Doctors should routinely talk to all arthritis patients about the importance of physical activity and exercise, according to new recommendations from the European League Against Rheumatism (EULAR). The recommendations, which received near-unanimous approval from an international team of experts, were published in July in Annals of the Rheumatic Diseases.
In EULAR’s broad definition, physical activity includes exercise, sports, physical labor and ordinary chores like washing the car or gardening. According to the task force, physical activity is safe and effective for people with every type of arthritis, including rheumatoid arthritis (RA), spondyloarthritis (SpA), and hip and knee osteoarthritis (OA) and should be a key part of standard patient care.
Effective and Safe
The EULAR task force based its recommendations on data from a number of studies that looked at the benefits of exercise for people with OA or inflammatory arthritis.
They found that cardiovascular exercise (any activity that gets your heart pumping) and weight training improved overall fitness as well as disease-specific problems like pain and mobility for all types of arthritis. They didn’t find that adding flexibility exercises had much benefit for people with OA or SpA. They acknowledge, however, that some of those studies were poor quality and didn’t look at stretching versus doing nothing.
They also found that all types of physical activity are as safe for people who have arthritis as for those who don’t.
“The same exercise recommendations that apply to the general public apply just as much to people with arthritic diseases,” writes Anne-Kathrin Rausch Osthoff, a physiotherapist at Zurich University of Applied Sciences in Switzerland and the recommendations’ lead author.
Despite strong evidence to the contrary, some people with arthritis believe exercise will further damage their joints; others think pain and stiffness are reasons to avoid activity.
Most experts, including the EULAR task force and experts at the Centers for Disease Control and Prevention (CDC), say the vast majority of people with arthritis can exercise safely, and those who have contraindications to engaging in certain activities can usually find alternatives, such as swimming or cycling. (Try the Arthritis Foundation’s YES tool app for tips to make many activities easier and less painful.) The EULAR panel didn’t specify the type or optimal amount of physical activity for people with arthritis. They point to current U.S. guidelines for adults, which recommend a minimum of 150 minutes of moderate-intensity physical activity a week, including strength training at least twice weekly. Aerobic activity can be accomplished in bouts as short as 10 minutes to reach the recommended 150 minutes a week.
Fewer than half of Americans meet these standards, and many people with arthritis are even less physically active, according to CDC surveys.
Getting Doctors on Board
The EULAR experts are so convinced of the importance of exercise for arthritis they say doctors should actively promote it. Rheumatologists should assess patients’ activity and fitness levels and recommend appropriate programs for them. They should also continually monitor patient goals and fitness, possibly using self-reports and tools like activity trackers.
This almost never happens, mainly because doctors are time-crunched and don’t feel qualified to recommend exercise regimens to their patients. The EULAR task force suggests that rheumatologists receive more training in counseling patients about physical activity and work closely with experts like sports medicine doctors and physical therapists.
Bert Mandelbaum, MD, a sports medicine specialist at the Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, thinks a doctor’s most important job “is to motivate patients to take control of their fitness.”
He writes, “If we don’t exercise, our bodies don’t function well. And lack of exercise is contributing to most of the common diseases we now face.”
The most important piece of the puzzle are patients themselves. Even with professional guidance and support, some people may find it hard to be more active. The EULAR experts say doctors need to help patients understand how vital physical activity is to their health and well-being and find ways to help them change the way they think about exercise and their ability to do it.
Author: Linda Rath
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