Improving strength training in people with rheumatoid arthritis

What We've Learned

Scientific Study Title:

I START: Improving Strength Training and Tailoring among people with Rheumatoid ARThritis

Start Date:

October 2018

End Date:

Ongoing

Research Category

Health Habits & Wellbeing

Why do this research?

Reason For Research

Strength training has a lot of important benefits for people living with rheumatoid arthritis (RA). In addition to reducing pain and fatigue, it also lowers the risk of cardiovascular disease. However, only up to 14% of people living with rheumatoid arthritis regularly do strength training exercises, even among those with a well-controlled disease. In the I START project, we wanted to find out what helps people with rheumatoid arthritis take up strength training. Our ultimate goal of this project is to eventually develop effective strategies to empower people living with rheumatoid arthritis to take part in this activity to improve their health.

Methodology

Execution of Research

The study included patient partners from Arthritis Research Canada’s Patient Advisory Board, clinician researchers, and the founder and president of Arthritis Consumer Experts and used the Patient Engagement in Research (PEIR) Framework. Discussions in the early phases of the ‘I START’ project outlined strategies for building, sustaining, and strengthening partnerships with potential users and those who would deliver strength training programs.

Three research studies were completed; all studies were co-developed and informed by the team. More specifically, patient partners and healthcare professionals collaborated on various aspects of this research such as informing the research questions, shaping the methodologies, and interpreting results.

In study 1, semi-structured interview guides were co-created with input from patient partners to understand why so few people with rheumatoid arthritis engage in strength training. 13 participants with rheumatoid arthritis were interviewed to identify the barriers and facilitators they experience with strength training. They were asked to share their preferences for tailored interventions to increase participation.

Study 2 gathered and summarized the existing research on recommendations for prescribing strength training for people living with rheumatoid arthritis. We wanted to understand the reasons that encouraged or negatively impacted participation in strength training. Patient partners co-developed the research questions, and methods, helped interpret the findings, and contributed to writing the manuscript.

Study 3 reviewed existing research on tailored physical activity interventions for people living with arthritis and summarized their impact and effectiveness. Patient partners were involved in creating the research questions and methods, reviewing the findings, and identifying priority topics for the manuscript’s discussion.

Findings & Next Steps

In study 1, interview participants revealed almost 50 different factors that affected their participation in strength training. These factors included:
1. Individuals’ perceptions around pain, fatigue and fear;
2. Influence of people around them (e.g., knowledge of health and exercise professionals to work with people with rheumatoid arthritis);
3. Environmental supports, including having resources on how to do strength training experience, and access to gym facilities and equipment.
In summary, strength training isn’t easy and requires solutions that support the individual and their environment.

In study 2, 27 articles were identified that provide recommendations on how to tailor strength training, specifically for people with rheumatoid arthritis. Findings included recommendations for exercise precautions, providing education, being adaptable to symptoms, using behaviour change strategies to ‘start and stick to it’, and engaging in collaborative care.

In study 3, 39 studies were identified that delivered physical activity programs for people living with arthritis. Among these studies, 24 assessment factors and 23 intervention strategies were commonly used in tailored physical activity interventions for people with arthritis (i.e., osteoarthritis, inflammatory arthritis, and/or fibromyalgia). Some assessment factors included past physical activity, disease symptoms, goals, barriers, and confidence. Intervention strategies included goal setting, physical activity prescriptions, and problem solving. Of the studies identified, 27 led to positive improvements in at least one measure of physical activity. This study found many ways to customize physical activity programs for people with arthritis.

The next steps of this research include the development and dissemination of the ‘I START’ toolkit, including a website for hosting training materials, conversation guides, and exercise videos featuring people living with arthritis. There is a ‘client version’ and a ‘practitioner version’ to ensure the materials support patients and health and exercise professionals to engage in shared decision-making throughout the strength training journey. This research program will continue to use an integrated knowledge translation approach, including potential users (e.g., patients) and prescribers (e.g., clinicians) throughout the next phases of this research.

Related Publications

Ma J, Collins J, Davidson E, English K, Hoens A, Tsui K, McQuitty S, Sequeira L, Li L. Strength Training for People with Rheumatoid Arthritis: Barriers, Facilitators, and Tailoring Considerations [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/strength-training-for-people-with-rheumatoid-arthritis-barriers-facilitators-and-tailoring-considerations/. Accessed June 19, 2024.
*Wu ML, *Ma JK, Tsui K, Hoens AM, Li LC. Tailoring Strength Training Prescriptions for People with Rheumatoid Arthritis: A Scoping Review. American Journal of Lifestyle Medicine. 2024;18(2):200-215. doi:10.1177/15598276221125415
Ma JK, Ramachandran S, Sandhu A, Tsui K, Hoens AM, Hu D, Li LC. Tailored Interventions for Supporting Physical Activity Participation in People with Arthritis and Related Conditions: a Systematic Review. Current treatment options in rheumatology. 2022;8(4):117–142. doi:10.1007/s40674-022-00194-5
*Ma JK, *Ramachandran S, Hoens AM, McQuitty S, Sequeira L, Collins JA, Tsui K, Davidson, E, Jiwa S, Koehn C, Li LC. Co-developing strength training behaviour change interventions for people with rheumatoid arthritis. In: McCutcheon C, Reszel J, Kothari A, Graham ID, editors. How We Work Together: The Integrated Knowledge Translation Research Network Casebook. Volume 4. Ottawa, ON: Integrated Knowledge Translation Research Network. 2021; 20-25. Available from: https://iktrn.ohri.ca/projects/casebook/

*Contributed as co-first authors.