LEIDEN, The Netherlands—Rheumatoid arthritis (RA) patients who used an individualized, Internet-based exercise program may be more likely to get daily physical activity than their counterparts who only receive general information on exercise via the Internet, but their self reports of increased activity did not correspond with activity recorded by electronic monitoring devices, according to a study in the December 15 issue of Arthritis Care & Research.1
Is the Internet the missing link?
While regular exercise is considered an important element in the management of RA patients, many patients do not comply with physical activity recommendations. Advice alone does not seem to make a difference, but the researchers hoped that using the Internet and email could be more effective. Currently, almost 50% of people with arthritis have access to the Internet and this number appears to be growing,2,3 they write.
The new study comprised 160 physically inactive RA patients who had a computer with Internet access. Participants were randomly assigned to an individualized Internet-based physical activity program with individual guidance, a bicycle ergometer, and group contacts (n = 82), or they were assigned to a general Internet-based program providing only general information on exercises and physical activity (n = 78). Both interventions were delivered through the same Web site (www.cybertraining.nl).
The main outcome measures were the quantity of physical activity as assessed via a questionnaire and by Actilog V3.0 activity monitor, functional ability, quality of life, and disease activity at baseline, 3, 6, 9, and 12 months. The monitor is a matchbox-size device that is worn on the ankle and records activity scores in an internal memory every 5 minutes. Activity monitors were worn for 24 hours for 5 consecutive days at baseline, 6 months, and 12 months.
Participants in the individualized group received a detailed program of muscle strengthening exercises, range-of-motion exercises, and cycling that were to be performed five times a week on 5 separate days. Each week patients returned their completed program schedule and received a new one. They were given such exercise equipment as an elastic band, a wooden exercise stick, an ergometer, and a chest band measuring heart rate. Participants received personalized supervision from physical therapists. They were also invited to attend meetings once every 3 months and encouraged to chat with each other via a discussion forum on their Web page.
According to participants' self reports, the proportion engaging in moderate intensity exercise for 30 minutes in a row on at least 5 days a week was significantly greater in the individualized group as compared to the generalized group at 6 and 9 months (P <.05). Participants in the individualized group were also more likely to have participated in vigorous intensity exercise for 20 minutes straight on at least 3 days a week at 6, 9, and 12 months (P <.005).
However, the activity monitors detected no significant differences in physical activity between the two study groups. There were also no differences in functional ability, quality of life, or disease activity.
"The findings are sort of encouraging in the sense that people can utilize the Internet to change health behaviors," said Kevin Fontaine, PhD, assistant professor of medicine at Johns Hopkins University, in Baltimore, Maryland.
"The Internet is a new technology to try to promote health behaviors, but like any new technology we are not really sure how best to utilize it yet," he told CIAOMed. "Tailoring the program by providing more resources, plus emails to check up and activity logs—and making it more proactive by providing individuals with more feedback and information—is better than offering a general program without feedback and supervision," he said. "This is consistent with what we find clinically."
"Most RA patients report that their doctors are not encouraging them to exercise," Dr. Fontaine said. "Rheumatologists can perhaps improve on that, and it is possible to take advantage of Internet technologies to do so."
Many RA patients may not be so Internet savvy
The new study "does demonstrate what can be achieved by using the Internet," said Margaret-Mary Gordon, MD, consultant rheumatologist at Gartnavel General Hospital, in Glasgow, Scotland.
But Dr. Gordon has some concerns about the findings. "The study population is self selecting to an extent," she told CIAOMed. "The motivated minority who volunteered are by definition more likely to comply with the program."
In addition, she added that the process seems a little complicated for the computer illiterate. "We found that although almost half our patients had access to a computer, only one quarter used it to find medical information," she said concerning her own published research.3 "Even now, not all patients are able to access or use a computer to derive the required information."
However, "the strategy [used in the new study] itself…is quite complicated and time consuming, and I am not convinced adds anything to a supervised exercise group," Dr. Gordon said. "I think the Internet is an extremely valuable resource for RA patients, but I see it more as a two-way information resource than practical physical resource."
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References
1. van den Berg MH, Ronday HK, Peeters AJ, et al. Using internet technology to deliver a home-based physical activity intervention for patients with rheumatoid arthritis: A randomized controlled trial. Arthritis Care Res. 2006;55:935-945.
2. Richter JG, Becker AM, Specker C, et al. Disease-oriented internet use in outpatients with inflammatory rheumatic diseases. J Rheumatol. 2004;63:216-222.
3. Gordon M-M, Capell HA, Madhok R. The use of the internet as a resource for health information among patients attending a rheumatology clinic. Rheumatology. 2002:41:1402-1405.
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