Patients with arthritis, the country's leading cause of disability, tend to be less fit than their peers who don't have this condition. Studies have shown, however, that they can safely participate in exercise programs to increase their fitness, strength and psychosocial status and that health providers recommend that arthritis patients participate in exercise. A new study evaluated the effects of the Arthritis Foundation Exercise Program, formerly called People with Arthritis Can Exercise (PACE) to promote managing arthritis through exercise. Although pilot studies had shown that the program led to improvements for arthritis patients, this was the first randomized controlled trial to evaluate the program.
Led by Leigh F. Callahan, of the University of North Carolina at Chapel Hill, NC, the study involved 346 patients with an average age of 70 who had self-reported arthritis. The participants were divided into an intervention group that took part in the Arthritis Foundation Exercise Program, which consisted of exercise classes at basic and advanced levels that met twice a week for one hour for 8 weeks and a control group that was offered the program after 8 weeks.
The intervention group also completed self-report assessments 3 and 6 months after completing the program. Pain, stiffness and fatigue were measured using visual analog scales, which are tools that help patients rate the intensity of sensations such as pain. Physical function was evaluated by using self-reporting as well as performance-based measures such as lifting weights, and psychosocial outcomes were assessed using four different scales.
The results showed that the intervention group had significant improvements in pain, fatigue, and managing arthritis at 8 weeks and maintained improvements in pain and fatigue at 6 months. Although the Arthritis Foundation Exercise Program focuses mainly on range-of-motion and low-resistance exercises, a separate analysis found that those completing the program showed increased strength in their upper and lower extremities. This indicates that strength training, one of the more minor components of the program, was effective. Exercise endurance did not increase, but this is not surprising given the nature of the Arthritis Foundation Exercise program.
Although the participants maintained improvement in symptoms six months after completing the program, their function and belief that they could adequately complete the exercises (self-efficacy) were worse. However, participants who continued the program independently at home reported continued improvements, indicating that continued participation in exercise offers additional benefits. It is unclear why there was a decline in self-efficacy for exercise at 6 months, but the researchers note that it may be related to the fact that participants understood the benefits of exercise yet felt less confident without the class structure, frequency and social support.
"Our findings indicate that the basic 8-week PACE (Arthritis Foundation Exercise) Program is a safe program for sedentary older individuals with arthritis to start exercising without exacerbating their symptoms," the authors conclude, adding that symptoms actually improved. They note that studies need to be conducted to determine if offering the program more than twice a week and for longer periods leads to additional benefits.
Article: "A Randomized Controlled Trial of the People With Arthritis Can Exercise Program: Symptoms, Function, Physical Activity, and Psychosocial Outcomes," Leigh F. Callahan, Thelma Mielenz, Janet Freuburger, Jack Shreffler, Jennifer Hootman, Teresa Brady, Katherine Buysse, Todd Schwartz, Arthritis Care & Research, January 2008; 59:1; pp. 92-101.
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