Work Group Recommendations: 2002 Exercise and Physical Activity Conference, St. Louis, Missouri—Session V: Evidence of Benefit of Exercise and Physical Activity in Arthritis

Session V: Evidence of Benefit of Exercise and Physical Activity in Arthritis

Work Group Members: Marian Minor, PhD, PT, University of Missouri-Columbia, Columbia, Missouri (Chair); Christina H. Stenstrom, PhD, RPT, Karolinski Institutet, Huddinge, Sweden; Susan E. Klepper, PhD, PT, Columbia University, New York; Michael Hurley, PhD, King's Healthcare, East Dulwich Grove, Dulwich, United Kingdom; Walter H. Ettinger, MD, MBA, Lenox Hill Hospital, New York.

Recommendations for Physical Activity/Exercise

  1. Aerobic exercise for people with hip/knee osteoarthritis:

    • Accumulate 30 minutes of moderate intensity (50–70% maximal heart rate) physical activity or exercise on at least 3 days a week;

    • Tailor the type of aerobic activity and venue to individual needs;

    • If overweight, to reduce weight, combine activity/exercise with diet modification;

    • Incorporate self-management education into activity/exercise recommendations and programs

  2. Neuromuscular rehabilitation for people with knee osteoarthritis:

    • A lower extremity exercise program should combine strengthening, endurance, coordination/balance and functional exercise;

    • Recommended programs will progress in duration, intensity and complexity; be tailored to the individual needs, abilities and preferences; move from clinical supervision to self-directed community setting; be periodically reviewed, revised and reinforced.

  3. Conditioning exercise for cardiovascular and neuromuscular fitness in adults with rheumatoid arthritis:

    • Initial assessment of fitness to determine safety and dose

    • Supervised or self-directed settings

    • Periodic review, revision, and reinforcement

    • Cardiovascular recommendations: Intensity: 60–85% maximal heart rate, progressively adjusted; Frequency: 2–3 times per week; Duration: 30–60 minutes; Mode: whole body, dynamic (walk, dance, water, stationary cycle)

    • Neuromuscular recommendations: Intensity: 50–80% of maximal load, progressively adjusted; Frequency: 2–3 times per week; Volume: 8–10 exercises; 8–12 repetitions; 1–2 sets; Mode: dynamic (static)

  4. Exercise and physical activity recommendations for children with juvenile arthritis:

    • To decrease pain, joint swelling/tenderness, improve aerobic capacity and the efficiency of gait, perform 30 minutes of moderate intensity physical activity or exercise (land or water)

    • To improve function, muscle strength and endurance, perform individualized resistance exercise 3 times per week

Research Agenda

  • Develop and evaluate multi-factorial interventions that combine exercise/physical activity, self-management, diet and pharmacologic agents

  • Develop and test interventions that target specific impairments, disabilities, and general fitness

  • Evaluate strategies to promote adoption and maintenance of community-based physical activity and exercise programs

  • Identify valid measures of physical fitness for people with rheumatoid arthritis

  • Identify response criteria for physical activity and exercise interventions across the life span

  • Examine exercise beliefs and physical activity habits in children with juvenile arthritis

  • Identify methods to promote lifetime physical activity in children with juvenile arthritis

  • Perform more long-term studies

Strategies Needed for Implementation of Recommendations

  • Promote consistent support from health professionals and community for adequate levels of exercise/physical activity by people with arthritis

  • Incorporate self-management and self-efficacy skill building in all recommendations and programs

  • Improve physical, social, and economic access to clinical and community-based opportunities

  • Maximize the efficiency and commitment of health care systems to enhance continuity or care and provide long-term support in the community.