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).
Journal
Arthritis Care & Research