Dangers of Activity Pacing?
In the original study which caught my eye, Cuperus et al. “hypothesize that by instructing activity pacing, physical inactivity – rather than physical activity – is instigated.” Researchers continue, “Therefore, activity pacing might not only be ineffective, it might even be potentially harmful, as inactivity-related comorbidities increase the risk for mortality and negatively influence quality of life.” (Cuperus, 2012)
An interesting aspect of their research project was the division of the 30 participants into two groups: an adequate pacing group, comprising participants labelled as good or somewhat good activity pacers and a non-adequate pacing group, comprising participants labelled as bad or somewhat bad activity pacers.
What makes a good or bad pacer? Even the two assessors in the trial initially disagreed on the classification in 37% (11/30) of the cases. The authors do not suggest what makes a good vs. bad activity pacer. Ultimately, nine participants (30%) were categorized as adequate pacers, while 21 (70%) were non-adequate pacers. No significant differences were apparent in demographic or disease-related characteristics between groups.
Participants wore accelerometers to measure activity and 21% (6/29) were categorized as ‘sufficiently active’ according to the Dutch Physical Activity Norm. Each of these patients were also classified as non-adequate pacers. Conversely, all nine patients who classified as adequate pacers were not sufficiently active. Researchers found that non-adequate pacers were significantly more active than adequate pacers (p=0.025) (Cuperus, 2012).
Cuperus et al. conclude:
- Activity pacing is associated with undertaking less physical activity.
- Therapists should stop supporting activity pacing, but should start promoting physical activity and exercise.
- Commonly used methods to elicit patients’ activity patterns overestimate actual activity levels.
- People with rheumatoid arthritis are at risk of physical inactivity.
What do you think of this small research study? Do you feel that pacing yourself leads to being less active? How much exercise/activity do you really engage in each week?
Cuperus N, Hoogeboom TJ, et al. Are people with rheumatoid arthritis who undertake activity pacing at risk of being too physically inactive? Clin Rehabil published online 10 February 2012. DOI: 10.1177/0269215512437417
Feinberg R and Feinberg S. Pacing Means Moving Ahead and Not Falling Behind. The American Chronic Pain Association (ACPA) Chronicle, December 2008. Reprinted at http://www.cfidsselfhelp.org/library/pacing-means-moving-ahead-and-not-falling-behind
Lee J, et al. The public health impact of risk factors for physical inactivity in adults with rheumatoid arthritis. Arthritis Care & Research 2012; DOI: 10.1002/acr.21582