Despite proof that movement is helpful and being sedentary isn’t, most people with rheumatic conditions are inactive, said the 2020 ARP Distinguished Lecturer.
Patricia Katz, PhD, professor of medicine, University of California, San Francisco delivered How to Promote Physical Activity and Its Benefits for Patients with Rheumatic Diseases as part of ACR Convergence 2020. Registered meeting attendees have on-demand access to view the lecture through Wednesday, March 11, 2021.
“Probably the most important reason people with rheumatic diseases are not exercising is that they are not getting the message that physical activity is a good thing for them, that it’s beneficial for their disease,” Dr. Katz said. “They’re not getting that message from their physician or other healthcare providers.”
Only 20%-30% of these individuals meet the Centers for Disease Control and Prevention guidelines for physical activity, compared to 48% of U.S. adults overall. For some, Dr. Katz said, there is a perceptual barrier that exercise will lead to increased fatigue or exacerbate other symptoms. But exercise is not only recognized as safe for individuals with rheumatic disease, it is recommended.
Dr. Katz shared data from the Osteoarthritis Initiative (OAI), which shows that more time spent engaged in moderate to vigorous physical activity is associated with lower risk of disability onset and progression. What’s more, multiple studies of individuals with rheumatic conditions have shown unstructured physical activity and structured exercise interventions generally result in reductions in pain.
“There’s reason to think that physical activity might change central pain processing,” Dr. Katz said.
Dr. Katz’s Physical Activity to Improve Rheumatoid Arthritis Fatigue (PARAFit) study found decreases in fatigue among patients who increased their physical activity. Patients with higher levels of baseline fatigue, shorter disease duration, higher levels of depressive symptoms, and those who met the criteria for depression were more likely to have more significant decreases in fatigue.
Diverse factors are associated with inactivity among patients with rheumatic diseases. Just as in the general population, women, older individuals, and people with lower levels of education are more likely to be less active, Dr. Katz said. Disease-specific barriers to physical activity include disease activity and radiographic joint damage.
Structural barriers—time, safety concerns, financial resources, weather, lack of social supports, programs that are not responsive to racial or ethnic preferences, and programs that are not tailored to rheumatic diseases—also may prevent individuals from pursuing more physical activity.
Underscoring the crucial role of provider messaging, she said research has shown recommendations from a health professional are strongly associated with people actually engaging in physical activity or exercise. Still, providers may shy away from delivering specific advice about physical activity because they may not consider themselves competent in this area, or the provider may not have time during a routine office visit, Dr. Katz said.
To remedy the situation, she offered suggestions for promoting the CDC-recommended 150 minutes of moderate to vigorous physical activity each week, with muscle strengthening at least two days a week.
“There’s really no clear evidence of what type of activity is most beneficial,” Dr. Katz said. “The important thing is whether it’s something someone enjoys because if they enjoy it, they’re more likely to do it.”
Structured exercise programs and simple changes in one’s routine both can be beneficial. Just standing up twice an hour during the 10 hours most people are sitting during a day adds up to 20 minutes of light activity.
Engaging in physical activity at least three times per week is recommended. For those who have depression, the recommended frequency increases to at least five times per week.
Walking may be the most accessible activity for those who are inactive. It can be easily scaled for time and intensity and done solo or in a group.
There are some disease-specific considerations to take into account before starting an exercise regimen. For example, for someone with a rheumatic condition with disease involvement in their feet, careful selection of shoes is important to prevent pain, which could result in discouragement and, ultimately, discontinuance of physical activity.
“Anything is better than nothing,” Dr. Katz said. “That’s one clear message. Moving your body is really important.”