COLUMBIA, SC—New research may shed light on why people with arthritis don't exercise and help clinicians get arthritis patients moving. High on the list of the new report in Arthritis Care & Research: fear of pain and lack of social support.1

"We know that a physician recommendation can go a long way in encouraging people to exercise." —Sara Wilcox, PhD
Aerobic exercise and resistance training have been shown to reduce pain, prevent disability, improve quality of life and physical functioning, and reduce comorbities among people with arthritis, but the level of exercise among patients with arthritis is generally low. This study was launched to find out why by Sara Wilcox, PhD, of the department of exercise science at the Arnold School of Public Health, University of South Carolina, in Columbia, and her colleagues.

"We know that a physician recommendation can go a long way in encouraging people to exercise. I hope that the findings will impact how messages are delivered, because exercise is one of the best things that people with arthritis can do to maintain their functioning," Dr. Wilcox told CIAOMed.

The researchers divided 68 arthritis patients into 12 focus groups to discuss perceived exercise barriers, benefits, and enablers. The groups were stratified by exercise status, socioeconomic status, and race. 

Among the key findings:

● Pain was the number one physical barrier to exercise among exercisers and nonexercisers, although exercisers were more likely to make adjustments due to pain and modify the type or intensity of exercise or take breaks during flares. "I think providers can emphasize that exercise helps to manage pain, promotes mobility, and enhances quality of life," Dr. Wilcox said. "Providers also need to help people with arthritis understand that they may need to make modifications to their exercise programs to accommodate their disease."
● Fatigue and impaired mobility were also physical barriers to exercise among exercisers and nonexercisers.
● Comorbid conditions ranging from musculoskeletal to cardiovascular were more likely to be physical barriers for exercisers than nonexercisers.
● Psychological barriers included lack of time, lack of motivation, and lack of enjoyment of exercise. Some patients simply felt "I should, but I don't" exercise. Nonexercisers said these obstacles stopped them from exercising, while exercisers said those factors just made exercising more difficult.

Nonexercisers reported fear of water and fear of pain as barriers; both groups of patients said that perceived negative outcomes of exercise, such as hurting more afterward, were barriers.
Social barriers included a lack of support, having no one to exercise with, and competing role responsibilities (such as feelings of responsibility to the family). Nonexercisers, in particular, reported that they had less energy as a result of competing roles.  Nonexercisers also were more likely to say that their physician had not referred them to an exercise program and to voice a desire for exercise partners with similar limitations, the study showed.

Environmental barriers included a lack of programs or facilities that cater to people with arthritis. Weather, cost, and transportation were also obstacles.

The main factors that promoted regular exercise were patients' feelings that it

● made them feel better
● provided the ability to move and function better
● boosted their strength
● promoted weight loss.

Psychological benefits included independence, improved self-confidence, improved sense of well being, and general enjoyment. Exercisers and nonexercisers also pointed to the potential social benefits of exercise when done in and around groups.

Both exercisers and nonexercisers said that access to a water-based exercise program made exercise easiest. They also said that access to programs tailored to people with arthritis and owning exercise equipment both promoted exercise.

"People with arthritis want to hear from their physician that exercise is safe and will be beneficial," Dr. Wilcox said. "If rheumatologists can recommend specific types of exercises, that would also be useful, [and] referring people with arthritis to specific exercise community programs (especially those geared to people with arthritis) can help these people know where to go and take the initial steps to become more active."

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Reference

1. Wilcox, S, Der Ananian CD, Abbott, J, et al. Perceived exercise barriers, enablers, and benefits among exercising and nonexercising adults with  arthritis: results from a qualitative study. Arthritis Care Res. August 2006; DOI: 10.1002/art.22098