Physical exercise and rheumatoid arthritis

Over the weekend I watched Night at the Museum 2 with my nephew. In it, Robin Williams’ Teddy Roo­sevelt char­acter says that the secret to hap­pi­ness is diet and exer­cise. I was delighted by that line — so true…and yet so dif­fi­cult. Why is that? We all know that a good diet and reg­ular exer­cise have a slew of mental and phys­ical ben­e­fits alike, but for some of us, that knowl­edge simply isn’t enough to moti­vate us into action.

While this is true for the gen­eral pop­u­la­tion, it may be even more true for patients with rheuma­toid arthritis, or RA, an autoim­mune dis­ease in which the body attacks its own joint tissue. Just as for the rest of us, research shows that main­taining a reg­ular phys­ical activity plan can help con­trol an RA patient’s symp­toms. But those symp­toms include things like joint damage, pain, dis­ability, and increased car­dio­vas­cular risk — all things that would cer­tainly scare me away from exercising.

At this year’s annual con­fer­ence of the Amer­ican Phys­ical Therapy Asso­ci­a­tion, Northeastern’s phys­ical therapy depart­ment chair Maura Iversen, along with sev­eral of her stu­dents, pre­sented new work about the rela­tion­ship between RA and phys­ical activity. They pre­sented results from two research NIH funded research projects that explored how phys­ical activity and dis­ease activity cor­re­late and what fac­tors dis­tin­guish very active and very inac­tive patients.

The first study was a sta­tis­tical analysis of 892 patients over age 18. Iversen’s team found, as they expected to, a “small but sig­nif­i­cant” cor­re­la­tion between dis­ease and phys­ical activity — meaning that patients with more active symp­toms were less likely to exer­cise. The research team makes no claims about why this is, but I’m willing to go out on a limb and say that as those symp­toms get worse, exer­cise becomes less and less appealing. Even if you you do know that exer­cising would help tamp down your dis­ease activity.

They also found a few fac­tors that cor­re­lated with increased phys­ical activity: Women, people with stronger social net­works, tee­to­talers, and the more well-​​educated among the group tended to be more active.

The second study was a more objec­tive look at how RA patients engage with phys­ical activity. They selected a group of patients based on their answers to a phys­ical activity survey — the most and least active 10 per­cent. Then, they got them all together in small focus groups and led dis­cus­sions about phys­ical exer­cise and rheuma­toid arthritis. They recorded and ana­lyzed the dis­cus­sion con­ver­sa­tions and found five emer­gent themes, which seem to me to be in line with the results from the first study:

Social sup­port was impor­tant both in helping highly active people stay active and in get­ting inac­tive people to start exer­cising. Envi­ron­mental fac­tors and ease of access were also impor­tant, “it’s easier to start and keep moti­vated if the classes are easy to get to,” said one participant.

Highly active par­tic­i­pants dif­fered from their less active coun­ter­parts in the way they viewed the impact of phys­ical activity on their dis­ease state. “We found that patients with RA who remain active con­cep­tu­alize activity as a drug,” said Iversen. “The seden­tary group saw it as a nice thing, but not a med­ica­tion to help treat their disease.”

It was easier for patients who were active before their diag­nosis to remain active than it was for his­tor­i­cally inac­tive patients to start up a new routine…which doesn’t sur­prise me a bit. I know how hard it is to start and main­tain an exer­cise rou­tine, not being nat­u­rally inclined to move as some of my uber-​​fit friends.

Finally, and this is per­haps one of the most inter­esting find­ings, patients in both groups asso­ci­ated phys­ical activity with inde­pen­dence. The dif­fer­ence is that less active patients regret their loss of phys­ical inde­pen­dence whereas highly active patients claim their inde­pen­dence through exercise.

That last bit brings me back to Robin Williams’ fic­tional Teddy Roo­sevelt. While I’m not about to launch into a philo­soph­ical rumi­na­tion on the rela­tion­ship between hap­pi­ness and inde­pen­dence, I would like to point out how so much of this has to do with one’s state of mind and how it affects the way we approach dif­fi­cult tasks that we know will improve both our mental and phys­ical health.

One com­ment by a less active patient said that two of his/​her kids call every single day to find out where their parent is plan­ning to walk that day. That’s an example of the social net­work having an impact on one’s phys­ical activity. Teddy Roosevelt’s secret to hap­pi­ness state­ment is in response to Ben Stiller’s night guard char­acter, Larry Daley, who says he thinks the secret is doing what you love and being around the people you love. Turns out being around the people we love may just improve our exer­cise habits, at least this study sug­gests so in the case of rheuma­toid patients. And I would ven­ture to guess we’re not all so different.