What is associated with being active in arthritis? Analysis from the Obstacles to Action study

Long-time follow up of physical activity level among older adults with rheumatoid arthritis

BACKGROUND

Physical activity and exercise are acknowledged as important parts in the management of rheumatoid arthritis (RA). However, long-term maintenance of exercise is known to be difficult. The aim of this study was to evaluate change in physical activity and physical fitness after four years in older adults with RA who had previously participated in exercise with person-centred guidance compared to controls.

METHOD

A follow-up study was performed where older adults (> 65 years) who had participated in a randomized controlled trial where they were allocated to either exercise with person-centred guidance or home-based, light-intensity exercise (controls) were invited to one visit and assessed with performance-based test, blood-sampling and self-reported questionnaires. Forty-seven out of 70 older adults accepted participation, 24 from the exercise group and 23 from the control group. Comparisons of the result with baseline values were performed and explanatory factors for increase of physical activity were examined with logistic regression.

RESULTS

The result show that there was no significant difference in weekly hours of physical activity when groups where compared. However, participants in the exercise group rated significantly increased weekly hours of physical activity after four years (p = 0.004) when compared to baseline. Higher levels of fatigue, BMI and physical activity, at baseline were negatively associated with increased physical activity after four years. There was no significant difference in change of physical fitness between the groups. Within group analysis showed that the control group reported increased pain (p = 0.035), fatigue (p = 0.023) increased number of tender joints (p = 0.028) higher disease activity (p = 0.007) and worsening of global health (p = 0.004) when compared to baseline while the exercise group remained at the same level as at baseline.

CONCLUSION

These results indicate that introducing moderate- to high intensity exercise with person-centred guidance might favor increased physical activity after four years in older adults with RA. Previous partaking in moderate- to high intensity exercise might also be protective against increased disease activity, pain and fatigue over time.

Determining Rheumatology Patient Interest in a Group Strength Training Program - Results of an Exercise Survey

Background:

Exercise has proven benefits in rheumatologic disease including reducing inflammation and improving symptoms. A Group Strength Training (GST) program design has improved adherence to exercise in primary care patients but the effect is unknown in rheumatology patients. We examined the interest of rheumatology patients with different diagnoses and the effect of comorbidities in pursuing an organized GST program.

Methods:

We conducted a cross-sectional survey of patients from a rheumatology practice in central Pennsylvania in February and April 2017. This survey assessed self-reported interest of patients in a GST program in addition to demographics, comorbidities, and quality of life measures. Primary care data from a previous survey were used for comparative analysis for the primary outcome: interest in a GST program.

Results:

Fifty percent of rheumatology patients were interested in a GST program and there was no difference of interest compared to primary care patients (X² = 2.04, p = 0.15). There was no difference in interest in a GST program for rheumatology patients with poor health compared to patients with good health (OR = 0.9, p = 0.8). Female patients were more interested in a group strength training program than male patients (OR = 3.7, p = 0.001). Patients with a BMI of 25–30 (OR = 2.2, p = 0.04) or > 30 (OR = 1.7, p = 0.12) were more interested compared to those with a normal BMI. There was no difference in interest in group strength training regardless of rheumatology diagnosis or comorbidities.

Conclusion:

Our data suggest that rheumatology patients are interested in a GST program regardless of disease, medical comorbidities, perceived mental or physical health, or education level. Further study is needed to determine the effects of GST on rheumatologic diseases.

Balance, falls, and exercise: Beliefs and experiences in people with hemophilia: A qualitative study

BACKGROUND

Prior research has established that falls are commonplace in adults with hemophilia, and advises that physical therapy and exercise are successful in fall prevention. Recognizing obstacles and catalysts to physical therapy and exercise in people with hemophilia may augment the efficacy of efforts to prevent falls in this population.

OBJECTIVES

To learn about the experiences and ideas of patients with hemophilia, especially associated with balance, falls, and exercise.

METHODS

Semi-structured interviews with 14 adult patients with hemophilia were performed. The interviews were coded for themes founded on the study aims.

RESULTS

Most subjects described difficulty with balance, often ascribed to joint problems. They believed that staying strong and fit could positively influence balance, but expressed concerns and fear related to falling. Those who exercised regularly did not view exercise as hazardous, while those who did not dependably exercise articulated worry that dangers of exercise may offset the benefits. The most common obstacle to exercise was pain and having someone to exercise with was often described as an enabler. Barriers to partaking in physical therapy included weak proof of its success and distrust in the therapist. Positive physical therapy experiences in the past and the connection with the therapist were reported as facilitators.

CONCLUSIONS

People with hemophilia describe some attitudes and experiences that are unique to hemophilia while others are found in the general population. Attending to fear, pain, and support for interventions, while encouraging a robust therapeutic alliance and a plan for routine exercise may aid fall prevention behaviors.

Health and Lifestyles Factors Associated With Osteoarthritis among Older Adults in Portugal

OBJECTIVE

This study aimed to identify independent associations of sociodemographic, functionality, physical activity, physical and mental health, and osteoarthritis (OA), among older adults.

METHODS

A sample of 1,645 older adults (50+ years) observed by rheumatologists, from EpiReumaPt, a population-based study was analyzed. A structured interview included sociodemographic data, chronic non-communicable disease, and physical activity. Functional ability was assessed by the Health Assessment Questionnaire Disability Index; depression and anxiety were assessed by Hospital Anxiety and Depression Scale. OA (knee OA and/or hip OA and/or hand OA) was defined after medical evaluation by rheumatologists according to expert opinion combined with the fulfillment of the American College of Rheumatology classification criteria.

RESULTS

1,059 participants (64.9%) met the OA classification criteria. Statistically significant differences were found between persons with and without OA in all sociodemographic variables, non-communicable diseases, functional status, physical activity, depression, and anxiety. In the unadjusted logistic regression models, all variables were associated with OA. The final adjusted model explained 32% of the variance. Those who are female with higher age, have more than five comorbidities, and lower levels of function and physical activity were more likely to meet the criteria for a diagnosis of OA.

DISCUSSION

We have analyzed data from a population-based study and found that a diagnosis of OA was independently associated with age, female gender, higher number of comorbidities, physical disability, and low levels of physical activity. These results reinforce the usefulness of the development of a multidimensional assessment to design and test effective interventions for this population.

Relationship Between Attitudes and Beliefs and Physical Activity in Older Adults With Knee Pain: Secondary Analysis of a Randomized Controlled Trial

OBJECTIVE

To investigate how attitudes and beliefs about exercise relate to physical activity behavior in older adults with knee pain attributable to osteoarthritis (OA).

METHODS

We conducted secondary data analyses of a randomized controlled trial of exercise interventions (ISRCTN: 93634563). Participants were adults ≥45 years old with knee pain attributable to OA (n = 514). Crude and adjusted cross-sectional and longitudinal associations between baseline Self-Efficacy for Exercise (SEE), Positive Outcome Expectations for Exercise (POEE), Negative Outcome Expectations for Exercise scores, and physical activity level, at baseline, 3 months, and 6 months (measured by self-report using the Physical Activity Scale for the Elderly [PASE]), and important increases in physical activity level (from baseline to 6-month followup) were investigated using multiple linear and logistic regression.

RESULTS

Cross-sectional associations were found between SEE and PASE scores (β = 4.14 [95% confidence interval (95% CI) 0.26, 8.03]) and POEE and PASE scores (β = 16.71 [95% CI 1.87, 31.55]), adjusted for sociodemographic and clinical covariates. Longitudinal associations were found between baseline SEE and PASE scores at 3 months (β = 4.95 [95% CI 1.02, 8.87]) and 6 months β = 3.71 (0.26, 7.16), and baseline POEE and PASE at 3 months (β = 34.55 [95% CI 20.13, 48.97]) and 6 months (β = 25.74 [95% CI 11.99, 39.49]), adjusted for baseline PASE score and intervention arm. However, no significant associations with important increases in physical activity level were found.

CONCLUSION

Greater exercise self-efficacy and more positive exercise outcome expectations were associated with higher current and future physical activity levels. These may be targets for interventions aimed at increasing physical activity.

Psychosocial factors associated with increased physical activity in insufficiently active adults with arthritis

OBJECTIVES

Although physical activity can potentially reduce symptoms of arthritis, 50% of people with arthritis are insufficiently active. The aim was to identify psychosocial factors associated with increased physical activity in mid-age adults with arthritis who did not meet recommended physical activity levels.

DESIGN

Longitudinal cohort study.

METHODS

Data were from 692 insufficiently active men and women (mean age 55 ± 6.6 years) with arthritis, who answered mailed surveys in 2007 and 2009 in the HABITAT study. Increased physical activity was defined as a change of ≥ 200 MET min/week in walking, moderate and vigorous activities from 2007 to 2009. Scale scores were used to measure psychosocial factors including intention, experiences, attitudes, efficacy, barriers, motivation, social support, and health professional advice. Associations between (1) 2007 psychosocial factors and (2) 2007-2009 improvement (≥ +1 standard deviation) in psychosocial factors and increased physical activity were examined with logistic regression models. Results were adjusted for education, body mass index, and self-rated health.

RESULTS

Between 2007 and 2009, 296 participants (42.8%) increased their physical activity. Engagement, mastery and physical activity intention in 2007 were associated with this increase in physical activity (engagement OR = 1.11, 99% confidence interval (CI) = 1.05-1.17; mastery OR = 1.12, 99%CI = 1.02-1.22; physical activity intention OR = 1.29, 99%CI = 1.06-1.56). Improved scores for encouragement (OR = 2.07, CI = 1.07-4.01) and self-efficacy (OR =2 .27, CI = 1.30-3.97) were also significantly associated with increased physical activity.

CONCLUSIONS

Positive physical activity experiences and intentions were predictors of increased physical activity among people with arthritis. Improved physical activity confidence and social support were associated with increased physical activity. It is important to consider these psychosocial factors when planning physical activity interventions for people with arthritis.

Self-efficacy and arthritis disability: An updated synthesis of the evidence base and its relevance to optimal patient care

Self-efficacy, denoting the degree of confidence an individual has in carrying out a specific activity, was initially discussed in the 1970s as a potential correlate of disease outcomes. Drawn from 35 years of related research, this review provides an updated understanding of the concept of self-efficacy and its relevance for arthritis management. There is a consistent link between self-efficacy, arthritis pain and disability, and adherence to recommended therapeutic strategies. A wide variety of intervention strategies improve arthritis self-efficacy, as well as outcomes. Steps to assess and intervene thoughtfully to maximize self-efficacy beliefs are likely to impact arthritis disability outcomes quite favorably and significantly, regardless of disease type, duration, or sociodemographic factors.

Physical activity maintenance in patients with rheumatoid arthritis: a qualitative study

Objective:

To describe the experience of physical activity maintenance in patients with rheumatoid arthritis.

Design:

A qualitative salutogenic-oriented interview study.

Setting:

A rheumatology outpatient clinic.

Subjects:

A purposive sample of 16 physically active patients (mean age 50, range 37–67) diagnosed with rheumatoid arthritis on average 21 years previously (range 4–46 years).

Methods:

In-depth interviews were conducted using a semi-structured interview guide to illuminate how the phenomenon ‘physical activity maintenance’ was experienced by patients with rheumatoid arthritis. The interviews were analysed using systematic text condensation, inspired by Giorgi’s descriptive phenomenological methodology.

Results:

The analysis revealed three categories: (1) knowing and enjoying the body; (2) responsibility and challenges; (3) autonomy and social belonging. On the basis of these categories, the essential meaning of the phenomenon of physical activity maintenance for patients with rheumatoid arthritis was summarized into ‘striving for a transparent body and participation’, pointing to experiences of sensations of wellbeing, liberation from restrictions and social participation on equal terms with non-arthritis populations.

Conclusion:

This study demonstrates that physical activity in patients with rheumatoid arthritis may be understood as a resource to resist disability and to feel and stay healthy while creating and sustaining meaningfulness in life.

Perceptions of issues relating to exercise and joint health in rheumatoid arthritis: a UK-based questionnaire study

OBJECTIVES

This questionnaire study investigated the perceptions of rheumatoid arthritis (RA) patients across the UK in relation to exercise and joint health. The validity of the measure was also assessed.

METHODS

Members of the National Rheumatoid Arthritis Society (NRAS) with self-reported RA completed the questionnaire online. Items related to five factors that emerged from previous qualitative research. Participants responded using a five-point Likert-style scale (strongly disagree to strongly agree). The International Physical Activity Questionnaire (IPAQ) assessed physical activity. The model was tested using confirmatory factor analysis (LISREL 8.8); statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS).

RESULTS

A total of 247 responses were collected over 47 days (88% females; age: 18-77 years; disease duration: <1-51 years). Acceptable factorial validity was revealed (Satorra-Bentler χ(2)  = 774.47, df = 454, p < 0.001, root mean squared error of approximation (RMSEA) = 0.05, 90% confidence interval RMSEA = 0.05-0.06, comparative fit index = 0.94, standardized root mean square residual = 0.09), with the following factor endorsements: 'Health professionals show exercise knowledge' (19%); 'Knowing what exercise should be done' (43%); 'Having to exercise because it is helpful' (72%); 'Worry about causing harm to joints' (44%); and 'Not wanting to exercise as joints hurt' (52%). Patient concerns about joint pain, joint harm and how to exercise were significantly associated with lower physical activity (p < 0.05).

CONCLUSIONS

These results confirm that patients perceive exercise as beneficial. However, concerns about how to exercise, joint pain, causing harm to joints and a perceived lack of exercise knowledge among health professionals remain. Addressing these concerns may have implications for increasing physical activity within the RA population.

Benefits of exercise in rheumatoid arthritis

This paper aims to highlight the importance of exercise in patients with rheumatoid arthritis (RA) and to demonstrate the multitude of beneficial effects that properly designed exercise training has in this population. RA is a chronic, systemic, autoimmune disease characterised by decrements to joint health including joint pain and inflammation, fatigue, increased incidence and progression of cardiovascular disease, and accelerated loss of muscle mass, that is, “rheumatoid cachexia”. These factors contribute to functional limitation, disability, comorbidities, and reduced quality of life. Exercise training for RA patients has been shown to be efficacious in reversing cachexia and substantially improving function without exacerbating disease activity and is likely to reduce cardiovascular risk. Thus, all RA patients should be encouraged to include aerobic and resistance exercise training as part of routine care. Understanding the perceptions of RA patients and health professionals to exercise is key to patients initiating and adhering to effective exercise training.