Individualized Training the Most Effective Means to Increase Physical Activity with RA

Christine Miller Health Guide
  • A recent article in the online December issue of Arthritis & Rheumatism compared the effectiveness of two different types of Internet-based physical activity interventions for people with rheumatoid arthritis. In this study from the Netherlands, 160 patients were monitored over a period of a year. The patients were divided into two groups each accessing a different part of a website; one receiving an individualized activity program and one receiving general arthritis and exercise information.

    The people in the individualized training group received a weekly, detailed personal activity program including muscle strengthening exercises, range-of-motion exercises, and cycling on a bicycle ergometer (measures the amount of work done by muscles during cycling). The program had to be performed 5 times a week on 5 separate days. Every week, the participants would email a report of their activity and the researchers would then post a new schedule of activity on each person’s personal web page. Each program was tailor-made for duration and intensity. All patients were also advised to engage in other physical activity on the other 2 days of the week such as walking or biking outside. Each received weekly, individual supervision by email from 2 physical therapists. They were also invited to attend group meetings once every three months where new exercises were demonstrated, more information on exercise was given and participants could share their experiences with each other. There was also a discussion forum on the webpage. Participants also received advice on self-management strategies for pain and fatigue management, energy conservation and joint protection via email and during group meetings.
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    On the other hand, the general training group accessed web pages with general information on aerobic exercise, muscle strengthening and ROM exercises and physical activity in RA patients. Participants were advised to perform moderate physical activity at least 5 days a week and were offered suggestions for increasing duration and intensity of activity to meet this goal. They could also order a free copy of a CD-ROM developed for the general population which offered advice on physical activity. Information on the webpage was updated once per month with new activities and exercises, news, and brochures.

    Predictably, the researchers found that the proportion of patients reporting moderate or vigorous physical activity was significantly higher in the individualized training (IT) group than in the general training (GT) group over a 12-month period. 38% percent of patients in the IT group who reported moderately intense activity for 30 minutes, 5 times per week at the 6 month mark. This number dropped by only 3% at 9 months. However, only 22% of the GT group reported moderate activity levels after 6 months and that number plummeted to 11% at 9 months. The findings were similar for reporting of vigorous activity, which the researchers defined as 20 successive minutes of vigorous activity least three days a week. The scientists found no significant long-term differences in functional ability or quality of life in the two groups.

  • Like many other studies of exercise, the researchers found that the number of patients meeting recommended activity levels declined significantly over time in both groups. They concluded that a doctor giving advice to get more exercise just isn’t enough. They recommended strategies for physicians and clinics to increase compliance through theory-based physical activity interventions, promoting self-regulatory skills, and using phone calls and emails to give ongoing individual guidance and reinforcement. They also reported a decline in the use of the websites, suggesting that websites of this sort should include more interactive features, incentives, and newsletters to encourage ongoing and regular use.
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    I tried a simple search online for internet-based physical activity programs for arthritis, but came up empty-handed. However, that doesn’t mean that they don’t exist! Talk to your rheumatologist. I would think that larger health centers like academic teaching hospitals or rheumatology clinics would know of opportunities for individualized, web-based RA-related exercise programs. Or they are likely to know of community-based programs to attend. For example, the Arthritis Foundation has a recreational, community-based program run through local chapters called “People with Arthritis Can Exercise (PACE).” Also, it might be helpful to work with a trainer or physical therapist to set up an individualized program for you and to work with you to set achieveable goals and to follow-up with that person every couple of months.

    Have you tried either an RA-specific exercise program or a web-based exercise program? Please share your experiences by leaving a comment here on the RA Message Boards.
Published On: February 02, 2007