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Yekini A, Grace JM. Effects of Exercise on Body Composition and Physical Function in Rheumatoid Arthritis Patients: Scoping Review. Open Access Rheumatol 2023; 15:113-123. [PMID: 37521003 PMCID: PMC10378614 DOI: 10.2147/oarrr.s412942] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 08/01/2023] Open
Abstract
Background In rheumatoid arthritis (RA) patients, an adverse change in body composition, which usually results in muscle wasting and increased fat mass, is high, contributing to increased functional disability. There are indications that resistance and dynamic exercise interventions could improve body composition and functional capacity in RA patients and should be recommended to manage RA. Purpose The scoping literature review aimed to analyze available literature about the effects of exercise on body composition in RA patients. Secondly to identify the contribution of exercise to improve physical function in RA patients, thirdly to identify gaps in the literature about physical exercises and health outcomes in RA patients, and make recommendations for future research. Methods A scoping literature review design was employed following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. A systematic search of three databases (PubMed, CINAHL, and Scopus) for studies published from 2012 to 2022 was conducted. The words searched include "exercise intervention" AND "body fat" OR "muscle wasting" OR "lean body mass" AND "functional ability" OR "health assessments". The search strategy was limited to studies published in English on RA patients and exercise interventions. Results This search yielded 2693 studies, of which 11 met the inclusion criteria and were selected for review. The findings showed significant, positive effects of exercise interventions on RA patients' body composition and functional capacity, with exercise being highly beneficial. It is evident that high-intensity resistance exercise, as a stand-alone intervention, is feasible and safe for managing RA conditions. Conclusion Physical exercises, following scientific guidelines, should be included as an integrated approach to managing RA conditions.
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Affiliation(s)
- Amidu Yekini
- Discipline of Biokinetics, Exercise and Leisure science, College of Health Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Jeanne Martin Grace
- Discipline of Biokinetics, Exercise and Leisure science, College of Health Sciences, University of Kwazulu-Natal, Durban, South Africa
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Leach W, Doherty C, Olave M, England BR, Wysham K, Kerr G, Quinones M, Ogdie A, White D, Neogi T, Scanzello CR, Baker JF. Protocol for a multi-center randomized controlled trial to evaluate the benefits of exercise incentives and corticosteroid injections in osteoarthritis of the knee (MOVE-OK). Trials 2022; 23:604. [PMID: 35897080 PMCID: PMC9327347 DOI: 10.1186/s13063-022-06529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a high-priority problem among the aging population. While exercise has been shown to be beneficial in management of the disease, scalable and low-cost interventions to improve exercise in this population are lacking. Recent controversy over the value of corticosteroid injections for palliation has also arisen. Therefore, we designed a randomized, double-blind, placebo-controlled clinical trial with a 2-period crossover design to study (1) behavioral incentives to promote exercise and (2) corticosteroid injections to reduce pain and improve function in patients with KOA when compared to lidocaine only. METHODS The study design is a pragmatic factorial and crossover randomized clinical trial. Patients with KOA who are deemed eligible by their provider to receive knee injections and are able to walk without assistive devices will be recruited from clinical practices at four sites within the Veterans Affairs (VA) Health System in the USA. In total, 220 participants will be randomized to receive social incentives with gamification (i.e., incorporation of game elements) to promote exercise and compared to controls that receive a Fitbit but no incentive. Each patient will also be assigned to receive a blinded corticosteroid injection and a lidocaine-only injection in random order. The primary outcomes are the change in average daily step counts from baseline and the change in Knee Osteoarthritis Outcome Score (KOOS) from baseline. The study team will continuously collect step count, heart rate, and sleep data using activity monitors and patient-reported outcomes using the Way to Health (WTH) platform at two four-week intervals over eight months of follow-up. Mixed effects regression incorporating all available data points will be used for analysis. DISCUSSION The "Marching on for Veterans with Osteoarthritis of the Knee" (MOVE-OK) trial will take a pragmatic approach to evaluate (1) whether incentives based on behaviorally enhanced gamification can improve physical activity in this patient population and (2) whether corticosteroids injections reduce pain and disability in patients with KOA. Results of this trial will help to direct clinical practice and inform management guidelines. TRIAL REGISTRATION ClinicalTrials.gov NCT05035810 . Registered on 5 September 2021.
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Affiliation(s)
- William Leach
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Caleigh Doherty
- Perelman School of Medicine, University of Pennsylvania, 5th Floor White Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Marianna Olave
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Bryant R England
- Medicine Service, VA Nebraska-Western Iowa Health Care System and Department of Internal Medicine, Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Katherine Wysham
- VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
| | - Gail Kerr
- Washington DC VA Medical Center, Washington, D.C, USA
| | | | - Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, 5th Floor White Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Dan White
- University of Delaware, Newark, DE, USA
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, MA, USA
| | - Carla R Scanzello
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, 5th Floor White Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Perelman School of Medicine, University of Pennsylvania, 5th Floor White Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Sweeney M, Carpenter L, de Souza S, Chaplin H, Tung H, Caton E, Galloway J, Cope A, Yates M, Nikiphorou E, Norton S. The impact of COVID-19 on clinical care, self-management and mental health of patients with inflammatory arthritis. Rheumatol Adv Pract 2022; 6:rkab095. [PMID: 35043091 PMCID: PMC8690299 DOI: 10.1093/rap/rkab095] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/28/2021] [Indexed: 01/17/2023] Open
Abstract
Objectives The coronavirus disease 2019 (COVID-19) lockdown and ongoing restrictions in the UK affected access to clinical care, self-management and mental health for many patients with inflammatory arthritis. The aim of this study was to determine the impact of lockdown on inflammatory arthritis clinical care, self-management, disease outcomes and mental health. Methods In total, 338 people with inflammatory arthritis participated in a prospective study, completing a series of online questionnaires. The questionnaires assessed demographics, inflammatory arthritis condition and management, clinical care, quality of life and mental health. Visual analogue scales (VASs) were completed at each assessment. Linear regression, controlling for confounders, was conducted to determine factors associated with physical and mental health outcomes. Results More than half of participants reported worsening VAS by >10 points for patient global assessment (PGA), pain, fatigue and emotional distress during the initial lockdown. Changes in clinical care were associated with worse PGA (b = 8.95, P = 0.01), pain (b = 7.13, P = 0.05), fatigue (b = 17.01, P < 0.01) and emotional distress (b = 12.78, P < 0.01). Emotional distress and depression were also associated with worse outcomes in PGA, pain and fatigue, whereas loneliness was not. In contrast, physical activity seemed to mitigate these effects. Loneliness did not show any associations with outcomes. Over time, these effects decreased or disappeared. Conclusion Changes to clinical care owing to lockdown were associated with worse disease outcomes in patients with inflammatory arthritis. There has also been a clear impact on mental health, with possibly complex relationships between mental health and psychosocial factors. Physical activity emerged as a key influence on disease outcomes and mental health.
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Affiliation(s)
- Melissa Sweeney
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Lewis Carpenter
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
| | - Hema Chaplin
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Hsiu Tung
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Emma Caton
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - James Galloway
- Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
| | - Andrew Cope
- Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
| | - Mark Yates
- Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London.,Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
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Abstract
PURPOSE OF REVIEW The aim of this article is to describe the benefits of physical activity and exercise on rheumatoid arthritis disease activity, functioning, and symptoms; and offer recommendations for promotion of physical activity and exercise among people with rheumatoid arthritis. RECENT FINDINGS In addition to well-known benefits of exercise such as improving cardiovascular health and metabolic syndrome and reducing obesity, exercise has consistently shown rheumatoid arthritis-specific benefits. Exercise and increases in physical activity improve clinically measured disease activity, reduce symptoms such as fatigue and pain, and improve function and mental health. In spite of these benefits, most people with rheumatoid arthritis are inactive. Patient barriers to engaging in physical activity may include fears of joint damage, rheumatoid arthritis symptoms, and lack of understanding that physical activity improves the symptoms that may be barriers. However, the greatest barrier to healthy levels of physical activity among individuals with rheumatoid arthritis appears to be the lack of direction from healthcare providers. SUMMARY Exercise is safe and highly beneficial for people with rheumatoid arthritis. Because receiving recommendations from healthcare providers may be the factor most strongly associated with engaging in physical activity or exercise, providers are encouraged to give patients positive messages about the benefits of physical activity and the extremely low risks of harm.
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German recommendations for physical activity and physical activity promotion in adults with noncommunicable diseases. Int J Behav Nutr Phys Act 2020; 17:12. [PMID: 32024526 PMCID: PMC7003325 DOI: 10.1186/s12966-020-0919-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background Existing physical activity guidelines predominantly focus on healthy age-stratified target groups. The objective of this study was to develop evidence-based recommendations for physical activity (PA) and PA promotion for German adults (18–65 years) with noncommunicable diseases (NCDs). Methods The PA recommendations were developed based on existing PA recommendations. In phase 1, systematic literature searches were conducted for current PA recommendations for seven chronic conditions (osteoarthrosis of the hip and knee, chronic obstructive pulmonary disease, stable ischemic heart disease, stroke, clinical depression, and chronic non-specific back pain). In phase 2, the PA recommendations were evaluated on the basis of 28 quality criteria, and high-quality recommendations were analysed. In phase 3, PA recommendations for seven chronic conditions were deducted and then synthesised to generate generic German PA recommendations for adults with NCDs. In relation to the recommendations for PA promotion, a systematic literature review was conducted on papers that reviewed the efficacy/effectiveness of interventions for PA promotion in adults with NCDs. Results The German recommendations for physical activity state that adults with NCDs should, over the course of a week, do at least 150 min of moderate-intensity aerobic PA, or 75 min of vigorous-intensity aerobic PA, or a combination of both. Furthermore, muscle-strengthening activities should be performed at least twice a week. The promotion of PA among adults with NCDs should be theory-based, specifically target PA behaviour, and be tailored to the respective target group. In this context, and as an intervention method, exercise referral schemes are one of the more promising methods of promoting PA in adults with NCDs. Conclusion The development of evidence-based recommendations for PA and PA promotion is an important step in terms of the initiation and implementation of actions for PA-related health promotion in Germany. The German recommendations for PA and PA promotion inform adults affected by NCDs and health professionals on how much PA would be optimal for adults with NCDs. Additionally, the recommendations provide professionals entrusted in PA promotion the best strategies and interventions to raise low PA levels in adults with NCDs. The formulation of specific PA recommendations for adults with NCDs and their combination with recommendations on PA promotion is a unique characteristic of the German recommendations.
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Chancay MG, Guendsechadze SN, Blanco I. Types of pain and their psychosocial impact in women with rheumatoid arthritis. Womens Midlife Health 2019; 5:3. [PMID: 31417683 PMCID: PMC6688257 DOI: 10.1186/s40695-019-0047-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/01/2019] [Indexed: 02/06/2023] Open
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease predominantly affecting middle-aged women. Very commonly, pain is a manifestation of active disease and because untreated RA can result in joint deformities, the current evaluation of pain has largely focused on inflammation. In addition, treatment has centered on the premise of reducing disease activity with the hopes of halting worsening damage, preventing future deformities, and ultimately providing pain relief for the patient. Yet research shows that all patients with RA, but women in particular, often suffer from increased mechanical pain and fibromyalgia, as well as anxiety, depression, sleep disturbances, sexual dysfunction, and disability, which add to the burden of the illness. Determining and addressing alternative pain triggers as well as understanding the psychosocial burden of RA is key in treating patients, especially in those who may not improve with traditional pharmacotherapy.
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Affiliation(s)
- Maria Gabriela Chancay
- 1Department of Rheumatology, Albert Einstein College of Medicine, 1300 Morris Park Ave, Forchh 701N, Bronx, NY 10461 USA
| | | | - Irene Blanco
- 1Department of Rheumatology, Albert Einstein College of Medicine, 1300 Morris Park Ave, Forchh 701N, Bronx, NY 10461 USA
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Thomsen T, Esbensen BA, Hetland ML, Aadahl M. Motivational Counseling and Text Message Reminders: For Reduction of Daily Sitting Time and Promotion of Everyday Physical Activity in People with Rheumatoid Arthritis. Rheum Dis Clin North Am 2019; 45:231-244. [PMID: 30952395 DOI: 10.1016/j.rdc.2019.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Most patients with rheumatoid arthritis tend to be physically inactive and spend more time in sedentary behaviors compared with the general population. This inactive lifestyle can lead to serious health consequences, for example, increased risk of cardiovascular disease. For this reason, there is an interest in increasing participation in physical activity in patients with rheumatoid arthritis. The relatively new approach of reducing sedentary behavior and replacing it with light-intensity physical activity has been shown to be feasible and effective in promoting physical activity in patients with rheumatoid arthritis. However, methods to facilitate this behavior have not yet been fully explored.
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Affiliation(s)
- Tanja Thomsen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Nordre Ringvej 57, Indgang 5, Glostrup, DK-2600, Denmark.
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Nordre Ringvej 57, Indgang 5, Glostrup, DK-2600, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Nordre Ringvej 57, Indgang 5, Glostrup, DK-2600, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; The DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Nordre Ringvej 57, Indgang 5, Glostrup, DK-2600, Denmark
| | - Mette Aadahl
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen 5, Frederiksberg 2000, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
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Hammer NM, Midtgaard J, Hetland ML, Krogh NS, Esbensen BA. Physical activity behaviour in men with inflammatory joint disease: a cross-sectional register-based study. Rheumatology (Oxford) 2018; 57:803-812. [PMID: 29390089 DOI: 10.1093/rheumatology/kex498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Indexed: 12/15/2022] Open
Abstract
Objectives Physical activity is recommended as an essential part of the non-pharmacological management of inflammatory joint disease, but previous research in this area has predominantly included women. The aim of this study was to examine physical activity behaviour in men with inflammatory joint disease. Methods The study was conducted as a cross-sectional register-based study. Data on physical activity behaviour in men with RA, PsA and AS were matched with sociodemographic and clinical variables extracted from the DANBIO registry. Logistic regression analyses using multiple imputations were performed to investigate demographic and clinical variables associated with regular engagement in physical activity (moderate-vigorous ⩾2 h/week). Descriptive statistics were applied to explore motivation, barriers and preferences for physical activity. Results A total of 325 men were included of whom 129 (40%) engaged in regular physical activity. In univariate analyses, higher age, visual analogue scale (VAS) for pain, VAS fatigue, VAS patient's global, CRP level, disease activity, functional disability and current smoking were negatively associated with regular engagement in physical activity. In the final multivariable regression model only a high VAS fatigue score (⩾61 mm) (OR = 0.228; CI: 0.119, 0.436) remained significantly independently associated with regular physical activity. Conclusion A majority of men with inflammatory joint disease do not meet the recommendations of regular physical activity. Both sociodemographic and clinical parameters were associated with engagement in physical activity, and fatigue especially seems to play a pivotal role in explaining suboptimal physical activity behaviour in this patient group.
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Affiliation(s)
- Nanna Maria Hammer
- The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Julie Midtgaard
- The University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, Section of Social Medicine, Copenhagen, Denmark
| | - Merete Lund Hetland
- The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Bente Appel Esbensen
- The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Uutela TI, Kautiainen HJ, Häkkinen AH. Decreasing muscle performance associated with increasing disease activity in patients with rheumatoid arthritis. PLoS One 2018; 13:e0194917. [PMID: 29630626 PMCID: PMC5890969 DOI: 10.1371/journal.pone.0194917] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/10/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Increasing evidence suggests that inflammation has a detrimental effect on muscle strength. Our objective was to analyse the association between muscle performance and different disease activity levels in patients with rheumatoid arthritis (RA). METHOD A total of 199 consecutive outpatients were subject to cross-sectional assessment. Measurements of grip strength, endurance of the upper and lower limbs and trunk strength were combined as a muscle performance composite score (MPCS), using a standardised method. The disease activity for 28 joints (DAS28), radiographs of small joints (Larsen score), rheumatoid factor, body mass index (BMI), comorbidities and anti-rheumatic drugs were verified. Patients' questionnaires included sociodemographic information, pain level, global disease activity, the Beck Depression Inventory, the mental and physical component scores of Short Form-36 and physical activity level. RESULTS Of the 199 patients, 36%, 17% and 47% patients had remission, low/moderate and high DAS28, respectively. The patients in remission had significantly shorter disease duration, better parameters in terms of pain, physician's assessment, Larsen, Beck or physical component score of Short Form-36, and they were more physically active than other patients. After adjustments for age, sex, RA duration, radiographs and BMI, the decreasing MPCS associated linearly with the increasing DAS28 activity levels (linearity, P <0.001). CONCLUSION Poorer MPCS is clearly associated with higher disease activity in patients with RA. Muscle performance is a modifiable risk factor. The findings suggest evaluating muscle performance in clinical practice as a part of patient care.
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Affiliation(s)
- Toini I. Uutela
- Department of Medicine, Central Hospital of Lapland, Rovaniemi, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Hannu J. Kautiainen
- Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Arja H. Häkkinen
- Department of Physical and Rehabilitation Medicine, Central Hospital of Jyväskylä, Jyväskylä, Finland
- Department of Health Science, University of Jyväskylä, Jyväskylä, Finland
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Nessen T, Opava CH, Martin C, Demmelmaier I. Physiotherapists' management of challenging situations in guiding people with rheumatoid arthritis to health-enhancing physical activity. Physiother Theory Pract 2018; 35:31-39. [PMID: 29447492 DOI: 10.1080/09593985.2018.1434847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To explore strategies used by physiotherapists (PTs) in guiding people with rheumatoid arthritis to health-enhancing physical activity (HEPA) in a group setting during a 1-year intervention study. METHODS Exploratory design with qualitative video analysis performed in three steps. Eleven female PTs were video recorded while leading support group sessions aiming at facilitating HEPA (twice-weekly exercise sessions at public gyms and 150 weekly minutes of moderately intense aerobic physical activity). RESULTS Three categories of challenging situations emerged. They occurred when the HEPA intervention participants reported barriers to performing physical activity, when they neglected to use the planning tool for physical activity as intended in the program, and when they received negative results from physical capacity tests. PTs used different strategies to manage these challenges, with main focus either on information-giving, corresponding to a traditional health professional approach, or utilizing group resources by organizing participation. CONCLUSIONS This study provides detailed descriptions of PTs' clinical behavior in video-recorded sessions. The results imply that motivated PTs can, despite their biomedical and practitioner-focused training, learn to adapt their communication strategies to different situations, altering between traditional information-giving and utilizing group resources by organizing participation.
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Affiliation(s)
- Thomas Nessen
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy 23100 , Karolinska Institutet , Huddinge , Sweden
| | - Christina H Opava
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy 23100 , Karolinska Institutet , Huddinge , Sweden
| | - Cathrin Martin
- b Department of Neuroscience, Physiotherapy , Uppsala University , Uppsala , Sweden
| | - Ingrid Demmelmaier
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy 23100 , Karolinska Institutet , Huddinge , Sweden
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Katz P, Margaretten M, Gregorich S, Trupin L. Physical Activity to Reduce Fatigue in Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2017; 70:1-10. [PMID: 28378441 DOI: 10.1002/acr.23230] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 02/21/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Effective treatments for rheumatoid arthritis (RA) fatigue are limited. We tested the effect of a pedometer-based intervention on increasing physical activity and decreasing fatigue among individuals with RA. METHODS Participants completed baseline questionnaires; had 1 week of activity monitoring; were randomized to control (education [EDUC]), pedometer and step-monitoring diary (PED), or pedometer and diary plus step targets (PED+) groups, and were followed for 21 weeks. At week 10, questionnaires were administered by phone to all participants. During the final week, all participants again had 1 week of activity monitoring. Primary outcomes were changes in average weekly steps and fatigue (Patient-Reported Outcomes Measurement Information System 7-item questionnaire) from baseline to week 21. Secondary outcomes were self-reported disease activity, physical function, pain interference, and depressive symptoms. Changes in steps were tested using a linear mixed model. Changes in fatigue were tested with repeated-measures models, including baseline, week-10, and week-21 scores. RESULTS A total of 96 individuals participated. Eight did not complete the 21-week assessments. Both intervention groups significantly increased steps (+1,441 [P = 0.004] for PED and +1,656 [P = 0.001] for PED+), and the EDUC group decreased steps (-747 [P = 0.14]) (group-by-time interaction P = 0.0025). Between-group changes in fatigue were not significantly different (interaction P = 0.21). Mean changes in fatigue scores from baseline to week 21 were -1.6 (with-group P = 0.26), -3.2 (P = 0.02), and -4.8 (P = 0.0002) for EDUC, PED, and PED+ groups, respectively. Function and self-reported disease activity also improved in the PED and PED+ groups. CONCLUSION Provision of pedometers, with and without providing step targets, was successful in increasing activity levels and decreasing fatigue in this sample of individuals with RA.
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Quinn T, Bs MF, von Heideken J, Iannaccone C, Shadick NA, Weinblatt M, Iversen MD. Validity of the Nurses' health study physical activity questionnaire in estimating physical activity in adults with rheumatoid arthritis. BMC Musculoskelet Disord 2017; 18:234. [PMID: 28569163 PMCID: PMC5452372 DOI: 10.1186/s12891-017-1589-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/17/2017] [Indexed: 02/08/2023] Open
Abstract
Background Patients with rheumatoid arthritis (RA) demonstrate reduced aerobic capacity, excess cardiovascular risk, mobility limitations and are less physically active than their healthy peers. Physical activity may decrease RA disease activity through its anti-inflammatory effects and psychological and health benefits. To successfully manage RA symptoms and reduce cardiovascular risks associated with RA through increased physical activity (PA), accurate physical activity assessments are critical. Accelerometry is an objective physical activity measure, but not widely used. Validity of the Nurses’ Health Study physical activity questionnaire II (NHSPAQ) has not been determined for estimation of physical activity in RA. This study examined NHSPAQ validity in adults with RA compared to accelerometry-based metabolic equivalents determined (METs) and results of performance tests. We hypothesized NHSPAQ scores would correlate moderately (0.4–0.5) with accelerometer physical activity estimates. Methods Thirty-five adults with RA (mean age [SD] 62 (Williams et. al, Health Qual Life Outcomes10:28, 2012) years, 28 females (80%) recruited from a hospital-based clinic registry participated in a one-week accelerometry trial. Medical data was compiled. Participants completed the NHSPAQ, a self-paced 20-m walk test, and modified timed step test. Participants wore an accelerometer for 7 consecutive days, then completed a physical activity log and another NHSPAQ. Metabolic equivalents (METs) were derived from NHSPAQ and accelerometers using standardized formulas. NHSPAQ METs were correlated with accelerometer METs and data from performance measures. Results Average disease duration was 21 years (SD = 11), 63% patients took biologics. The average weekly METs reported were 29 (SD = 33) and accelerometer METs were 33 (SD = 22). NHSPAQ METs correlated moderately with accelerometer-derived METs (r = 0.48 95% CI (0.15–0.70). Self-reported PA correlated moderately with Step Test performance (r = 0.50 95% CI (0.18–0.72). Conclusion Patients with RA exhibit low physical activity levels. General fitness measures were moderately correlated with physical activity levels. A moderate significant correlation existed between NHSPAQ and accelerometry METs. These preliminary data suggest the NHSPAQ may be useful to describe physical activity levels in this population.
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Affiliation(s)
- Thomas Quinn
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Michelle Frits Bs
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA, USA
| | - Johan von Heideken
- Department of Women and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - Christine Iannaccone
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA, USA
| | - Nancy A Shadick
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael Weinblatt
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Maura D Iversen
- Division of Rheumatology, Immunology & Allergy, Brigham & Women's Hospital, Boston, MA, USA. .,Department of Women and Children's Health Karolinska Institutet, Stockholm, Sweden. .,Harvard Medical School, Boston, MA, USA. .,Department of Physical Therapy, Movement and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue Rm 301c Robinson Hall, Boston, MA, 02115, USA.
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15
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Konijn NPC, van Tuyl LHD, Boers M, den Uyl D, ter Wee MM, Kerstens P, Voskuyl AE, Nurmohamed M, van Schaardenburg D, Lems WF. Effective Treatment for Rapid Improvement of Both Disease Activity and Self-Reported Physical Activity in Early Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016. [DOI: 10.1002/acr.22668] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Maarten Boers
- VU University Medical Center and Reade; Amsterdam The Netherlands
| | - Debby den Uyl
- VU University Medical Center; Amsterdam The Netherlands
| | | | - Pit Kerstens
- Reade, Amsterdam, and Westfriesgasthuis; Hoorn The Netherlands
| | | | | | | | - Willem F. Lems
- VU University Medical Center and Reade; Amsterdam The Netherlands
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16
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Bulaj G, Ahern MM, Kuhn A, Judkins ZS, Bowen RC, Chen Y. Incorporating Natural Products, Pharmaceutical Drugs, Self-Care and Digital/Mobile Health Technologies into Molecular-Behavioral Combination Therapies for Chronic Diseases. CURRENT CLINICAL PHARMACOLOGY 2016; 11:128-45. [PMID: 27262323 PMCID: PMC5011401 DOI: 10.2174/1574884711666160603012237] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 02/08/2023]
Abstract
Merging pharmaceutical and digital (mobile health, mHealth) ingredients to create new therapies for chronic diseases offers unique opportunities for natural products such as omega-3 polyunsaturated fatty acids (n-3 PUFA), curcumin, resveratrol, theanine, or α-lipoic acid. These compounds, when combined with pharmaceutical drugs, show improved efficacy and safety in preclinical and clinical studies of epilepsy, neuropathic pain, osteoarthritis, depression, schizophrenia, diabetes and cancer. Their additional clinical benefits include reducing levels of TNFα and other inflammatory cytokines. We describe how pleiotropic natural products can be developed as bioactive incentives within the network pharmacology together with pharmaceutical drugs and self-care interventions. Since approximately 50% of chronically-ill patients do not take pharmaceutical drugs as prescribed, psychobehavioral incentives may appeal to patients at risk for medication non-adherence. For epilepsy, the incentive-based network therapy comprises anticonvulsant drugs, antiseizure natural products (n-3 PUFA, curcumin or/and resveratrol) coupled with disease-specific behavioral interventions delivered by mobile medical apps. The add-on combination of antiseizure natural products and mHealth supports patient empowerment and intrinsic motivation by having a choice in self-care behaviors. The incentivized therapies offer opportunities: (1) to improve clinical efficacy and safety of existing drugs, (2) to catalyze patient-centered, disease self-management and behavior-changing habits, also improving health-related quality-of-life after reaching remission, and (3) merging copyrighted mHealth software with natural products, thus establishing an intellectual property protection of medical treatments comprising the natural products existing in public domain and currently promoted as dietary supplements. Taken together, clinical research on synergies between existing drugs and pleiotropic natural products, and their integration with self-care, music and mHealth, expands precision/personalized medicine strategies for chronic diseases via pharmacological-behavioral combination therapies.
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Affiliation(s)
- Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, Skaggs Pharmacy Institute, University of Utah, 30 South 2000 East, Salt Lake City, Utah 84112, USA.
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17
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Ogdie A, Eder L. Improving cardiovascular health and metabolic comorbidities in patients with psoriatic arthritis. ACTA ACUST UNITED AC 2015; 10:451-459. [PMID: 27134682 DOI: 10.2217/ijr.15.45] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Numerous studies have suggested a link between psoriatic arthritis (PsA) and comorbidities, in particular cardiovascular disease and metabolic comorbidities such as diabetes. The co-existence of these comorbidities is likely the result of systemic inflammation. In order to improve the health of patients with PsA and provide optimal care, these comorbidities must be addressed. However, little is known about how to improve metabolic and cardiovascular health in patients with PsA. In this perspective, we describe the research needs in the area of improving cardiovascular disease and metabolic comorbidities among patients with PsA.
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Affiliation(s)
- Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, White Building, Room 5024, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Lihi Eder
- Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
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18
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Baxter SV, Hale LA, Stebbings S, Gray AR, Smith CM, Treharne GJ. Walking is a Feasible Physical Activity for People with Rheumatoid Arthritis: A Feasibility Randomized Controlled Trial. Musculoskeletal Care 2015; 14:47-56. [PMID: 26228264 DOI: 10.1002/msc.1112] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Exercise has been recognized as important in the management of rheumatoid arthritis (RA). Walking is a low-cost and low-impact activity, requiring little supervision. It requires no specialist training, is suited to a variety of environments and is inherently a clinically meaningful measure of independence. The aim of the present study was to determine whether a designed walking programme for people with RA successfully facilitated regular physical activity in participants, without detriment to pain levels. METHODS Thirty-three people with RA were recruited from Dunedin Hospital rheumatology outpatient clinics and enrolled in a walking randomized controlled trial (RCT) feasibility study. Participants were randomly allocated to the walking intervention (n = 11) or control (n = 22) groups. Control participants received a nutrition education session, and the walking intervention group received instructions on a walking route with three loops, to be completed 3-4 times per week. The walking route shape was designed so that the length of the walk could be tailored by participants. Both groups were assessed at baseline and six weeks later. The primary outcome measures were feasibility, acceptability and safety. The principal secondary outcome was change in walking speed after the intervention. Additional outcome measures were a step-up test, activity limitations (on the Health Assessment Questionnaire), global well-being (on the European Quality of Life Questionnaire), self-efficacy for managing arthritis symptoms, self-efficacy for physical activity, daily pedometer readings and a daily visual analogue scale for pain. RESULTS Participants successfully completed the walk for the suggested frequency, indicating feasibility and acceptability. There were no reported adverse effects of participation and the walking intervention group did not have higher daily pain levels than the control group, indicating safety. The walking intervention group showed a pattern of improvements in self-efficacy and global well-being; no changes in these outcomes were noted in the control group. No outcome measure showed statistically significant between-group differences. CONCLUSIONS Walking appears to be a feasible, acceptable and safe intervention for people with RA. These findings inform the design and power requirements of larger trials of structured walking interventions. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Susan V Baxter
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Aotearoa/New Zealand.,Department of Psychology, University of Otago, Dunedin, Aotearoa/New Zealand
| | - Leigh A Hale
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Aotearoa/New Zealand
| | - Simon Stebbings
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, Aotearoa/New Zealand
| | - Andrew R Gray
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, Aotearoa/New Zealand
| | - Catherine M Smith
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Aotearoa/New Zealand
| | - Gareth J Treharne
- Department of Psychology, University of Otago, Dunedin, Aotearoa/New Zealand
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19
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Christie A, Hagen KB, Mowinckel P, Dagfinrud H. Aquatic Exercises were Associated with an Acceptable State of Symptoms in Patients with Inflammatory Rheumatic Diseases: Results from a Study with Interrupted Time-Series Design. Musculoskeletal Care 2014; 13:139-147. [PMID: 25490962 DOI: 10.1002/msc.1092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM OF STUDY The aim of this study was two-fold: to compare symptoms and daily activity in patients with inflammatory rheumatic diseases across periods with and without aquatic exercises, and to examine whether the patients reached an acceptable state of symptoms during the periods with aquatic exercises. METHODS Thirty-six patients reported pain, fatigue, stiffness and ability to carry out daily activities across periods with and without aquatic exercises. The study has an interrupted time-series design and variables were collected with text messages on mobile phones twice a week over a period of 35 weeks. RESULTS There was a significant reduction in pain, fatigue, stiffness and enhanced level of daily activity (p > 0.05) during periods of aquatic exercises compared to periods without. Further, a significantly higher proportion of patients reached an acceptable state for both pain and fatigue during periods with aquatic exercises. CONCLUSIONS Living with an inflammatory rheumatic disease is a lifelong challenge. Pain and fatigue are considered major obstacles for daily functioning and adequate self-management strategies are requested. Based on the high proportion of patients reporting to be in an acceptable state of both pain and fatigue during periods with aquatic exercises, the intervention should be regarded as an important self-management tool rather than a treatment option assuming long-lasting effects. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anne Christie
- National Advisory Unit for Rehabilitation on Rheumatology (NKRR), Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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20
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[How does the German Association against Rheumatism and Arthritis convey health literacy?]. Z Rheumatol 2014; 73:721-8. [PMID: 25260819 DOI: 10.1007/s00393-014-1411-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The German Association against Rheumatism and Arthritis considers the improvement of health literacy as one of their most important tasks. In local groups people with arthritis have the chance to exchange experiences and to benefit from consultation. Individual experiences are merged into a collective knowledge. Numerous printed media as well as information and exchange via the internet help to improve health literacy. Self-management courses and patient education courses are specific instruments to improve the competences of people with arthritis to manage their own condition. Through exercise programs, which are offered locally, the Association strives to improve self-efficacy regarding exercise. A survey of the members showed that the activities of the patient association are well accepted and valued. The empowered patient has more and more become a partner in the micro-level communication with their doctor. On the macro-level, patient representatives play an important role in the committees of the German self-administration of health insurance and physician organizations.
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21
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Conceição CSD, Gomes Neto M, Mendes SMD, Sá KN, Baptista AF. Systematic review and meta-analysis of effects of foot orthoses on pain and disability in rheumatoid arthritis patients. Disabil Rehabil 2014; 37:1209-13. [PMID: 25249238 DOI: 10.3109/09638288.2014.961654] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This meta-analysis examined the effects of foot orthoses (FO) on pain and disability in rheumatoid arthritis (RA) patients. METHODS MEDLINE, Cochrane Controlled Trials Register, EMBASE, SPORT Scielo, and CINAHL were searched through July 2014 for randomized controlled trials (RCTs) examining the effects of orthoses on pain and disability in RA patients. Two reviewers selected studies independently. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I(2) test. RESULTS Three studies, involving 110 patients who received FO and 108 control patients, met the study criteria. Relative to controls, FO had a positive impact on pain (WMD 0.40; 95% CI 0.04-0.57). Between group differences in disability were not statistically significant. CONCLUSIONS FO may improve pain in RA patients, but their impact on disability remains undetermined. Additional large RCTs are needed to investigate the effects of these devices in RA patients. Implications for Rehabilitation The use of foot orthoses (FO) often part of the conservative treatment of patients with rheumatoid arthritis (RA). However, the indication of these devices is usually empiric. Thus, the results of this meta-analysis can provide guidance to rehabilitation professionals to undertake these devices to therapeutic programs. There is no consensus among rehabilitation professionals regarding the efficacy of FO improved pain and disability in patients with RA. The results of this meta-analysis suggest that the use of the FO improves pain but has no impact on disability. Thus, rehabilitation professionals, from reading this article will make clear to their patients that benefit of the FO is exclusively in pain improvement. Healthcare professionals and organizations should take into account the costs of production of FO during the definition of the therapeutic program. In case of low cost, the effect on improvement of pain in the feet can justify the indication of these devices to a patient with RA.
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Affiliation(s)
- Cristiano Sena da Conceição
- Biofunction Department, Physical Therapy, Institute of Health Sciences, Federal University of Bahia - UFBA , Salvador, Bahia , Brazil
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22
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Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease which, if left untreated, leads to functional disability, pain, reduced health-related quality of life and premature mortality. Between 0.5% and 1% of the population are affected worldwide, and between 25 and 50 new cases evolve in a population of 100,000. Practically all patients with RA require initiation with disease-modifying antirheumatic treatment to retard or stop progression, control disease manifestations and reduce the disease burden. If disease course is monitored with adjustment of medication, lifestyle factors, and exercise, as well as physical activity levels, co-morbidities may be prevented in the course of RA. During the last decade, major progress has been made in treating RA through early identification and treatment of the disease. Many patients still experience premature work disability and co-morbidities. For societies, the economic burden of RA is high in terms of direct and indirect costs, including modern drug treatment.
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Affiliation(s)
- Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, 0319, Oslo, Norway,
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23
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Demmelmaier I, Lindkvist Å, Nordgren B, Opava CH. "A gift from heaven" or "This was not for me". A mixed methods approach to describe experiences of participation in an outsourced physical activity program for persons with rheumatoid arthritis. Clin Rheumatol 2014; 34:429-39. [PMID: 24941928 DOI: 10.1007/s10067-014-2723-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 06/07/2014] [Indexed: 12/27/2022]
Abstract
Most persons with rheumatoid arthritis (RA) do not perform health-enhancing physical activity (HEPA). Evaluations of innovative HEPA programs need to be complemented with descriptive and qualitative data from the users. The aim of this mixed methods study was to explore and describe how a subgroup of the RA population perceives participation during the first year of an outsourced 2-year HEPA program. Data were collected by a study-specific postal survey to 220 program participants (response rate 87%, n = 191) and by interviews with a purposefully selected subsample of 35, including completers and dropouts. The survey data were analyzed by descriptive statistics and the interviews by qualitative content analysis.The survey demonstrated increased self-reported physical activity in 165 participants (86%). After the first year of the program, participants reported having performed "regular" or "periodical" circuit training (78%) and physical activity in daily life (92%). The most valued program components were circuit training and physical activity in daily life, both rated median 5/5. Coach support, prompts by text messages, and expert lectures were rated median 4/5. Five categories emerged from the interviews describing expectations, facilitators, gains, maintenance, and obstacles/suggestions for improvement of the program. The results demonstrate that HEPA outside health care is highly appreciated by a subgroup of the RA population. Professional coaching and prompts by text messages seem to be particularly useful facilitators. Individual preferences emphasize the need to tailor settings, exercise formats, and behavioral support for HEPA even in a narrow, self-selected group with RA.
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Affiliation(s)
- Ingrid Demmelmaier
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,
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Associations of alcohol consumption and mental health with the prevalence of arthritis among US adults: data from the 2012 National Health Interview Survey. Rheumatol Int 2014; 34:1241-9. [PMID: 24667977 DOI: 10.1007/s00296-014-2992-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/14/2014] [Indexed: 01/03/2023]
Abstract
The findings of association between alcohol consumption and arthritis are mixed while little is known about age differences in the associations of mental health and behavioral factors with arthritis. This study aimed to estimate the prevalence and associated factors of arthritis among US adults using data from the 2012 National Health Interview Survey. In total, 8,229 adults with arthritis and 26,256 controls were selected from the adult respondents. Weighted univariate and multiple logistic regression analyses were used to estimate the odds ratios (ORs) with 95 % confidence intervals. The overall prevalence of arthritis was 22.1 %. The prevalence increased with age (6.8, 29.6, and 47.9 % for 18-49, 50-64, and 65+ years of age, respectively). The prevalence of mental problems was higher in cases than controls [4 vs. 1 % for serious psychological distress (SPD), 29 vs. 16 % for anxiety, and 26 vs. 11 % for depression, respectively]. Multiple logistic regression analyses showed that being female, older age, smoking, alcohol consumption, obesity, SPD, depression, and anxiety were positively associated with arthritis. Stratified by age, SPD was associated with arthritis only in young adults (18-49 years old) while the ORs of anxiety and depression with arthritis decreased as age increased. Alcohol consumption revealed stronger associations in middle-aged adults and elderly. Using a large nationally representative sample in the USA, alcohol consumption, smoking, SPD, anxiety, and depression were associated with arthritis, and the associations varied across different age groups.
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25
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Cardiovascular risk in rheumatoid arthritis: How to lower the risk? Atherosclerosis 2013; 231:163-72. [DOI: 10.1016/j.atherosclerosis.2013.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 08/30/2013] [Accepted: 09/08/2013] [Indexed: 12/21/2022]
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