CHAPEL HILL, North Carolina—A randomized, controlled trial shows that the 8-week Arthritis Foundation Exercise Program, formerly called People with Arthritis Can Exercise (PACE), can safely improve pain and fatigue in otherwise sedentary older patients, according to research in the January issue of Arthritis Care & Research.¹ Pilot studies had previously shown that this program works, but the new research is the first randomized controlled trial to evaluate it.

"Our findings indicate that the basic 8-week PACE program is a safe program for sedentary older individuals with arthritis to start exercising without exacerbating their symptoms," concluded lead researcher Leigh F. Callahan, PhD, of the University of North Carolina at Chapel Hill.

What is the Arthritis Foundation Exercise Program?

The Arthritis Foundation Exercise Program is an 8-week program in which participants meet twice weekly for 1 hour. The program is offered at basic and advanced levels and focuses on gentle activities to increase joint flexibility, range of motion, and exercises in order to maintain muscle strength. Physicians can advise patients to call their local chapter of the Arthritis Foundation to find out where and when it is available in their communities.

The new study comprised 346 patients, with an average age of 70, who had self-reported arthritis. The participants were divided into an intervention group that took part in the Arthritis Foundation Exercise Program for 8 weeks and a control group that was offered the program after 8 weeks. The exercisers completed self-report assessments 3 and 6 months after completing the program. Researchers measured pain, stiffness and fatigue using visual analog scales. Physical function assessment include self-reports and performance-based tests including timed 10-lb lifts and timed chair tests. The researchers also assessed psychosocial outcomes using four different scales.

Patients randomized to the Arthritis Foundation Exercise Program showed significant improvements in pain, fatigue, and managing arthritis at 8 weeks. Moreover, the improvements in pain and fatigue were maintained at 6 months. Those arthritis patients who completed the program showed increased strength in their upper and lower extremities. Exercise endurance did not increase, the study showed.

While pain and fatigue improvement were maintained 6 months postprogram among program patients, there was a decline in self-efficacy for exercise at 6 months and assessment of disability using the health assessment questionnaire (HAQ) was also worse 6 months postprogram. Further research is needed to determine if offering the program more than twice a week and for longer periods yields additional benefits.

No downside to regular exercise

"As a doctor, I ask myself 'what can I do to address quality of life and pain relief that would have little side effects when even the simple drugs like ibuprofen have a considerable number of side effects?' and 'do I really know what that I am telling them works?,'" questioned Patience White, MD, MA, chief public health officer of the Arthritis Foundation and a professor of medicine and pediatrics at George Washington University in Washington, DC. The Arthritis Foundation Exercise Program works, she said, "People really enjoy it and it really makes a big difference in their quality of life and there are virtually no side effects."

There are other benefits that were not measured in the new study. "Physical activity helps general wellbeing and depression, which is a big factor in arthritis," Dr. White said.

Exercise also helps patients lose weight. "Every couple of pounds gained makes osteoarthritis worse." Her bottom line? "It's a good place to send people to learn how to do exercises and we know that you are going to help them with the things that they complain about most—pain and fatigue. Physicians should think of more than direct drug therapy in arthritis," she said. "Many say 'you are supposed to exercise and lose weight,' but they can actually send them someplace where you know that pain will get better," Dr. White ended.

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