Exercise-related goals and self-efficacy as correlates of aquatic exercise in individuals with arthritis

OBJECTIVE: To examine whether aquatic exercise-related goals, task self-efficacy, and scheduling self-efficacy are predictive of aquatic exercise attendance in individuals with arthritis. A secondary objective was to determine whether high attendees differed from low attendees on goals and self-efficacy. METHODS: The sample comprised 216 adults with arthritis (mean age 69.21 years). Measures included exercise-related goal difficulty and specificity, task and scheduling self-efficacy, and 8-week aquatic exercise attendance. RESULTS: Results of a multiple hierarchical regression analysis were significant (P < 0.01). Goal difficulty, specificity, and task self-efficacy were independent predictors of attendance (P < 0.05). A significant multivariate analysis of variance (P < 0.01) indicated that high attendees had higher task and scheduling self-efficacy and lower goal difficulty than did low attendees (P < 0.05). CONCLUSION: Support for the importance of exercise-related goal setting and self-efficacy was demonstrated. Implications pertain to the design of interventions to impact aquatic exercise.     

A disease‐specific self‐help program compared with a generalized chronic disease self‐help program for arthritis patients

Objective

Both the Arthritis Self‐Management Program (ASMP) and the generic Chronic Disease Self‐Management Program (CDSMP) have been shown to be successful in improving conditions in patients with arthritis. This study compared the relative effectiveness of the 2 programs for individuals with arthritis.

Methods

Patients whose primary disease was arthritis were randomized to the ASMP (n = 239) or to the CDSMP (n = 116). Analyses of covariance were used to compare the outcome measures for the 2 programs at 4 months and 1 year. Measures included quality of life outcomes (self reported, health distress, disability, activity limitation, global health, pain, and fatigue), health behaviors (practice of mental stress management, stretching and strength exercise, aerobic exercise), self efficacy, and health care utilization (physician visits and hospitalizations).

Results

Both programs showed positive results. The disease‐specific ASMP appeared to have advantages over the more generic CDSMP for patients with arthritis at 4 months. These advantages had lessened slightly by 1 year.

Conclusion

The disease‐specific ASMP should be considered first where there are sufficient resources and participants. However, both programs had positive effects, and the CDSMP should be considered a viable alternative.

     

Changes in self‐efficacy and health status over 5 years: A longitudinal observational study of 306 patients with rheumatoid arthritis

Objective

To investigate changes in self‐efficacy and health status over 5 years in patients with rheumatoid arthritis (RA), the relationships between these changes, and the influence of baseline values on subsequent changes.

Methods

306 adult patients with RA, born in 1926 or later, were examined by questionnaire in 1994 and again in 1999. We analyzed data regarding pain (visual analogue scale [VAS], Arthritis Impact Measurement Scale [AIMS2] symptom scale, Short Form‐36 [SF‐36] pain scale), fatigue (VAS, SF‐36 vitality scale), mental distress (AIMS2 affect scale, SF‐36 mental health scale) and self‐efficacy (Arthritis Self‐Efficacy Scales for pain and for other symptoms).

Results

On group level, all health status measures were numerically somewhat improved, and self‐efficacy slightly reduced. Changes in self‐efficacy and in corresponding health status measures were significantly correlated. For patients with above average educational level self‐efficacy for pain at baseline was positively correlated to improvement in pain measures. Good mental health at baseline was correlated to improvement in self‐efficacy for other symptoms, but only for patients with below average educational level.

Conclusion

Baseline self‐efficacy seems to influence future level of perceived pain and baseline mental health status seems to influence future self‐efficacy. These associations seem to be affected by level of education.

     

Use of self‐management behaviors to cope with rheumatoid arthritis stressors

Objective

To examine self‐management behaviors used to cope with 5 rheumatoid arthritis (RA)‐related stressors (pain, fatigue, physical limitations, joint changes, and symptom unpredictability) and the relationship between use of self‐management behaviors and ability to perform life activities.

Methods

Data were from telephone interviews of 511 persons with RA. Participants were presented with lists of self‐management behaviors for each stressor and asked to indicate which they had used in the past year. Performance of life activities was assessed concurrently (baseline) and 1 year later (followup). The number of activities affected (difficulty performing or unable to perform) and the number that individuals were completely unable to perform were calculated. Multiple regression analyses were used to examine the association of perceived stressor impact and arthritis education with strategy use and the association of self‐management behaviors with performance of life activities.

Results

Four self‐management strategies were identified: accommodation, active remediation, social, and perseverance. Greater perceived impact of stressors was associated with use of more self‐management strategies in total for each stressor (β = 0.43–0.73, all P < 0.0001) and with use of accommodation (β = 0.26–0.29, P < 0.0001), social (β = 0.23–0.43, P < 0.0001), and perseverance (β = 0.29–0.46, P < 0.0001) strategies. Greater use of accommodation strategies at baseline was associated with an increase in the number of activities affected at followup (β = 0.11, P < 0.05); greater use of perseverance strategies was associated with a decrease in activities unable to perform (β = ?0.13, P < 0.01).

Conclusion

Self‐management behaviors are commonly used and may help prevent loss of the ability to perform life activities.

     

A survey of exercise beliefs and exercise habits among people with arthritis

Objective . To explore a possible explanation for the problem of why few people exercise despite the positive health advantages, by examining the relationship between exercise beliefs and participation in exercise activities. Methods . Eighty-one respondents aged 27–80 were recruited from 3 Chicago-area health care facilities to complete the study survey; 68 (84%) did so. Participants were asked about their participation in 6 types of exercise activities; they also reported their beliefs concerning their ability to exercise (self-efficacy for exercise), barriers to exercise, benefits of exercise, and the impact of exercise on their arthritis. Results . Study results indicate that belief in the benefits of exercise and self-efficacy for exercise are associated with participation in exercise activities. Also, severity of disease differentiated exercisers from non-exercisers. Conclusions . Results suggest the importance of finding ways to strengthen belief in the benefits of exercise and self-efficacy for exercise in people with arthritis, particularly people with moderate to severe disease-related limitations.     

Perceived self‐efficacy gained from,and health effects of,a rehabilitation program after hip joint replacement

Objective

To examine whether a routine multidisciplinary inpatient rehabilitation program can increase patient self‐efficacy, and to investigate the effects of high self‐efficacy at admission, and increases in self‐efficacy, on health changes in patients who undergo such rehabilitation after hip joint replacement.

Methods

Participants in this longitudinal study were 1,065 patients who underwent inpatient rehabilitation after hip joint replacement. Questionnaires were administered at admission, discharge, and 6‐month followup. The main outcome variables were disability, pain, depressive symptomatology, and self‐efficacy to cope with disability and pain.

Results

Significant improvements from admission to discharge from the inpatient rehabilitation program in disability, pain, depressive symptoms, and self‐efficacy were found. In addition, higher levels of self‐efficacy at admission and larger increases in self‐efficacy over the course of the program predicted larger health changes (i.e., greater decreases in disability, pain, and depressive symptoms). Results were generally similar for health changes from discharge to 6‐month followup.

Conclusion

A routine multidisciplinary inpatient rehabilitation program after hip joint replacement can result in enhanced self‐efficacy.

     

Self‐monitoring has potential for home exercise programmes in patients with haemophilia

Haemophiliacs who have had to keep a physically inactive lifestyle due to bleeding during childhood are likely to have little motivation for exercise. The purpose of this study is to clarify the effectiveness of the self‐monitoring of home exercise for haemophiliacs. A randomized controlled trial was conducted with intervention over 8 weeks at four hospitals in Japan. Subjects included 32 male outpatients aged 26–64 years without an inhibitor who were randomly allocated to a self‐monitoring group and a control group. Individual exercise guidance with physical activity for improvement of their knee functions was given to both groups. The self‐monitoring materials included an activity monitor and a feedback system so that the self‐monitoring group could send feedback via the Internet and cellular phone. The self‐monitoring was performed by checking exercise adherence and physical activity levels, bleeding history and injection of a coagulation factor. Both groups showed significant improvements in exercise adherence (P < 0.001) and physical function such as the strength of knee extension (P < 0.001), range of knee extension (P < 0.001), range of ankle dorsiflexion (P < 0.01), a modified Functional Reach (P < 0.05) and 10 metre gait time (P < 0.01). In particular, improvements in exercise adherence (P < 0.05), self‐efficacy (P < 0.05), and strength of knee extension (P < 0.05) were significant in the self‐monitoring group compared with those in the control group. No increase in bleeding frequency and pain scale was noted. The self‐monitoring of home exercise for haemophilic patients is useful for the improvement of exercise adherence, self‐efficacy and knee extension strength.     

The side‐effects and efficacy of leflunomide in Japanese patients with rheumatoid arthritis

Aims: To investigate the efficacy and safety of leflunomide, including the side‐effects, we assessed 84 rheumatoid arthritis (RA) patients who received leflunomide treatment. Methods: We analyzed the C‐reactive protein (CRP), white blood cell count (WBC), KL‐6, and visual analogue scale (VAS) scores, modified Stanford Health Assessment Questionnaire (MHAQ) score, American Rheumatism Association score (ACR20 and ACR50) within a time course after treatment with leflunomide. We treated 84 RA patients, 12 male and 72 female from 28 to 81‐years‐old, with an average age of 63.5 years. The patients were divided into three groups: a group consisting of 38 patients who received 100 mg/day of leflunomide for 3 days followed by 20 mg/day thereafter; a second group of 11 patients who received a no‐loading dose of 10 mg/day; and a third group of 35 patients who received a no loading dose of 20 mg/day. Results: The 50% decrease of CRP seen in 2 weeks was 52% of the total of 84 patients. The WBC score did not change significantly after the medication was given. The KL‐6 score did not change significantly, either. The VAS pain score improved 4 weeks later, and then further improved 8 weeks later. Therefore, RA patients using leflunomide obtained pain relief 4 weeks after commencing medication. The MHAQ score did not change significantly until 8 weeks after the patients started the medication. ACR20 was 62% and ACR50 was 38% at 8 weeks after treatment. The side‐effects of leflunomide observed in our patients were rash, respiratory infection, diarrhea, nausea, alopecia, muscle pain, headache, dizziness and general fatigue. Twenty‐three out of 84 patients experienced side‐effects (27%), and 48/84 (57%) experienced withdrawal. In our hospital, there were no patients who developed severe interstitial pneumonia (IP) or who died after taking leflunomide; however, the incidence of side‐effects of the 100 mg/day loading dose (42.1%) was 2.5 times higher than in the patients who received 20 mg/day (17.1%) of a no‐loading dose. Conclusion: Because of this, it is possible that a 100 mg/day loading dose is a relatively high risk dose in terms of causing side‐effects, especially for severely ill RA patients with a high CRP level.     

Randomized trial of a self‐management program for primary care patients with acute low back pain: Short‐term effects

Objective

We evaluated the effect of a self‐management program (SMP) on primary care patients with acute low back pain (ALBP) from low income, inner city neighborhood health centers and an emergency department of a public teaching hospital.

Methods

We randomized 211 primary care patients who visited a physician for ALBP (<90 days duration) to usual care or an SMP. The SMP consisted of 3 group sessions and telephone followup that focused on understanding back pain, increasing physical activity, and dealing with fears and frustrations.

Results

Of the eligible patients, 52% expressed interest in participation and 39% of all eligible patients were randomized into the study. Among patients in the treatment group, 28.3% attended at least 1 group class, 62.3% received the intervention by mail, telephone, and audiotapes, and 9.4% received no intervention. Interviewers, blinded to the treatment given, collected data at baseline and at 4 months following randomization. Compared with the control group, the intervention group reported significantly better emotional functioning (P < 0.01), increased self efficacy to manage ALBP (P = 0.03), and less fear of movement (P = 0.05) after 4 months.

Conclusion

This SMP produced short‐term improvements in emotional functioning and self efficacy to manage symptoms among patients with ALBP living in the inner city. However, methods of program delivery other than group classes are needed to reach a greater portion of the inner city patients.

     

Effect of aquatic exercise on mental health,functional autonomy,and oxidative dysfunction in hypertensive adults

The aquatic exercise is an effective non-pharmacological therapy for prevention and control of hypertension. The objective of the present study was to investigate the effect of aquatic exercise on mental health, functional autonomy, and oxidative dysfunction in hypertensive adults. Methodologically 29 adults (mean age 53 ± 7.5 years) were included in the study, and were randomly grouped as hypertensive (n = 16) and non-hypertensive (n = 13). Both groups underwent low-intensity aquatic exercise program for 12 weeks. Outcomes were evaluated at week 0 and 12. The values for the following parameters decreased in the hypertensive group post training: anxiety (?6.2 ± 2 score; 60%), Timed Up and Go test (?7.4 ± 0.3 sec; 30%), protein carbonylation (?0.15 ± 0.03 nmol/mg protein; 50%), nitric oxide (12.4 ± 6 nmol/mg protein; 62%), interleukin-6 (?27.6 ± 5.7 pg/mg protein; 46%), and tissue necrosis factor-alpha (?52.4 ± 3.8 pg/mg protein; 40%); however, the values of the following parameters increased before training: Berg score (56 ± 2; 7.8%), flexibility (27 ± 1 cm; 71%); glutathione (3.1 ± 1.3 nmol/mg protein; 138%), and superoxide dismutase (1.6 ± 0.4 nmol/mg; 166%). In conclusion, we suggest that low-intensity aquatic exercise program improved anxiety, functional autonomy, and oxidative dysfunction in hypertensive adults.     

Volunteers' experiences of becoming arthritis self‐management lay leaders: “It's almost as if I've stopped aging and started to get younger!”

Objective

To determine whether undergoing training to become a lay leader and conducting an arthritis self‐management course is associated with improvements in physical and psychological health status, arthritis self‐efficacy, use of self‐management techniques, and visits to the general practitioner. In addition, we aimed to describe the experiences of training and course delivery from the older volunteers' perspective.

Methods

21 participants completed all assessments and had a median age of 58, median disease duration of 10 years, and either osteoarthritis (n = 13) or rheumatoid arthritis (n = 8). The study was a pretest–posttest design with qualitative data collected at 3 points in time: before training, 6 weeks after training, and 6 months after training. Quantitative data were collected through self‐administered postal questionnaires at baseline and 6‐month followup.

Result

Six months after training, participants reported small, significant increases in arthritis self‐efficacy for pain (P = 0.002), cognitive symptom management (P = 0.004), and communication with their physician (P = 0.024) and a small, significant decrease in depressed mood (P = 0.04). Qualitative data supported these findings, with participants reporting more confidence, happiness, and a changed outlook on life in general. Volunteerism was associated with altruistic behavior and with filling the vocational void caused by retirement.

Conclusion

Findings support the value of volunteerism and training to become lay leaders in arthritis self‐management programs. Volunteers reported positive changes both in themselves and in course participants. They enjoyed helping similar others and being involved in a worthwhile activity, and they valued their newly acquired status as lay leaders. Many had begun to apply their newfound knowledge about self‐management to their own situation, reporting less pain and more willingness “to get on with life.”