EXTENDED REPORT

High intensity exercise or conventional exercise for patients with rheumatoid arthritis? Outcome expectations of patients, rheumatologists, and physiotherapists

M Munneke^1,2, Z de Jong², A H Zwinderman³, H K Ronday⁴, C H M van den Ende⁵, T P M Vliet Vlieland², J M W Hazes^2,6

¹ Department of Physical Therapy and Occupational Therapy, Leiden University Medical Centre (LUMC), Leiden, The Netherlands and Department of Physical Therapy, University Medical Centre Nijmegen, The Netherlands
² Department of Rheumatology, LUMC, Leiden, The Netherlands
³ Department of Medical Statistics, LUMC, Leiden, The Netherlands
⁴ Department of Rheumatology, Leyenburg Hospital, The Hague, The Netherlands
⁵ Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
⁶ Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, The Netherlands

Correspondence to:
Correspondence to:
M Munneke
Leiden University Medical Centre, St Radboud, Department of Physiotherapy (326), PO Box 9101, 6500 HB Nijmegen, The Netherlands; m.munneke{at}neuro.umcn.nl

Objective: To examine the outcome expectations of RA patients, rheumatologists, and physiotherapists regarding high intensity exercise programmes compared with conventional exercise programmes.

Methods: An exercise outcome expectations questionnaire was administered to 807 RA patients, 153 rheumatologists, and 624 physiotherapists. The questionnaire consisted of four statements regarding positive and negative outcomes of high intensity exercise programmes and four similar statements for conventional exercise programmes. A total expectation score for both conventional and high intensity exercise was calculated, ranging from –2 (very negative expectation) to 2 (very positive expectation).

Results: The questionnaire was returned by 662 RA patients (82%), 132 rheumatologists (86%), and 467 physiotherapists (75%). The mean (95% confidence interval) scores for high intensity exercise programmes were 0.30 (0.25 to 0.34), 0.68 (0.62 to 0.74), and –0.06 (–0.15 to 0.02), and for conventional exercise programmes were 0.99 (0.96 to 1.02), 1.13 (1.09 to 1.17), and 1.27 (1.21 to 1.34) for RA patients, rheumatologists, and physiotherapists, respectively. In all three respondent groups, the outcome expectations of high intensity exercise were significantly less positive than those of conventional exercise programme.

Conclusions: Despite the existing evidence regarding the effectiveness and safety of high intensity exercise programmes, RA patients, rheumatologists, and physiotherapists have more positive expectations of conventional exercise programmes than of high intensity exercise programmes. Physiotherapists were the least positive about outcomes of high intensity exercise programmes while rheumatologists were the most positive. To help the implementation of new insights in the effectiveness of physical therapy modalities in rheumatology, the need for continuous education of patients, rheumatologists and physiotherapists is emphasised.

Abbreviations: EOE-Q, exercise outcomes expectation questionnaire

Keywords: exercise; rheumatoid arthritis; beliefs; high intensity exercise programs

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Panoulas, V. F., Metsios, G. S., Pace, A. V., John, H., Treharne, G. J., Banks, M. J., Kitas, G. D. (2008). Hypertension in rheumatoid arthritis. Rheumatology (Oxford) 47: 1286-1298 [Abstract] [Full Text]  
• Summers, G. D., Deighton, C. M., Rennie, M. J., Booth, A. H. (2008). Rheumatoid cachexia: a clinical perspective. Rheumatology (Oxford) 47: 1124-1131 [Abstract] [Full Text]