Non-Pharmacologic Management of Rheumatic Illnesses - New Findings About Exercise - Encouraging Physical Activity
Abstract 1568 Predictors of Exercise Behaviors Among Fibromyalgia Patients
RA Gallagher, N Cronan, HR Walen, TA Cronan, San Diego, CA
Objective: To identify predictors of regular exercise among persons with Fibromyalgia.
Methods: As part of a larger study, 600 persons (572 female and 28 male) with a physician diagnosis of Fibromyalgia (ACR criteria) were surveyed about psychosocial factors, health status, and levels of physical activity. Participants had a mean age of 54 + 12 years. Most were Caucasian (82%), married (62%), had at least some college education (76%) and reported a median income of $30-$40,000 per year.
Results: Logistic regression was used to predict regular exercise. Individuals who were younger, married, employed, had a lower BMI, were more satisfied with their social support network and had higher levels of exercise self-efficacy were more likely to exercise regularly. Exercise self-efficacy (i.e., one's belief in their ability to exercise under a variety of conditions) was by far the strongest predictor of exercise behavior [odds ratio of 4.41 (p=.0001)]. Variables that were not significantly associated with regular exercise included income, education, symptom duration, depression, helplessness, pain or well being.
Editorial Comments: Though exercise has been shown to be generally safe and helpful in patients with Fibromyalgia, most patients (like most Americans) do not exercise regularly. Predictors of regular exercise behavior have been studied extensively among healthy adults. Results of this study suggest that, in persons with Fibromyalgia, pain, depression, and health status were not significantly associated with exercise behavior. Thus, it appears that persons with Fibromyalgia do not face additional barriers beyond those already well documented (i.e., time, location, social support).
Bottom line: Health care providers can support increases in physical activity among their patients by increasing exercise self-efficacy and social support in their patients. Encourage them to join an arthritis exercise class or work directly with physical therapists and/or clinical exercise specialists.
Abstract 915 Exercise in Rheumatoid Arthritis: Audit of the Use and Effectiveness of an Exercise Leaflet
SR Benjamin, A Trehane, P Cornell, PW Thompson, England.
Objective: To evaluate the effectiveness of a disease-specific pamphlet in increasing physical activity among patients with RA.
Methods: Approximately 500 persons attending a hospital-based Rheumatology Follow Up Clinic were given a pamphlet tailored to the needs of patients with rheumatoid arthritis (RA). The pamphlet outlined a simple exercise plan designed to maintain or improve muscle strength around the neck, shoulder, elbow, wrist/hand, hip/knee and foot/ankle joints, range of movement and physical functioning. A brief questionnaire querying the usefulness of the pamphlet was also provided.
Results: About half (i.e., 240) of the questionnaires were returned. Nearly one quarter of the patients reported that they were exercising daily, 69% exercise a couple of times a week and 6% were completely sedentary. Almost all (i.e., 89%) reported that the pamphlet was helpful and that it encouraged them to think more about exercise.
Editorial Comments: As in the US, the majority of patients with RA in this UK study have sub-optimal levels of physical activity for their health and well-being. Though this study provides only a crude estimate, it appears that patients with RA in the UK are significantly more active than those in the U.S. (Current estimates suggest that 25% of Americans are completely sedentary, and 60% do not exercise regularly.)
An important challenge for health care providers is uncovering how to effectively promote physical activity among persons with RA. One of the most widely used behavioral theories (i.e., Stages of Change) suggests that exercise adoption occurs as a process over time. Sedentary persons go through a phase of contemplating how, why and when to become more physically active prior to increasing their activity levels. In clinical trials, tailored materials have been shown to move healthy adults through the change process more quickly and significantly increase rates of physical activity. Results from the current study suggest that tailored exercise pamphlets may work effectively with patients with RA as well.
Bottom Line: Regular discussions with patients about increasing physical activity can be effectively supplemented with the appropriate materials to increase the adoption of physical activity. (Note: The Arthritis Foundation offers an excellent booklet entitled Exercise and Your Arthritis as well as exercise classes and videos suitable for patients with RA.)