‘Exercise is recognized as safe—it’s been recommended for people with rheumatic muscular & skeletal diseases for quite some time.’ —Patricia Katz, PhD
Patients had a baseline visit and wore an activity monitor for a week to establish a baseline activity level. The monitor had no readout on steps for the patients to see, so that their behavior would be less likely to change. They came back for another visit, then were randomized to a group that received educational materials, a pedometer and a step diary; or one that received the educational materials, pedometer and a step diary, and were given step goals; or a control group that received only educational materials.
The goals were based on the baseline monitoring and were designed to increase steps by about 10% every two weeks, an amount considered manageable. Patients had a median of about 4,200 steps a day at baseline, which is well below the threshold for a sedentary lifestyle. They also had moderate disease activity and moderate levels of disability.
Researchers found that the rate of sedentary behavior significantly declined in the two intervention groups compared to the control group, in which the rate of sedentary behavior increased (P=0.04). The two intervention groups also showed significant declines in fatigue levels (P=0.02 for the pedometer-only group and P=0.0002 for the pedometer and goals group).
Those with higher levels of baseline fatigue, those with a shorter disease duration and those with higher levels of depressive symptoms were more likely to have a meaningful decrease in fatigue, Dr. Katz said.
Beyond fatigue, exercise has also been shown to be a potent treatment for depression, Dr. Katz noted, with studies suggesting that it is equivalent to psychological therapy and pharmacological therapy.7
Cognitive impairment, shown to be common in some rheumatic conditions, has also been linked with physical inactivity. A study by Dr. Katz et al. in 2012, based on self-reported activity by women with lupus, found that inactivity was associated with an elevated risk of impairment in memory and executive function.8
Perceived barriers to physical activity abound for people with rheumatic diseases, including disease activity, fatigue, concerns about harming joints and a general lack of motivation, along with such structural barriers as having a safe place to exercise, financial barriers and not having exercise programs tailored to rheumatic conditions, Dr. Katz said.
Medical Recommendation Important
But recommendations for exercise from healthcare providers have been shown to be closely associated with levels of physical activity. These recommendations might not always be made, she suggested, because some physicians might feel they’re not qualified to make such recommendations and feel pressed for time in the clinic.
“There are a lot of things to cover in that very short period and having counseling on physical activity may just be a bridge too far in that setting,” Dr. Katz said.
