Rheumatologists urged to get arthritics moving

Strength training and aerobic exercise benefit people with osteoarthritis (OA) or rheumatoid arthritis (RA), but surprisingly few arthritis patients are incorporating reasonable levels of physical activity into their daily lives, reports Dr Margaret Shih (Los Angeles County Department of Health Services, CA) In an analysis of data from the 2002 National Health Interview Survey, Shih and colleagues write in the May 2006 issue of the American Journal of Preventive Medicine that more than one third of adults with arthritis were inactive and the rest were significantly less likely than nonarthritics to engage in recommended levels of moderate or vigorous activity.

“The most notable finding was that 37% of adults with arthritis do notengage in any leisure-time physical activity, despite the known benefits of physical activity. One question it raised is how do we get people with arthritis more involved in regular physical activity, especially women, the elderly, and racial/ethnic minorities, and also how can we increase adherence to exercise programs,” Shih told rheumawire.Counseling, pain management, treatment of comorbid anxiety/depression might help Shih and colleagues estimated the proportion of adults with arthritis who met four physical-activity recommendations from the Healthy People 2010(HP2010) initiative and one arthritis-specific recommendation. The four general recommendations were engaging in some regular leisure-time physical activity; 30 minutes per day of moderate activity; 20 minutes of vigorousphysical activity on at least three days per week; and exercise that promotes strength and endurance. The arthritis-specific activity was 30 minutes of moderate-intensity physical activity at least three days a week.”Patients with arthritis are not getting enough physical activity, even though moderate-intensity physical activity is safe for most patients with arthritis who do not have severe functional limitations. Physical activity can decrease arthritis-related pain, improve physical functioning, and delay disability in patients with arthritis. Clinicians should provide physical-activity counseling in conjunction with pain-management measures when treating patients with arthritis. Clinicians should be aware of the availability of evidence-based interventions such as the Arthritis Self-Help Course, the Arthritis Foundation Exercise Program (formerly known as ‘People with Arthritis Can Exercise’), and the Arthritis Foundation Aquatics Program,” Shih said.Adults with arthritis were not significantly less likely than nonarthritics to report inactivity (37% arthritis, 38% no arthritis), to participate in strengthening exercise (20% both), or to meet the arthritis-specific recommendation (37% arthritis vs 39% no arthritis). Adults with arthritis were significantly less likely to meet the recommended levels for moderate/vigorous exercise (30% vs 33%, p=0.05) or vigorous activity (21% vs 24%, p=0.006). Patients with four or more functional limitations, one or more social/leisure limitations, a need for special equipment, or who lacked access to a fitness facility were most likely to report inactivity,as were those with frequent anxiety or depression.”Rheumatologists should ask their arthritis patients directly whether or not they are physically active and what type of activities they are involved in, so they can engage their patients in a discussion of the importance of physical activity and what types of exercise might be mostappropriate for individual patients. It would also be an opportunity to address any concerns the patient might have about starting an exercise program (eg, concerns about worsened pain or potential damage to joints) and to connect them to local self-management or exercise programs,” Shih said.The authors also point to “the need for healthcare providers to counsel on physical activity, to manage pain adequately, and to recognize the risk from comorbid mental-health disorders.”(Source: (1) Shih M, Hootman JM, Kruger J, et al. Physical activity in men and women with arthritis. National Health Interview Survey, 2002. Am J Prev Med 2006; 30:385-393: Rheumawire: Joint and Bone: April 2006.)