RA, which affects 1.3 million adults, is a painful condition that causes joints to be swollen, stiff, and damaged. Inactivity puts RA patients at risk of increased pain, weakened muscles, poor balance, and stiffened joints. But many people with RA lack the motivation to exercise -- or don’t know that exercise may help them feel better.
For the study, researchers at Northwestern University recruited 176 RA patients ranging in age from 23 to 86. Most of the participants were white, college-educated women over 50 who had had the disease for an average of 13.5 years.
Measuring Activity Spikes
All of the study participants were given an accelerometer, a device that measures the intensity of physical activity. For one week, each participant strapped it to his or her belt first thing in the morning and left it on until bedtime.
The devices can’t distinguish between different activities -- running vs. climbing stairs, for example. Instead, they provide data on when and how long a wearer increases the pace of movement. The researchers looked for spikes in activity that lasted for at least 10 minutes at a time, because that kind of sustained movement indicates moderate to vigorous exercise.
Of the 176 participants, about 2 in 5 logged no upticks in activity at all. According to researcher Jungwha Lee, PhD, MPH, an assistant professor of preventive medicine at Northwestern’s Feinberg School of Medicine, few of the other participants did much better.
“Only about 12% of the group met the recommended fitness guidelines of 150 minutes per week,” Lee says.
Lee says the overall results were expected, but not the extent of complete inactivity. “We had a sense that they were very inactive,” she says. “But we were so surprised that these people were just sitting and doing nothing.”
However, the study’s primary finding -- the reasons for the lack of exercise -- is potentially positive. Nearly two-thirds of the inactivity that Lee and her colleagues measured can be explained by modifiable risk factors.
Of the risk factors measured, two stood out: a lack of motivation to exercise, and a lack of awareness that exercise can protect joints and ease pain. In other words, for most RA patients, the only thing standing in the way of working out -- and thereby improving their health -- may be attitude.
That’s what Lee is studying right now. She’s trying to determine whether group- and web-based individual educational sessions can help change RA patients’ behavior.
Patient Education Crucial
Lee would like health-care professionals to spend more time encouraging RA patients to exercise. Through the early 1980s, doctors advised their patients to rest rather than get active, the study authors write. Since then, it’s become clear that that is not good advice.
“That message has not been spread effectively,” Lee says.
Rheumatologist Cong-Qiu Chu, MD, PhD, agrees that patient education is essential because many patients are afraid to exercise. They believe that the strain may make them feel worse. In his practice, however, Chu has found that patients who are informed about the benefits of exercise become motivated to get active.
“Most patients are motivated to be functional -- they just don’t have the knowledge that it is good for them,” says Chu, who directs the Early Arthritis Clinic at Oregon Health and Science University in Portland.
How much exercise a person is capable of must be determined on an individual basis, but Lee advises following the latest federal guidelines, which recommend 150 minutes of moderately intense activity each week for adults.
“We’re not encouraging our patients to do anything overly vigorous,” she says. “Water aerobics or 10 minutes of walking briskly, as if late for a meeting, are good exercises.”