Although multiple reviews, meta-analyses, and professional society guidelines recommend exercise and physical activity for treating chronic pain and fatigue, patients who live with rheumatologic diseases often face many barriers to developing successful exercise routines.
A research update on the issues surrounding fitness with fatigue and persistent pain was provided by Dr Daniel Clauw, Director of the Chronic Pain and Fatigue Research Center at the University of Michigan, in a presentation at the ACR/ARHP Annual Meeting in San Diego.
Strategies for rheumatologists to help enable their clients to improve their level of fitness were offered by Dr David Williams, Associate Director at the same research center.
The impact of fatigue
Dr Clauw explained that fatigue is quite common in patients who have rheumatologic diseases and that residual fatigue is possible even after successful treatment with a biologic medication. But while fatigue is often as functionally limiting as pain, Dr Clauw cited a study (Wolfe F, Pincus T. Arthritis Rheum. 1999) showing that only about 10% of rheumatologists even evaluate fatigue in their care of patients with rheumatoid arthritis.
Rheumatologists may ignore fatigue more often than they should because it can be difficult to determine exactly why it is happening, he noted. The myriad potential contributors to fatigue include psychological/psychiatric issues, sleep/chronobiology issues, inflammation, neurotransmitter imbalance, diet, endocrine, anemia, drugs, cardiovascular, muscular, obesity, and current level of fitness.
Dr Clauw emphasized that comorbid fibromyalgia can present additional challenges for some patients. In addition, managing fatigue can be difficult because the word “fatigue” doesn’t necessarily mean the same thing to every patient.
The role of exercise in treating fatigue
Other than properly treating underlying disease, Dr Clauw stressed that exercise is likely the most effective treatment for fatigue. Exercise is also the most effective treatment for fibromyalgia, coming out as the highest level recommendation in all treatment guidelines aimed at that condition.
Dr Clauw concluded that the types of exercise programs recommended to treat fatigue tend to have very few adverse effects and that the benefits generally exceed the risks.
Dr Williams continued that treatment guidelines across many disciplines offer a lot of evidence for addressing fatigue with exercise.
Patient-centric conversations about exercise
In spite of existing evidence on the benefits of exercise, patients often face a number of barriers to actually increasing their level of activity, Dr Williams noted, and without addressing these barriers, a recommendation to exercise more can be frustrating for both the patient and the clinician.
Williams DA, Kuper D, Segar M, et al. “Internet-enhanced management of fibromyalgia: a randomized controlled trial.” Pain. 2010;151:694-702. doi: 10.1016/j.pain.2010.08.034. Epub 2010 Sep 19.