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Key to Improving Life With OA May Be Teaching Patients to Pace Themselves

Activity pacing may be the best way to help persons with osteoarthritis of the hip and knee achieve optimum levels of daily physical activity.

"Self-efficacy" is widely recognized as an important component of managing osteoarthritis, and activity pacing (scheduling rest breaks in order to minimize pain and fatigue from exercise) is an accepted component of rehabilitation. Many guidelines recommend including activity pacing as part of physical therapy. But are the rest breaks in themselves sufficient to achieve better function and reduced pain?

A team of doctors and rehabilitation specialists from the University of Michigan who have pioneered the study of activity pacing are now launching a study to test the proposition. Their report, "Activity pacing for osteoarthritis symptom management," appears in BMC Musculoskeletal Medicine.

Beginning with a pilot study reported 3 years ago, which was headed by the director of clinical research at the Ann Arbor VA medical center, the Michigan researchers have been asking people who have OA of the lower extremities to wear accelerometers and also record their pain and fatigue over the course of several days. People who are good at keeping track of their activity have less exercise but also less fatigue, they have found. (The records include questions such as "During the past few hours … (1) have you gone slower and taken breaks to do activities, and (2) did you break up activities into manageable pieces to do them".

More recently, they reported in the American Journal of Occupational Therapythat such tailored interventions are better than more general instructions at reducing fatigue, but not pain.