Today, admonishments to “get some exercise” and “be more active” are difficult to avoid in both our personal and professional lives. That hasn't always been the case, and it takes some getting used to. In the twentieth century, science and technical advances improved our lives in many ways. However, the accompanying rise in sedentary occupations, reliance on motorized transportation, and loss of physically active leisure time resulted in mass physical inactivity, obesity, and a rise in inactivity-related conditions and poor health (1). Movements to reverse this trend began in the late 1960s. “Aerobics” became a household world. Kenneth Cooper became the spokesperson for exercise and fitness (2), and James Fixx wrote a best seller just about running (3). Research from the National Aeronautics and Space Administration (NASA) provided dramatic evidence of the effects of inactivity on virtually all organ systems and hypokinesia became a recognized and treatable condition (4). Initially the fitness craze focused on healthy people. However, the importance of exercise for cardiovascular health was imbedded in the movement from the beginning, and cardiac rehabilitation exercise programs began in the late 1970s and spread rapidly (5).

An appreciation of the benefits and safety of exercise in the management of rheumatologic and musculoskeletal disease has taken longer. Only in the past 10 years has the exercise message encompassed people with arthritis. Prior to 1990, the predominate medical advice for people with rheumatic disease was to rest and avoid strenuous activity. Now, people with a variety of rheumatologic diagnoses are encouraged to be more active, and physicians and other health professionals are expected to understand, prescribe, and support exercise for this patient population. Current recommendations in the clinical management of rheumatoid arthritis and osteoarthritis of the hip and knee (6–8) include various types of exercise as nonpharmacologic components of care. There is evidence that people with arthritis can safely exercise to improve health and function, and that certain types of exercise have positive effects on joint physiology and disease symptoms. Outside the clinical setting, public health initiatives in arthritis also recommend exercise and increased physical activity. The 1996 US Surgeon General Report on Physical Activity included people with arthritis in the target population (9). In 2000, the National Arthritis Action Plan also recommended exercise as a self-management behavior for reducing disability and improving quality of life for people with arthritis. Most recently, Healthy People 2010 addressed arthritis as a target condition and set decreasing activity limitation as a major public health objective (10).

The research underlying recommendations for exercise with arthritis is abundant and multidisciplinary. Mounting evidence from randomized controlled clinical trials supports aerobic and muscle conditioning exercise for most people with arthritis. However, detailed information to guide individualized prescription and implementation is not easy to find. Much of the relevant information that can deepen our understanding of exercise in people with arthritis does not appear in rheumatology journals. Research findings in biomechanics, cartilage and muscle physiology, and human behavior exist and are crucial to our understanding of the effects of exercise in this heterogeneous population. To make the best use of existing information and to proceed with a comprehensive research agenda, we must bring exercise-related knowledge and expertise from multiple disciplines to the common ground of rheumatology.

In March 2002 in St. Louis, the Missouri Arthritis Rehabilitation Research and Training Center, the American College of Rheumatology, and the Association of Rheumatology Health Professionals sponsored the International Conference on Health Promotion and Disability Prevention for Individuals and Populations with Rheumatic Disease: Evidence for Exercise and Physical Activity. This interdisciplinary, scientific meeting brought together leading researchers whose works build a scientific base for understanding the role of exercise and activity in rheumatic disease. The purpose of the conference was to report and integrate relevant information from diverse fields, develop statements regarding exercise benefit and safety to direct the prescription and implementation of appropriate and effective recommendations, and identify promising areas for future research. Invited speakers from the disciplines of physical therapy, biomechanics, rheumatology, public health, health education, epidemiology, and health services research presented papers in seven topic areas. Following the paper presentations, speakers and session chairs met in work groups to make recommendations for professional and public use of current information, and suggest strategies for implementation and future research.

Onsite conference activities confirmed that there is useful and intriguing information in a number of relevant fields of study and that communication and understanding among the various disciplines is just beginning. To disseminate the wealth of information from this conference to rheumatologists and rheumatology health professionals, the nineteen papers and six work group reports are being published as a special series in the first three 2003 issues of Arthritis Care and Research. The first two sessions, published in this issue, discuss the impact and consequences of disability in arthritis and the problems and challenges of inactivity in this population. In the April 2003 issue of Arthritis Care & Research, the topics of biomechanical considerations for exercise, and exercise in the presence of rheumatic disease will be addressed. The final section of the series will appear in the June 2003 issue and will cover the evidence for exercise in arthritis, and population approaches to health promotion and disability prevention through physical activity. The papers and recommendations in this series are a rich source of information for practitioners, researchers, and educators in clinical, academic, and public health settings. The commitment, energy, and enthusiasm of all participants and planners created an energizing experience for those present and a wealth of information and ideas to share were generated.


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  2. Acknowledgements

This series of papers is dedicated to the memory of Donald Rhodes Kay, MD, a rheumatologist, masterful clinician, and beloved teacher who believed in the power of exercise for people with arthritis. The individuals who contributed to the success of the conference and publication of the papers and proceedings are Amy Miller from the American College of Rheumatology for conference planning and logistics, the ACR/ARHP Conference Planning Committee (Mary Bell, Basia Belza, Rowland Chang, Susan Klepper, Kent Kwoh, Jill Noaker Luck, Jerry Parker, and Ed Yelin), Meichele Foster at the University of Missouri for administrative assistance, and the editorial staff of Arthritis Care and Research (Gene Hunder, Beverly Northouse, and Nancy Vickers).


  1. Top of page
  2. Acknowledgements
  • 1
    Booth FW, Gordon SE, Carlson CJ, Hamilton MT. Waging war on modern chronic diseases: primary prevention through exercise biology. J Appl Physiol 2000; 88: 77487.
  • 2
    Cooper KH. Aerobics. New York: Bantam Books; 1968.
  • 3
    Fixx JF. The complete book of running. New York: Random House; 1977.
  • 4
    Sandler H, Vernikos J. Inactivity: physiologic effects. Orlando (FL): Academic Press; 1986.
  • 5
    Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2002; 4.
  • 6
    RobbinsL, BurckhardtC, HannanM, editors. Clinical care in the rheumatic diseases. 2nd ed. Atlanta (GA): Association of Rheumatology Health Professionals; 2001. p. 17984.
  • 7
    American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee, 2000 Update. Arthritis Rheum 2000; 43: 190515.
  • 8
    EULAR recommendations for the management of knee osteoarthritis: report of a task force on the Standing committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2000; 59: 93644.
  • 9
    US Department of Health and Human Services (HHS). Physical Activity and Health: A Report of the Surgeon General. Atlanta (GA): Health and Human Services, CDC; 1996.
  • 10
    US Department of Health and Human Services. Healthy People 2010. 2nd ed. Understanding and Improving Health and Objectives for Improving Health. 2nd ed. Washington (DC): US Government Printing Office; November 2000.