Are Personal Characteristics Associated with Exercise Participation in Patients with Rheumatoid Arthritis? A Cross-Sectional Explorative Survey
Nele Vervloesem PT
Department of Rheumatology, University Hospital Leuven, Leuven, Belgium
Search for more papers by this authorNele Van Gils PT
Department of Rheumatology, University Hospital Leuven, Leuven, Belgium
Search for more papers by this authorL. Ovaere
RA patient, coordinator Patient Partner Program, Belgium
Search for more papers by this authorRené Westhovens MD, PhD
Department of Rheumatology, University Hospital Leuven, Leuven, Belgium
Search for more papers by this authorCorresponding Author
Dieter Van Assche PT, PhD
Department of Rheumatology, University Hospital Leuven, Leuven, Belgium
Dieter Van Assche, Department of Rheumatology, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium. Tel. +32 16342541, Fax +3216342543.
Email: [email protected]
Search for more papers by this authorNele Vervloesem PT
Department of Rheumatology, University Hospital Leuven, Leuven, Belgium
Search for more papers by this authorNele Van Gils PT
Department of Rheumatology, University Hospital Leuven, Leuven, Belgium
Search for more papers by this authorL. Ovaere
RA patient, coordinator Patient Partner Program, Belgium
Search for more papers by this authorRené Westhovens MD, PhD
Department of Rheumatology, University Hospital Leuven, Leuven, Belgium
Search for more papers by this authorCorresponding Author
Dieter Van Assche PT, PhD
Department of Rheumatology, University Hospital Leuven, Leuven, Belgium
Dieter Van Assche, Department of Rheumatology, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium. Tel. +32 16342541, Fax +3216342543.
Email: [email protected]
Search for more papers by this authorAbstract
Background
Organized exercise programs for patients with rheumatoid arthritis (RA) are useful to enhance physical activity and fitness. However, participation and adherence rates of these programs are low. This study aimed to identify demographic, personal and disease-related factors interfering with implementing an exercise program for RA.
Methods
A random sample of ambulatory RA patients from a single centre was divided into two groups, depending on their willingness to participate in an exercise program. Subsequently, demographic data (gender, age, disease duration and educational level) and disease-related and personal factors were obtained (Disease Activity Score; Short Form 36 [SF-36]; Health Assessment Questionnaire; Global Disease Activity; and also the Utrecht Coping List [UCL], Illness Cognition Questionnaire; TAMPA scale and modified Baecke questionnaire).
Results
Of the 154 people completing the survey, 113 (73%) indicated that they were willing to participate in an exercise program. These positive responders (PR) were more often female (p < 0.05), and had a higher educational level (p < 0.05). In the negative responders (NR), higher scores were found in the general health perception (54.7; [SD 18.3] versus 47.4; [SD 20.8]) and vitality (61.6 [SD 19.8] versus 53.7 [SD 20.1] sections of the SF-36, and a lower score was found on the reassuring thoughts subscale of the UCL (11.9 [SD 2.7] versus 12.9 [SD 2.7]) compared with the PR (all p < 0.05).
Conclusions
Although few differences were found between the groups, some insights regarding pitfalls in implementing an exercise program were highlighted. Further insights into external and personal motivators for patients are needed. Copyright © 2012 John Wiley & Sons, Ltd.
References
- Blair SN, Kohl HW 3rd, Barlow CE, Paffenbarger RS Jr, Gibbons LW, Macera CA (1995). Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA 12: 1093–1098.
- Boraita Pérez A (2008). Exercise as the cornerstone of cardiovascular prevention. Revista Española de Cardiología 61: 514–28.
- De Jong Z, Munneke M, Zwinderman A, Kroon H, Jansen A, Ronday HK, Van Schaardenburg D, Dijkmans B, Van den Ende C, Breedveld F, Vliet Vlieland TP, Hazes JM (2003). Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial. Arthritis and Rheumatism 48: 2414–2424.
- De Jong Z, Munneke M, Jansen LM, Ronday HK, Van Schaardenburg DJ, Brand R, Van den Ende C, Vliet Vlieland TP, Zuijderduin WM, Hazes JM (2004a). Differences between participants and nonparticipants in an exercise trial for adults with rheumatoid arthritis. Arthritis and Rheumatism 51: 593–600.
- De Jong Z, Munneke M, Kroon HM, van Schaardenburg D, Dijkmans BA, Hazes JM, Vliet Vlieland TP (2009). Long-term follow-up of a high-intensity exercise program in patients with rheumatoid arthritis. Clinical Rheumatology 28: 663–671.
- De Jong Z, Munneke M, Lems W, Zwinderman A, Kroon H, Pauwels E, Jansen A, Ronday HK, Dijkmans B, Breedveld F, Vliet Vlieland TP, Hazes JM (2004b). Slowing of bone loss in patients with rheumatoid arthritis by long-term high-intensity exercise. Arthritis and Rheumatism 50: 1066–1076.
- De Jong Z, Munneke M, Zwinderman AH, Kroon HM, Ronday HK, Lems WF, Dijkmans B, Breedveld F, Vliet Vlieland TP, Hazes JM, TWJ Huizinga (2004c). Long term hig intensity exercise and damage of small joints in rheumatoid arthritis. Annals of the Rheumatic Diseases 63: 1399–1405.
- De Jong Z, Vliet Vlieland TP (2005). Safety of exercise in patients with rheumatoid arthritis. Current Opinion in Rheumatology 17: 177–182.
- Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, Williams B, Ford GA (2006). Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. Journal of Hypertension 24: 215–33.
- Ekelund LG, Haskell WL, Johnson JL, Whaley FS, Criqui MH, Sheps DS (1988). Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. The Lipid Research Clinics Mortality Follow-up Study. The New England Journal of Medicine 319: 1379–84.
- Elfving B, Andersson T, Grooten WJ (2007). Low levels of physical activity in back pain patients are associated with high levels of fear-avoidance beliefs and pain catastrophizing. Physiotherapy Research International 12: 14–24.
- Evers AWM, Kraaimaat FW, Van Lankveld W, Jacobs WG, Bijlsma JWJ (1998). De ziekte cognietie lijst (ICQ). Gedrachstherapie 31: 205–220.
- Fries J, Spitz P, Kraines R (1980). Measurement of patient outcome in arthritis. Arthritis and Rheumatism 23: 137–45.
- Gabriel SE (2008). Why do people with rheumatoid arthritis still die prematurely? Annals of the Rheumatic Diseases 67 Suppl 3: viii30–4.
- Gift AG (1989). Visual analogue scales: measurement of subjective phenomena. Nursing Research 38: 286–288.
- Gift AG (1989). Validation of a vertical visual analogue scale as a measure of clinical dyspnea. Rehabilitation Nursing 14: 323–325.
- Goubert L, Crombez G, Vlaeyen JWS, Van Damme S, Van den Broeck A, Van Houdenhove B (2000). De Tampa Schaal voor Kinesiofobie. Psychometrische karakteristieken en normering. Gedrag & Gezondheid 28: 54–62.
- Gyurcsik NC, Brawley LR, Spink KS, Brittain DR, Fuller DL, Chad K (2009). Physical activity in women with arthritis: examining perceived barriers and self-regulatory efficacy to cope. Arthritis and Rheumatism 61: 1087–94.
- Häkkinen A, Sokka T, Kotaniemi A, Hannonen P (2001). A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis. Arthritis and Rheumatism 44: 515–22.
- Häkkinen A, Sokka T, Hannonen P (2004). A home-based two-year strength training period in early rheumatoid arthritis led to good long-term compliance: a five-year followup. Arthritis and Rheumatism 51: 56–62.
- Halbert JA, Silagy CA, Finucane P, Withers RT, Hamdorf PA (1999). Exercise training and blood lipids in hyperlipidemic and normolipidemic adults: a meta-analysis of randomized, controlled trials. European Journal of Clinical Nutrition 53: 514–22.
- Hertogh EM, Monninkhof EM, Schouten EG, Peeters PH, Schuit AJ (2008). Validity of the Modified Baecke Questionnaire: comparison with energy expenditure according to the doubly labeled water method. International Journal of Behavioral Nutrition and Physical Activity 5: 30.
- Iversen MD, Eaton HM, Daltroy LH (2004a). How rheumatologists and patients with rheumatoid arthritis discuss exercise and the influence of discussions on exercise prescriptions. Arthritis and Rheumatism 51: 63–72.
- Iversen M, Fossel A, Ayers K, Palmsten A, Want H, Daltroy L (2004b). Predictors of exercise behavior in patients with rheumatoid arthritis 6 months following a visit with their rheumatologist. Physical Therapy 84: 706–16.
- Mayoux-Benhamou MA, Roux C, Perraud A, Fermanian J, Rahali-Kachlouf H, Revel M (2005). Predictors of compliance with a home-based exercise program added to usual medical care in preventing postmenopausal osteoporosis: an 18-month prospective study. Osteoporosis International 16: 325–331.
- Munneke M, De Jong Z, Zwinderman A, Jansen A, Ronday HK, Peter W, Boonman D, Van Den Ende C, Vliet Vlieland TP, Hazes JM (2003). Adherence and satisfaction of rheumatoid arthritis patients with a long-term intensive dynamic exercise program (RAPIT program). Arthritis and Rheumatism 49: 665–672.
- Munneke M, De Jong Z, Zwinderman A, Ronday HK, Van den Ende C, Vliet Vlieland TP, Hazes JM (2004). High intensity exercise or conventional exercise for patients with rheumatoid arthritis? Outcome expectations of patients, rheumathologists, and Physical therapists. Annals of the Rheumatic Diseases 63: 804–808.
- Munneke M, De Jong Z, Zwinderman A, Ronday HK, Van Schaardenburg D, Dijkmans B, Kroon H, Vliet Vlieland TP, Hazes JM (2005). Effect of a High-intensity weight-bearing exercise program on radiologic damage progression of the large joints in subgroups of patient with rheumatoid arthritis. Arthritis and Rheumatism 53: 410–417.
- Murphy H, Dickens C, Creed F, Bernstein R (1999). Depression, illness perception and coping in rheumatoid arthritis. Journal of Psychosomatic Research 46: 155–164.
- Neuberger GB, Aaronson LS, Gajewski B, Embretson SE, Cagle PE, Loudon JK, Miller PA (2007). Predictors of exercise and effects of exercise on symptoms, function, aerobic fitness, and disease outcomes of rheumatoid arthritis. Arthritis and Rheumatism 57: 943–52.
- Neuberger GB, Kasal S, Smith KV, Hassanein R, DeViney S (1994). Determinants of exercise and aerobic fitness in outpatients with arthritis. Nursing Research 43: 11–17.
- Orozco LJ, Buchleitner AM, Gimenez-Perez G, Roqué i Figuls M, Richter B, Mauricio D (2008). Exercise or exercise and diet for preventing type 2 diabetes mellitus. Cochrane Database of Systematic Reviews CD003054.
- Panoulas VF, Douglas KM, Milionis HJ, Stavropoulos-Kalinglou A, Nightingale P, Kita MD, Tselios AL, Metsios GS, Elisaf MS, Kitas GD (2007). Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis. Rheumatology (Oxford, England) 46: 1477–82.
- Pekkanen J, Marti B, Nissinen A, Tuomilehto J, Punsar S, Karvonen MJ (1987). Reduction of premature mortality by high physical activity: a 20-year follow-up of middle-aged Finnish men. Lancet 1: 1473–7.
- Prevoo MLL, van 't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LBA, van Riel PLCM (1995). Modified disease activity scores that include twenty-eight-joint counts: development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis and Rheumatism 38: 44–8.
- Schreurs PJG, Tellegen B, van de Willige G (1984). Gezondheid, stress en coping: de ontwikkeling van de UCL. Gedrag: tijdschrift voor psychologie 12: 101–117.
- Schreurs PJG (1988). UCL: Utrechtse Coping Lijst, normscores. Available at: http://www.renetobe.nl/1e%20nivo%20mediteren/2e%20meditatie%202008_bestanden/ucl-normscore.pdf [Accessed May 25th 2010].
- Shaw K, Gennat H, O'Rourke P, Del Mar C (2006). Exercise for overweight or obesity. Cochrane Database of Systematic Reviews CD003817.
- Snowling NJ, Hopkins WG (2006). Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care 29: 2518–27.
- Strahl C, Kleinknecht RA, Dinnel DL (2000). The role of pain anxiety, coping, and pain self-efficacy in rheumatoid arthritis patient functioning. Behaviour Research and Therapy 38: 863–873.
- van den Berg MH, de Boer I, le Cessie S, Breedveld F, Vliet Vlieland TP (2007). Most people with rheumatoid arthritis undertake leisuretime physical activity and exercise in the Netherlands: an observational study. The Australian Journal of Physiotherapy 53: 113–8.
- van den Berg MH, van der Giesen FJ, van Zeben D, van Groenendael JH, Seys PE, Vliet Vlieland TP (2008). Implementation of a physical activity intervention for people with rheumatoid arthritis: a case study. Musculoskeletal Care 6: 69–85.
- Van Den Ende CH, Vliet Vlieland TP, Munneke M, Hazes JM (2000). Dynamic exercise therapy for rheumatoid arthritis. Cochrane Database of Systematic Reviews CD000322.
- van der Giesen FJ, van Lankveld W, Hopman-Rock M, de Jong Z, Munneke M, Hazes JM, van Riel PL, Peeters AJ, Ronday HK, Vlieland TP (2010). Exploring the public health impact of an intensive exercise program for patients with rheumatoid arthritis: a dissemination and implementation study. Arthritis Care & Research (Hoboken) 62: 865–872.
- Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, Eek van H (1995). Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 62: 363–372
- Vlaeyen JW, Linton SJ (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85: 317–32.
- Voorrips L, Ravelli A, Dongelmans P, Deurenberg P, Van Staveren W (1991). A physical activity questionnaire for the elderly. Medicine and Science in Sports and Exercise 23: 974–9.
- Ware JE, Snow KK, Kosinski M, Gandek B (1993). SF-36 Health Survey Manual and Interpretation Guide. Boston: New England Medical Center, The Health Institute.