Christina H. Opava

Coaching patients with early rheumatoid arthritis to healthy physical activity: a multicenter, randomized, controlled study.

OBJECTIVE To investigate the effect of a 1-year coaching program for healthy physical activity on perceived health status, body function, and activity limitation in patients with early rheumatoid arthritis. METHODS A total of 228 patients (169 women, 59 men, mean age 55 years, mean time since diagnosis 21 months) were randomized to 2 groups after assessments with the EuroQol visual analog scale (VAS), Grippit, Timed-Stands Test, Escola Paulista de Medicina Range of Motion scale, walking in a figure-of-8, a visual analog scale for pain, the Health Assessment Questionnaire disability index, a self-reported physical activity questionnaire, and the Disease Activity Score in 28 joints. All patients were regularly seen by rheumatologists and underwent rehabilitation as prescribed. Those in the intervention group were further individually coached by a physical therapist to reach or maintain healthy physical activity (> or =30 minutes, moderately intensive activity, most days of the week). RESULTS The retention rates after 1 year were 82% in the intervention group and 85% in the control group. The percentages of individuals in the intervention and control groups fulfilling the requirements for healthy physical activity were similar before (47% versus 51%; P > 0.05) and after (54% versus 44%; P > 0.05) the intervention. Analyses of outcome variables indicated improvements in the intervention group over the control group in the EuroQol VAS (P = 0.025) and muscle strength (Timed-Stands Test; P = 0.000) (Grippit; P = 0.003), but not in any other variables assessed. CONCLUSION A 1-year coaching program for healthy physical activity resulted in improved perceived health status and muscle strength, but the mechanisms remain unclear, as self-reported physical activity at healthy level did not change.

Current and Maintained Health-Enhancing Physical Activity in Rheumatoid Arthritis: A Cross-Sectional Study

To describe and identify the explanatory factors of variation in current and maintained health‐enhancing physical activity (HEPA) in persons with rheumatoid arthritis (RA).

Aerobic capacity correlates to self-assessed physical function but not to overall disease activity or organ damage in women with systemic lupus erythematosus with low-to-moderate disease activity and organ damage

The present aim is to investigate the relationships between aerobic capacity and disease activity, organ damage, health-related quality of life (HRQL) and physical activity in 34 women with systemic lupus erythematosus (SLE) with low-to-moderate disease activity and organ damage. Mean age was 51 (SD 10) years, disease duration 17 (SD 11) years. Aerobic capacity (maximal oxygen uptake/VO2 max) was measured with a bicycle ergometer exercise test. Overall disease activity was assessed with Systemic Lupus Activity Measure (SLAM) and the modified Systemic Lupus Erythematosus-Disease Activity Index (modified SLE-DAI), overall organ damage with the Systemic Lupus International Collaboration Clinics/American College of Rheumatology-Damage Index, [SLICC/(ACR)-DI], HRQL with the 36-item Short-form health-survey (SF-36) and physical activity with a self-assessed question. The women who were low-to-moderately physically active had 89—92% (P ≤ 0.001) of VO2 max predicted for sedentary women. Maximal oxygen uptake (L/min, mL/min/kg) correlated to SF-36 physical function (rs = 0.49, rs = 0.72) (P ≤ 0.01), but not (rs ≤ 0.25) to other HRQL scales, overall disease activity or organ damage or physical activity. The correlation between aerobic capacity and physical function and the absence of correlation between aerobic capacity and physical activity, suggest a possible disease-related factor behind the low aerobic capacity. However, with no correlation between aerobic capacity and overall disease activity and organ damage, low physical activity may contribute to the low aerobic capacity in our sample. Lupus (2008) 17, 100—104.

Physical Activity Coaching of Patients with Rheumatoid Arthritis in Everyday Practice: A Long-term Follow-up

OBJECTIVES To investigate the long-term effects on perceived general health, disease activity, pain, activity limitation and cognitive behavioural factors of a one-year coaching programme performed in ordinary physical therapy practice to promote the adoption of health-enhancing physical activity in patients with early rheumatoid arthritis (RA). METHODS A total of 228 patients with early RA, from 10 rheumatology clinics in Sweden, were randomly assigned to an intervention group (IG; n = 94) or a control group (CG; n = 134). The IG was coached by physical therapists during the first year to adopt health-enhancing levels of physical activity (30 minutes/day, moderately intensive, ≥ 4 days/week). No coaching was given during the subsequent year between post-intervention and follow-up. Follow-up assessment consisted of a postal questionnaire on physical activity and of visual analogue scales for ratings of general health perception and pain. The Health Assessment Questionnaire Disability Index (HAQ) and the Disease Activity Score in 28 joints (DAS 28) were collected at regular medical check-ups. RESULTS Sixty-five (69%) participants in the IG and 92 (69%) in the CG completed the entire study period by filling in the follow-up questionnaire on physical activity two years after baseline. The intervention seemed to lack any significant influence on long-term outcome. However, different patterns of change in physical activity behaviour were observed in the two groups. CONCLUSIONS No long-term improvement in perceived general health or other outcomes were found in the follow-up. This may partly be because the intervention lacked several important behavioural elements for physical activity maintenance.

Attitudes toward physical activity among people with rheumatoid arthritis

Physical activity confers health benefits in the general population, and this also seems to apply to people with rheumatoid arthritis (RA). Less explicit barriers than pain need to be explored and overcome to initiate and successfully maintain physical activity in individuals with RA. The present aim was to describe variations in attitudes to physical activity in a group of people with RA. Sixteen people with RA were chosen to represent various ages, genders, disease duration, functioning, and health habits. Semi-structured, in-depth interviews were carried out, transcribed, qualitatively analysed, and categorised on the basis of similarities and differences. The analysis indicated that attitudes toward physical activity could not be understood without inclusion of attitudes toward the disease and sometimes to life in general. Two dimensions of attitude, motivation and satisfaction, were identified. Four categories were revealed: motivated and satisfied, unmotivated and satisfied, motivated and dissatisfied, and unmotivated and dissatisfied, each representing different attitudes to physical activity. Our findings stress the importance of developing different educational interventions that address attitudes to physical activity in order to implement a healthy life style in individuals with RA.

Views on Exercise Maintenance: Variations Among Patients With Rheumatoid Arthritis

Background and Purpose: Individuals with rheumatoid arthritis (RA) often have to make changes in exercise behavior in order to gain and sustain health benefits. The purpose of this study was to explore and describe ways of understanding exercise maintenance among individuals with RA who had already started to exercise. Participants: Fourteen women and 4 men with RA of at least 2 years’ duration, selected from 4 hospitals or primary health care physical therapy clinics, participated. They had exercised regularly at least twice weekly during the previous 2 months with various levels of support from a physical therapist, and they had attempted to exercise without support outside of the health care environment during the previous year. Method: A phenomenographic approach was used to analyze semistructured interviews. A pattern of categories of descriptions was constructed based on the participants’ conceptions and ways of understanding the phenomenon of exercise maintenance. Results: Five categories were identified: “external control,” “sticks and carrots,” “a joint venture,” “the easy way,” and “on ones own terms.” The categories became clear by elucidating 2 aspects related to exercise maintenance: (1) the way the participants talked about and experienced the type of support needed and (2) personal factors. Discussion and Conclusion: The results highlight the importance of finding the proper context and support for each patients needs. Furthermore, preparing for exercise maintenance by strengthening the patients beliefs in his or her ability to exercise in different settings, by discussing pros and cons of exercise, and by exploiting the patients ability to adapt and continue exercise outside of the health care environment might be valuable.

Resistive Home Exercise in Patients with Recent-onset Polymyositis and Dermatomyositis — A Randomized Controlled Single-blinded Study with a 2-year Followup

Objective. To evaluate the outcome of resistive home exercise and its possible longterm influence on health, disability, and disease activity in patients with active polymyositis (PM) or dermatomyositis (DM). Methods. Nineteen patients with recent-onset PM/DM were included after introduction of high-dose prednisolone. They were assessed by independent assessors as to perceived health, muscle performance, aerobic capacity, and serum creatine phosphokinase (CPK) at baseline and after 24 weeks, including repeated muscle biopsies at 24 weeks (single-blinded randomized controlled study), and in an open-label followup at 52, 78, and 104 weeks. Patients were randomized to 12 weeks, 5 days/week resistive home exercise with telephone support and encouragement for another 12 weeks of twice-a-week home or gym exercise (EG, n = 10) or to 24 weeks, 5 days/week range of motion exercise (CG, n = 9). Patients in the CG group without inflammatory infiltrates in muscle biopsies at 24 weeks were invited to the 12-week resistive home exercises. Results. At baseline, the EG had poorer perceived health, but otherwise the groups were comparable. At 24 weeks, both groups improved in muscle performance and aerobic capacity (p < 0.001 to < 0.05) with no signs of increased inflammation assessed by CPK levels or muscle biopsies. Both groups improved in muscle performance and aerobic capacity up to 52 weeks (p < 0.05) lasting to 104 weeks in the EG (p < 0.05) and presented minor improvements in perceived health. Conclusion. Our study supports the safety of resistive exercise in patients with active PM/DM but did not reveal any between-group differences in exercise effects. An individually adapted physical therapist–supervised home exercise program might be recommended in early active PM/DM, with regular evaluation of muscle performance and health.

Long-term health-enhancing physical activity in rheumatoid arthritis - the PARA 2010 study

BackgroundPeople with rheumatoid arthritis (RA) suffer increased risk of disability andpremature mortality. Health-enhancing physical activity (HEPA) could be one importantfactor to reduce this risk. Rising health care costs call for the development and evaluation ofnew modes of rehabilitation, including physical activity in settings outside the health caresystem.Methods/DesignThis cohort study targets 450 patients with RA that do not currently meet HEPA recommendations, recruited from six hospitals reporting to the Swedish Rheumatology Quality Registers (SRQ). We have developed a two-year real-life intervention program including a minimum of twice-weekly circuit training, moderately intense physical activity the remaining days of the week and group meetings to support behavior change every other week. Our hypothesis is that increased physical activity and exercise will improve perceived health, reduce pain and fatigue, increase muscle function and aerobic capacity, impact psychosocial factors and prevent future cardiovascular events. Research questions regard outcomes, retention rates, dose–response matters and the exploration of responder characteristics. This protocol outlines recruitment procedure, design, assessment methods and the intervention program of the study.DiscussionThe PARA 2010 project is designed to expand the knowledge on HEPA in RA by a progressive approach regarding population, setting, intervention, time frames and outcome measures. To our knowledge this is the first long-term HEPA program based on Social Cognitive Theory, and performed in a real life environment to demonstrate if this new setting can promote increased and maintained physical activity in people with RA.Trial registration numberISRCTN25539102

Physical-activity coaching and health status in rheumatoid arthritis: A person-oriented approach

Purpose. No interventions to promote physical activity can succeed for all participants. Insights into the specific characteristics of those who do succeed are needed. One aim was to investigate whether a selection of correlates of general health perception creates cluster typologies in individuals with rheumatoid arthritis (RA). Another was to evaluate whether magnitude of change in health status differs between clusters after a 1-year coaching intervention targeting health-enhancing physical activity. Method. Two hundred and twenty-eight patients (74% women, mean age 56 years, disease duration 1 year) with RA, from 10 rheumatology clinics in Sweden, participated. The patients were assigned at random to intervention or control. The intervention group underwent 1 year of coaching to adopt health-enhancing physical activity (moderately intensive, 30 min/day, > 4 days/week). The cluster analysis included five correlates of general health perception: disease activity; pain; timed standing; activity limitation; and self-reported physical activity. The primary outcome of the coaching intervention was self-reported health status. Results. One-hundred and forty-six patients were eligible for inclusion in the cluster analysis. The eight clusters identified both at baseline and post interventions were operationalized according to the number of cluster variables affected: less (LE) affected or more (MO) affected, respectively. Clusters with LE affected variables had significantly better general health perception at baseline than those with MO affected variables. Further, coached individuals in MO affected clusters significantly improved self-reported health status compared both to those coached in LE affected clusters and to those in MO affected clusters in the control group. Conclusion. This person-based approach contributed more than did the results in a previous randomized controlled trial to the understanding of which patients benefit most from the present physical-activity coaching intervention. The intervention may thus be most beneficial for individuals more severely affected by their disease at baseline.

Patients with regular physical activity before onset of rheumatoid arthritis present with milder disease

Objectives Physical activity has been shown to decrease inflammatory markers; here we investigate the effect on the clinical presentation of rheumatoid arthritis (RA). Methods We used the cases from the population-based EIRA study (N=617), followed in the Swedish Rheumatology Quality Register, calculating the odds of having above median level of 28-joint disease activity score (DAS28), physician assessment, pain (visual-analogue scale (VAS), VAS-pain) and activity limitation (health assessment questionnaire (HAQ)) at diagnosis, as an effect of physical activity 5 years before diagnosis, investigated both in categories and dichotomised. Results Dose–response relationships were seen for all measures; the higher the level of physical activity, the lower the likelihood of having outcome measure above median. Further, regular physical activity associated with 42% reduced odds of having DAS28 above median (OR=0.58 (95% CI 0.42 to 0.81)). Effects were similar for VAS-pain (OR=0.62 (95%CI 0.45 to 0.86)) and physician assessment (OR=0.67 (95%CI 0.47 to 0.95)) but not for HAQ. Statistically significant effects were also found both for the combined objective components and the combined subjective components of DAS28. Conclusions Physically active individuals seem to present with milder RA, which adds to the evidence of beneficial effects of physical activity on inflammatory diseases. The observation should be important for both health professionals and individuals seeking to reduce their risk.