Physiotherapy counseling plus FitBit promote physical activity in RA, lupus
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The use of a wearable activity tracker, paired with counseling sessions with a physiotherapist, may potentially improve physical activity among patients with rheumatoid arthritis and systemic lupus erythematosus, according to findings published in Arthritis Care & Research.
“Being active is good, but most people do not do enough,” Linda C. Li, PT, PhD, of the University of British Columbia, in Vancouver, told Healio Rheumatology. “It is particularly challenging for people with inflammatory arthritis because of pain and fatigue, and the fear of flaring the symptoms. In this study, we tested an 8-week program with the use of a Fitbit and telephone counselling by a physiotherapist. This program aims to promote physical activity in people with rheumatoid arthritis or systemic lupus erythematosus.”
To analyze the efficacy of Fitbit use paired with a physiotherapy counselling in improving physical activity, Li and colleagues recruited 118 patients with RA and SLE from the Mary Pack Arthritis Program, which is part of the Vancouver Coastal Health Authority, and the Fraser Health Authority, in British Columbia. Researchers randomly assigned participants to one of two groups. In weeks 1 through 8, patients in the “immediate group” received education and counseling from a physiotherapist, and used a Fitbit and an online application to track their physical activity. They also received four follow-up calls from the physical therapist.
The other participants, assigned to the “delay group,” received the same intervention, but in weeks 10 through 17. Participants were assessed at baseline and subsequently at weeks 9, 18 and 27. The primary outcome was time spent engaged in moderate or vigorous physical activity for periods of 10 minutes or more. Other outcomes included step count, time in sedentary behavior, pain, fatigue, mood, selfmanagement capacity and habitual behaviors.
According to the researchers, the adjusted mean difference in moderate or vigorous activity was 9.4 minutes per day (95% CI, –0.5 to 19.3). Further, there was significant impact on pain (–2.45; 95% CI, –4.78 to –0.13), as well as perceived walking habit (0.54; 95% CI, 0.08-0.99) (P = .02). However, although other secondary outcomes improved, they were not statistically significant.
Additionally, the researchers’ hosthoc analysis demonstrated a significant effect in moderate or vigorous activity (14.3 minutes per day; 95% CI, 2.3-26.3) and pain (–4.05; 95% CI, –6.73 to –1.36) among participants with RA, but not SLE.
“Bottom line: Our program has potential to improve physical activity in people with inflammatory arthritis, but further study is needed to understand the mechanism and effect on different diseases,” Li said. “Supporting a physically active lifestyle is a core component of successful self-care in people with arthritis. The Exercise is Medicine initiative advocates for creation and implementation of effective strategies to promote physical activity for patients worldwide. Our results provide a foundation for further refining a simple program in this population.”
Perspective
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Linda Grinnell-Merrick, MS, NP-BC
This is a very interesting study that incorporated the use of the physical therapist and wearable monitors to assess the impact of moderate-to-vigorous physical activity on patients with inflammatory arthritis in a controlled manner. Health care providers have long felt that exercise and maintaining an active lifestyle is essential for our patients. However, this can be a very difficult prescription to sell to our patients when they are not feeling well and doubt the benefits.
I have long depended on initiating physical activity by prescribing a course of physical therapy. Many patients just don’t know where or how to start and what they can safely do. The physical therapist is able to develop an individualized and safe plan for them. I have also encouraged patients to use whatever resources they may have, such as their smart phones or smart watches.
Many will start and stop, but there are those who will embrace exercise and make it a part of their daily ritual and reap the many benefits: weight loss, decreased pain and mental well-being. These studies help to demonstrate the positive impact that exercise provides and should be an essential aspect of care for patients with inflammatory arthritis.
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