Patients with rheumatoid arthritis (RA) who exercise regularly and those who do not, report similar barriers to physical activity and exercise but different coping strategies. |
Support from healthcare providers and family/friends is an important facilitator for physical activity in RA. |
Knowledge about appropriate exercise programmes is lacking in RA patients and healthcare providers. |
1 Introduction
2 Literature Search Methodology
3 Findings
Study | Participants (n) | Assessment | Findings—RA specific | Findings—generic |
---|---|---|---|---|
Quantitative studies | ||||
Stenstrom et al. [33] | 79 RA—physician diagnosis (ACR) | Questionnaires | Pain | Time |
Neuberger et al. [34] | 100 (63 diagnosed RA, 37 OA—physician diagnosis) | Questionnaires | Inaccessibility of exercise facilities, no encouragement, exercise too tiring | Inconvenient schedule, time, effort |
Jensen and Lorish [35] | 305 rheumatology clinics (RA, OA, back pain—self-diagnosis) | Questionnaires | Lack of desired results, made more tired, joints felt worse | Got out of habit, boring/not fun |
Iversen et al. [36] | 140 RA—physician diagnosis (ACR) | Questionnaires | Pain | Time, boring |
Kang et al. [32] | 72 arthritis (12 RA)—physician diagnosis | Questionnaires | No convenient facility/place | Location of pool |
Van den Berg et al. [37] | 252 RA—physician diagnosis (ACR): 80 % active, 20 % inactive | Questionnaires | Lack of energy, pain, fear of damaging joints (no difference between physically active and inactive patients) | Lack of motivation |
Bajwa and Rogers [38] | 223 arthritis—self-reported diagnosis of arthritis | Interviews | Bad health, pain | |
Martin et al. [50] | 1292 arthritis—self-reported diagnosis of arthritis | Interviews | Ill or otherwise physically unable | |
Hutton et al. [39] | 1106 arthritis—self-reported diagnosis of arthritis 1106 age-, sex- and ethnicity-matched controls | Questionnaires | Arthritis/other health problems, lack of energy/too tired | |
Gyurcsik et al. [40] | 80 arthritis—physician diagnosis | Questionnaires | Fatigue, pain | |
Brittain et al. [41] | 248 arthritis—self-reported diagnosis | Questionnaires (online) | Pain, arthritis limits body capability, stiffness | Temperature, too tired after work, time |
Law et al. [26] | 247 RA—self-reported diagnosis | Questionnaires (online) | Worry about causing harm, joint pain | |
Henchoz et al. [27] | 89 RA—physician diagnosis (ACR) (34 % no regular exercise, 45 % regular exercise) | Questionnaires | Pain, stiffness, tired, arthritis-related limitations | |
Qualitative studies | ||||
Hammond [42] | 41 RA—physician diagnosis (ACR) | Interviews | Pain | Time/motivation, getting sufficient exercise already in job/household |
Kamwendo et al. [43] | 10 RA—physician diagnosis | Interviews | Tiredness, pain, fatigue, fear of pain, external barriers, lack of instructions | Time, environmental barriers (e.g. weather) |
Lambert et al. [24] | 12 arthritis—physician diagnosis | Focus groups | Uncertainty about safe exercise and injury prevention | |
Schoster et al. [44] | 36 arthritis completers of exercise program, 15 arthritis non-completers of exercise program—self-reported diagnosis | Interviews | Personal illness (non-completers arthritis related, completers general illness), class not challenging (non-completers) | |
Wilcox et al. [45] | 26 arthritis exercisers (14 RA), 32 arthritis non-exercisers (8 RA)—self-reported diagnosis | Focus groups | Pain, fatigue, mobility, co-morbid conditions, attitudes and beliefs, fear of pain, perceived negative outcomes, lack of support, no one to exercise with, lack of programmes/facilities | Competing roles/responsibilities, environmental conditions, cost, transportation |
Der Ananian et al. [46] | 15 arthritis non exercisers (4 RA), 15 arthritis insufficiently active (3 RA), 16 arthritis exercisers (6 RA)—self-reported diagnosis | Focus groups | Pain, mobility, co-morbidities, fatigue, attitudes and beliefs (e.g. lack of exercise knowledge, reducing pain/symptoms), perceived negative outcomes, insufficient advice from healthcare providers, lack of exercise programmes | Competing roles/responsibilities, attitudes and beliefs (e.g. laziness, lack of enjoyment/time), weather |
Martin et al. [50] | 19 arthritis—self-reported diagnosis | Focus group and interviews | Personal health, chronic illness | Cost |
Swardh et al. [47] | 18 RA—physician diagnosis | Interviews | Pain, fatigue | Time, cost and cold climate |
Law et al. [48] | 18 RA—physician diagnosis | Focus groups | Lack of knowledge of health professional and patient, joint and muscle pain, worry about causing harm to joint, fatigue | Lack of enjoyment, motivation and confidence |
Kaptein et al. [49] | 40 arthritis—self-reported diagnosis | Focus groups | Lack of knowledge about exercise, pain, unpredictable nature of arthritis, fatigue | Competing roles |
Study | Participants (n)
| Assessment | Findings—RA specific | Findings—generic |
---|---|---|---|---|
Quantitative studies | ||||
Stenstrom et al. [59] | 95 rheumatic condition (35 inflammatory arthritis)—self-reported diagnosis | Questionnaires | Psychological factors most important, then physiological factors and social factors Psychological motivation and physical motivation equally important, then social motivation | |
Hutton et al. [39] | 1106 arthritis—self-reported diagnosis 1106 age-, sex- and ethnicity-matched controls | Questionnaires | Want to take responsibility | Childcare, time (allowance by employer), companion |
Qualitative studies | ||||
Kamwendo et al. [43] | 10 RA—physician diagnosis | Interviews | Strength and aerobic capacity, self-efficacy, support from healthcare providers and friends/family, improvement in stiffness, fear of getting worse, intimidation when confronted with worse RA | Happiness, social benefits, personal satisfaction |
Schoster et al. [44] | 36 arthritis completers of exercise programme, 15 arthritis non-completers of exercise programme—self-reported diagnosis | Interviews | Instructor support, self-efficacy, exercise information | Class social support |
Wilcox et al. [45] | 26 arthritis exercisers (14 RA), 32 arthritis non-exercisers (8 RA)—self-reported diagnosis | Focus groups | Encouragement of significant other, programmes/knowledgeable instructors | Internal motivation, social interaction, exercise buddy, low-cost programmes |
Der Ananian et al. [46] | 15 arthritis non-exercisers (4 RA), 15 arthritis insufficiently active (3 RA), 16 arthritis exercisers (6 RA)—self-reported diagnosis | Focus groups | Social support from significant other/people with arthritis, healthcare provider advice, access to exercise programmes with knowledgeable instructors | Making exercise a priority, self-motivation |
Swardh et al. [47] | 18 RA—physician diagnosis | Interviews | Feeling of safety, support/guidance, encouragement of instructor, feeling of autonomy | |
Law et al. [48] | 18 RA—physician diagnosis | Focus groups | Assistance from instructors | Social interaction, low cost, easy access, weight reduction |
Kaptein et al. [49] | 40 arthritis—self-reported diagnosis | Focus groups | Social support | |
Loeppenthin et al. [58] | 16 RA—self-reported diagnosis | Interviews | Support/motivation from others (including healthcare professionals) |
Study | Participants (n) | Assessment | Findings—RA specific | Findings—generic |
---|---|---|---|---|
Quantitative studies | ||||
Hutton et al. [39] | 1106 arthritis—self-reported diagnosis 1106 age-, sex- and ethnicity-matched controls | Questionnaires | Good for health | Enjoyment, taking responsibility, role model for children |
Iversen et al. [25] | 113 RA—physician diagnosis (ACR) | Questionnaires | Pain relief | |
Jensen and Lorish [35] | 305 rheumatology clinics (RA, OA, back pain)—self-diagnosis | Questionnaires | Make joints feel better, able to do other tasks more easily, feel more in control, showing family/friends that I can do them | Feel better overall, pleasing person who prescribed exercise |
Law et al. [26] | 247 RA—self-reported diagnosis | Questionnaire (online) | Helpful | |
Henchoz et al. [27] | 89 RA—physician diagnosis (ACR) (34 % no regular exercise, 45 % regular exercise) | Questionnaire | Physical benefits (e.g. decreases stiffness), psychological benefits (e.g. better endure pain), functional benefits (e.g. functional ability and independence) | Physical benefits (e.g. lose weight), psychological benefits (e.g. pleasure), social benefits (e.g. spend time with friends and family) |
Qualitative studies | ||||
Eurenius et al. [62] | 16 RA—physician diagnosis (ACR) | Interviews | Preventing decline, maintaining physical capacity | Increase confidence |
Lambert et al. [24] | 12 arthritis—physician diagnosis | Focus groups | Exercise important factor in treatment, helpful to get away from pain | |
Wilcox et al. [45] | 26 arthritis exercisers (14 RA), 32 arthritis non-exercisers (8 RA)—self-reported diagnosis | Focus groups | Symptom management, mobility and function, strength and flexibility, independency, attitudes and beliefs | Weight loss, emotional benefits and enjoyment |
Der Ananian et al. [46] | 15 arthritis non-exercisers (4 RA), 15 arthritis insufficiently active (3 RA), 16 arthritis exercisers (6 RA)—self-reported diagnosis | Focus groups | Symptom management (more tolerable pain), improved mobility, independence | Feeling better, reducing stress |
Kamwendo et al. [43] | 10 RA—physician diagnosis | Interviews | Strength and aerobic capacity, prevention of stiffness, combat the fear of getting worse | Happiness, self-efficacy, social benefits |
Loeppenthin et al. [58] | 16 RA—self-reported diagnosis | Interviews | Joy, energy, preservation of bodily consciousness, manage illness, strength, functional ability, satisfaction, maintenance of independence and autonomy, sense of belonging |
3.1 Perceived Barriers to Physical Activity and Exercise
3.2 Perceived Facilitators for Physical Activity and Exercise
3.3 Perceived Benefits of Physical Activity and Exercise
3.4 Barriers and Benefits Related to Physical Activity Behaviour
4 Practical Implications and Recommendations
Perceived barriers to physical activity and exercise | Perceived benefits of physical activity and exercise | Perceived facilitators of physical activity and exercise |
---|---|---|
Pain | Symptom management | Support |
Fatigue | Pain relief and distraction | Exercise instructors |
Mobility | Joint function | Health care provider |
Stiffness | Independence | Family/friends |
Lack of RA exercise programmes | Strength and aerobic capacity |
5 Conclusion
Physically active patients are not different from inactive patients in terms of the perceived barriers, but those who are physically active are able to manage these perceived barriers more effectively than inactive patients Support from exercise instructors, healthcare providers and family/friends is an important facilitator for physical activity and exercise Perceived benefits are associated with physical activity, but knowledge about appropriate exercise programmes is lacking in patients and healthcare providers In order to increase the uptake and maintenance of physical activity behaviour and exercise, intervention programmes should |
encourage the development of coping strategies to overcome the perceived barriers |
increase the knowledge of the physical activity benefits for rheumatoid arthritis patients and healthcare providers |
provide clear educational materials about appropriate exercise programmes aimed towards the healthcare professionals, the patients, and relatives and friends of the patient |