Despite numerous public service campaigns and studies touting the benefits of exercise for people with arthritis, more than 40 percent of those with rheumatoid arthritis, or RA, remain inactive, according to a 2012 study published online in the journal Arthritis Care & Research. But the researchers found that up to 65 percent of this extra inactivity is due to two modifiable risk factors, suggesting that more effective public health initiatives could turn the situation around.

“We were surprised they were very inactive,” says the study’s lead author Jungwha “Julia” Lee, PhD, assistant professor in the department of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago. “Regular, moderate physical activity offers a host of benefits. It helps reduce pain and improve well-being.”

James O’Dell, MD, president of the American College of Rheumatology, or ACR, and chief of rheumatology, vice-chairman and residency program director at the University of Nebraska Medical Center in Omaha, agrees. “The bottom line is activity keeps you healthy,” he says. Physical activity can help shore up joints by strengthening the muscle around them and also combat heart disease, adds Dr. O’Dell, who is not associated with this study.

“The primary reason RA patients have decreased life expectancy is because of increased cardiovascular events. We know from many, many studies how important activity is to decreasing cardiovascular risk factors,” says Dr. O’Dell.
 

Lee and her colleagues looked at 176 adult RA patients, ages 23 to 86, in a randomized trial. For one week, from the time they got up until bedtime, each person wore an accelerometer, a device that measures movement. Forty-two percent of the participants were considered “inactive” – that is, they didn’t clock even one 10-minute stretch of moderate to vigorous activity during the week. Only 12 percent met the guidelines advised by the Centers for Disease Control and Prevention, or CDC. It recommends 150 minutes per week of at least moderate activity, such as water aerobics or mowing the lawn.

“Unfortunately, there is the widespread myth that people with arthritis need to rest,” says Lee, who believes that some patients still think resting their joints is the best route. “Patients don’t have to meet the CDC guidelines, but they should be as physically active as possible.”

The study also found that inactivity was closely related to two factors: motivation to participate (in other words, whether a person believed he was able to participate in physical activity) and a belief in the benefits of physical activity. People who lacked strong motivation for physical activity, and people who lacked a strong belief in the benefits of exercise were 2.5 to 3 times more likely to be inactive than those who had strong motivation or held strong beliefs.

These findings add to the results of an earlier analysis – by the same group of researchers and published in Arthritis Care & Research last September – by estimating what proportion of physical inactivity in this sample of people with RA could be addressed by improving beliefs and motivations concerning physical activity. The answer is approximately 65 percent.

The motivation and belief findings weren’t surprising to Dr. O’Dell. “Of course there’s a correlation. If you think it’s going to work, you’re more likely to do it and more likely to stick with it,” he says.

The challenge, Lee says, is to figure out why people with RA aren’t participating in at least moderate physical activity – such as walking briskly as if you were late for a meeting – and develop methods to change that. “The Arthritis Foundation and the YMCA are trying to get that message out to more doctors and patients.”

The best way to safely get started, according to Lee and Dr. O’Dell, is for people with RA to talk to their doctors about developing a tailor-made exercise program that doesn’t overtax delicate joints, but gives the body the workout it needs.