Doctors Increasingly Skip the Exercise Lecture in Patient Clinic

Patients with inflammatory arthritis and osteoarthritis should be participating in four different types of exercise: cardiovascular, strength, flexibility, and balance. But a new study shows that patients are overly focused on cardiovascular exercise and not enough on exercise types designed to strengthen and protect joints and bones.

The patients, researchers report, aren't receiving enough exercise guidance from healthcare providers.

"We found that most of our patients were participating in regular cardiovascular exercise, but found that people who were participating more in the recommended domains, weren't necessarily receiving any more guidance from their healthcare provider as compared to people who weren't," said Lauren Freid, M.D., a rheumatologist with the University of California Los Angeles and the lead investigator of the study.

In her study, Dr. Freid focused on patients with rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis. Exercise holds many benefits for these patients, including some protection against bone loss and osteoporosis. But some patients are under the impression that exercise may worsen a preexisting condition. Even though previous studies have shown that exercise is safe and beneficial for people with these arthritis types, Dr. Freid found that fewer than 20 percent of patients with inflammatory arthritis adopt regular aerobic, resistance, flexibility, and balance training.

While patients pointed to usual barriers to exercise, such as fatigue, financial constraints, arthritis‐related pain, and the belief that exercise may worsen arthritis, patients overwhelmingly said they don't receive enough clear exercise guidance from providers.

Up until recently, "we didn't really have any guidelines on how these people should be exercising even though all of our recommendations for us as healthcare providers, tell us that we should encourage our patients to exercise. So, in July 2018, the European League Against Rheumatism (EULAR)," penned recommendations which are now followed worldwide.

In Dr. Freid's new study study, 108 patients participated by answering survey questions, More than half (60) participated in regular aerobic exercise, 44 (41%) flex training, 42 (39%) resistance training, and 18 (17%) balance training. And, of these, only 43 patients said they were actively exercising. This group had lower body mass index, lower reported disease activity, and fewer comorbidities. They prioritized exercise and reported better energy levels. The group that didn't exercise, cited finances, pain, fatigue, and potentially worsening arthritis as barriers to exercise, but they understood the benefits of exercise, they said.

These findings have been studied and reported before and are intended as a baseline report to the 2018 EULAR physical activity guidelines, Dr. Freid said.

"It was meant to highlight the fact that we have room for improvement in these areas. These forms of exercise have been deemed safe and beneficial. The importance of participating in regular exercise is that it can address some of the things that medication does not. Exercising can regularly help with fatigue, sleep, weight control and pain. It's very important as adjunct modality to medication to manage some of the other factors of arthritis that impact quality of life," she said.

In this interview, Dr. Freid discusses her findings.

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REFERENCE

"Physical Activity Patterns in People With Inflammatory Arthritis Indicate They Have not Received Recommendation‐Based Guidance From Health Care Providers." Lauren M. Freid MDAlexis Ogdie MD, MSCEJoshua F. Baker MD, MSCE. First published: 28 September 2020. https://doi.org/10.1002/acr2.11183

"2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis." (https://ard.bmj.com/content/77/9/1251.long)