Law declared she had no conflicts of interest.