Arthritis Patients Find Exercise Too Much of a Pain

COLUMBIA, S.C., July 27 -- Lethargy, a reluctance to face pain, and a lack of incentive and encouragement from physicians are keeping too many patients with arthritis on the couch, further disabling themselves, said investigators here.

Researchers here conducted a series of focus groups among arthritis sufferers to understand why some of them exercised regularly while others did not, according to Sara Wilcox, Ph.D., of the Arnold School of Public Health at the University of South Carolina here.

Because randomized trials have demonstrated that aerobic and resistance training can reduce pain, delay disability, and improve physical function, quality of life, and muscle strength in people with arthritis, it makes sense to find out why some patients fight through the barriers and work out, while others don't, Dr. Wilcox and colleagues said in the August issue of Arthritis Care & Research.

The researchers enrolled 68 adults with arthritis, stratified by exercise status, socioeconomic status, and race, in 12 focus groups. Most participants lived in the greater Columbia metropolitan area, Dr. Wilcox and colleagues said.

For the study, 'exercisers' were defined as people who participated in moderate activities for 30 minutes or more on at least three days a week, vigorous activities for 20 minutes or more on at least three days a week, or at least 20 minutes of strength training three times a week. 'Nonexercisers' were defined as those who exercised for any length of time on one day or less a week, or those who exercised for less than 10 minutes two days a week.

The focus groups identified several main themes, including:

• Pain. Pain was seen as a barrier to exercise among all the participants, but those who regularly worked out were more likely to make adaptations and work through the pain, while non-exercisers were more likely to give up altogether.
• Attitudes and beliefs about exercise. Those who didn't exercise were more likely to think they were physically unable to exercise. Exercisers, on the other hand, tended to say that finding time among competing activities was a barrier.
• Support for exercise from doctors and friends. Non-exercisers often said their physician had not referred them to exercise programs. They also said they'd work out more if they had a partner with similar limitations.
• Lack of programs tailored to people with arthritis - a gap that both exercisers and non-exercisers saw as a barrier.
• Symptom management - regular exercisers tended to speak positively about the benefits of exercise, while non-exercisers said they had been told there would be benefits, but had little personal experience.

"Our findings provide useful information for understanding the experiences with and beliefs about exercise among persons with arthritis," Dr. Wilcox and colleagues concluded and may suggest ways to improve intervention. For physicians specifically, they suggested:

• Prescribing exercise, with referrals and instruction.
• Emphasizing ways that people with arthritis can modify exercise to accommodate physical limitations and manage any associated pain.