Understanding what people with arthritis believe about
exercise…Study of perceived exercise barriers, enablers
and benefits suggests ways to increase the rates of
regular exercise among arthritis patients
Arthritis is the leading cause of disability in the United
States. In total, the treatment and toll of this progressive disease
costs our country about $86 billion per year, a figure expected to
rise as Baby Boomers age. Among the many approaches to disease
management, exercise has been shown to reduce pain, delay
disability, and improve physical function, muscle strength, and
quality of life. Yet, despite such compelling, well-documented
benefits, rates of participation in regular exercise are lower among
individuals with arthritis than those without it.
Understanding what motivates and enables some people with
arthritis to exercise, and what prevents others, is the focus of a
study featured in the August 2006 issue of Arthritis Care & Research
(http://www.interscience.wiley.com/journal/arthritiscare).
Conducted at the University of South Carolina, and supported by a
grant from the Centers for Disease Control and Prevention and the
Association of Schools of Public Health, its findings have direct
implications for how to market exercise to arthritis patients, how
to tailor exercise programs to their challenges, and how to
encourage and sustain their participation.
To identify the perceived barriers to and benefits of
exercise among people with arthritis, 68 people with arthritis were
divided into 12 focus groups. To help participants feel more
comfortable and willing to talk openly, the groups were segmented by
exercise status, socioeconomic status, and race. Each focus group
came together and discussed their perceptions of exercise, as well
as their experiences. Each discussion was transcribed and coded by
two people. Following the sessions, NVivo software was used to
extract themes for exercisers with arthritis, defined by
participation in moderate activities on at least 3 days per week for
30 minutes per day or vigorous activities on at least 3 days per
week for 20 minutes per day or strength training on at least 3 days
per week for 20 minutes per day, and for non-exercisers with
arthritis. Among them:
Pain. Although all focus groups stressed pain as a barrier,
exercisers were more likely to make adaptations and work through the
pain to attain the benefits of exercise, while non-exercisers were
more likely to give up exercise altogether.
Attitudes and beliefs. Non-exercisers were much more likely
than exercisers to express the belief that they were physically
unable to exercise.
Lack of support. Non-exercisers were more likely to cite
their physician's failure to refer them to helpful exercise programs
and to voice their desire for exercise partners with similar
limitations.
Lack of programs. For both exercisers and non-exercisers, the
lack of exercise programs or facilities for individuals with
arthritis emerged as a barrier.
Symptom management. Exercisers tended to be more positive
about how exercise could reduce pain, improve mobility, and more,
because they had experienced these benefits. Non-exercisers often
used such phrases as "this is what I hear" or "this is what I
understand" to describe desired outcomes.
"Our findings provide useful information for understanding
the experiences with and beliefs about exercise among persons with
arthritis," notes study author, Sara Wilcox, Ph.D., "and informing
recruitment and intervention strategies." To increase the rates of
regular exercise among arthritis patients, Dr. Wilcox and her
colleagues offer concrete recommendations for health care
professionals and communities, including:
Make a practice of prescribing exercise, with referrals and
instruction.
Work to expand the availability of arthritis-specific
exercise programs.
Emphasize ways in which individuals with arthritis can modify
exercise to accommodate their physical limitations and effectively
manage the pain.
Move beyond knowledge-based approaches to change the mindsets
and behavior of non-exercisers.
###
Article: "Perceived Exercise Barriers, Enablers, and Benefits
Among Exercising and Nonexercising Adults With Arthritis: Results
From a Qualitative Study," Sara Wilcox, Cheryl Der Ananian, Jill
Abbott, JoEllen Vrazel, Cornelia Ramsey, Patricia A. Sharpe, and
Teresa Brady, Arthritis Care & Research, August 2006; (DOI:
10.1002/art.22098).
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