Arthritis: Self-directed Exercise Program Shows Benefits

Laird Harrison

December 31, 2014

A self-directed exercise program can improve the symptoms of arthritis, a new study shows.

After 12 weeks, participants in the First Step to Active Health program showed significant improvements in lower body strength, functional exercise capacity, lower body flexibility, pain, fatigue, stiffness, and arthritis management self-efficacy.

"This program adds a more flexible format to the existing list of evidence-based programs, and it may appeal to subgroups of the arthritis population with less access to community programs," write Sara Wilcox, PhD, from the Department of Exercise Science, University of South Carolina, Columbia, and colleagues in a report published in the January 2015 issue of the American Journal of Preventive Medicine.

Previous research has shown that exercise benefits people with arthritis, but most people do not exercise as much as they should, the researchers write.

The Centers for Disease Control and Prevention recommends exercise classes for people with arthritis, but attending them may not be convenient, affordable, or feasible for all these patients.

The researchers wanted to test a program that patients could complete on their own at home.

The First Step to Active Health uses guidelines from the American College of Sports Medicine to promote endurance, strength, balance, flexibility, and behavioral self-management strategies, including planning, goal setting, and self-monitoring.

Each of 197 participants received a kit containing weekly self-monitoring logs, stamped return envelopes for the logs, a one-page safety sheet that outlined arthritis-specific recommendations, and a study expectations calendar.

Participants progressed at their own pace through four steps: cardiovascular fitness, flexibility, strength, and balance, with the goal of completing all of the steps in 12 weeks.

To measure the effects of this program against a control group, the researchers designed a four-step nutrition program based on the US Department of Agriculture Food Pyramid. They assigned 204 participants to follow this program instead of the exercise program.

The two groups were not significantly different in demographics or disease severity. Their mean age was 56.3 years.

The exercise group became significantly more active over the course of 12 weeks. Surprisingly, so did the nutrition group.

Although the nutrition group did not increase its activity as much as the exercise group, the two groups experienced the same improvements in functional performance measures such as chair-stands, the 6-minute walk, and seated reach, as well as disease-specific outcomes such as stiffness, pain, fatigue, and arthritis self-management self-efficacy.

In addition, the two groups were both able to maintain most of these improvements for 9 months.

However, the two groups differed in other respects. The nutrition group lost an average of about 2 pounds over the course of 9 months, whereas the exercise group maintained a constant weight.

In addition, the exercise group experienced more adverse reactions, although most of these were minor muscle pulls and strains.

The authors said it was hard to explain why the nutrition group became more active but speculated that the participants in the group started the study feeling motivated to become more fit or benefited from their modest weight loss.

Table. Difference Between Exercise Group and Nutrition Group

Exercise Exercise Group Nutrition Group
Baseline exercise hours per week 2.1 1.8
Exercise hours per week at 12 weeks 3.1 2.3
Baseline number of chair stands in 30 seconds 10.2 10.2
Number of chair stands in 30 seconds at 12 weeks 11.6 11.5
Pain at baseline (scale of 1 - 10) 4.7 4.9
Pain at 12 weeks 4.3 4.2

"Although the magnitude of change is relatively modest, the potential for scalability of this low-cost intervention underscores its promise for making changes at a broader, public health level," the authors conclude.

The study was supported by the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion. The authors have disclosed no relevant financial relationships.

Am J Prev Med. 2015;48:1-12. Full text

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