Rheumatoid arthritis can make activities more difficult to accomplish.  It can cause severe fatigue and pain.  RA can also complicate how you manage to divvy up your time  each day, much less find time to exercise or stay physically active.

In a recent study, researchers in the Netherlands asked the question - “Are people with rheumatoid arthritis who undertake activity pacing at risk of being too physically inactive?”  (Cuperus, 2012). (subscription may be required) 

“Pace Yourself” - That’s what many of our doctors or physical therapists tell us to do.  Stop before you wear yourself out or cause physical injury.  Don’t overdo it. 

Sounds good to me.

What is Activity Pacing?

Activity pacing is a common strategy taught in pain management programs whereby you can tackle a task by going slower and taking breaks or breaking activities into smaller pieces (Murphy, 2008).  Rachel Feinberg, PT, writes that “pacing is not about decreasing the intensity of an exercise, doing less activity, or being unproductive. Pacing is actually the exact opposite.  Pacing is a tool that allows you to change the way you perform or complete an exercise or activity so that you can successfully increase strength, tolerance, and function.” (Feinberg, 2008)

In a small pilot study involving persons with osteoarthritis, the use of activity pacing was associated with less physical activity.  Reports of going slower, taking breaks, and breaking activities into smaller pieces were reflected in lower levels of physical activity.  Many of the participants who used higher amounts of pacing techniques were the same participants who reported higher levels of pain and fatigue throughout the day (Murphy, 2008).  It may be that pacing yourself is a natural reaction to pain and fatigue.

Inactivity in RA Patients

In a study involving 5,235 RA patients across 21 countries, only 13.8% of all patients reported physical exercise (i.e., ≥ 30 minutes with at least some shortness of breath and sweating) 3 or more times weekly. The majority of the patients were physically inactive with no regular weekly exercise.  Greater than 80% of RA patients in 7 countries received no regular physical activity, 88.1% in Argentina.  In 12 countries, 60–80% RA patients were inactive with 68.8% in USA reporting no regular physical exercise.  In Finland, 32.1% RA patients exercise more than 3 times weekly, with an additional 39.1% exercising once or twice weekly, leaving only 28.8% inactive (Sokka, 2008).

In a recent US study of RA patients, 42% of participants were inactive during a 7-day surveillance period.  Inactivity was defined as “no sustained 10-minute periods of moderate-to-vigorous intensity physical activity” (Lee, 2012).  Patients wore an accelerometer to collect data on their physical activity.  Factors most strongly related to inactivity were lack of strong motivation for physical activity which nearly tripled the chances of being inactive (2.85:1) and lack of strong beliefs in the benefits of physical activity (2.47:1).