Research about exercise for the over 65s
Although it has been long been understood that exercise is good for people with rheumatoid arthritis in general, there has been no specific information on how people 65+ with RA are affected by exercise. Now physiotherapist Elvira Lange has published her doctoral dissertation on this. The result is that they feel best after medium-hard workouts.
Who are you?
My name is Elvira Lange and I have been a physiptherapist for 12 years. Throughout almost all my clinical working life, I have worked in various forms of primary care. Among other things, I have worked on health promotion training for different groups with a mixed background. I joined a project on exercise for people 65+ with RA and worked on that project between 2015 and 2019. I completed my dissertation last Christmas and after that worked clinically, as well as research and teaching on the physiotherapy program.
Tell us about your thesis
Recent research has shown that people with RA enjoy good results from physical activity and exercise. However, research on training for older people with RA has been limited, and they are also less physically active than older people without rheumatism. That's why we decided to investigate!
The starting point for the dissertation was a randomized, controlled exercise study conducted in Gothenburg and Skövde with 74 participants, all older people over the age of 65 with RA. They were completing strength training and fitness training at medium to high intensity three times a week in a gym environment over 20 weeks. The training was supervised by a physiotherapist based on a person-centered approach. There was also a control group that performed easier home exercise and received advice about everyday activities.
The dissertation consisted of four sub-projects with as overall aim of studying different aspects of training with person-centered management for older people with RA.
The first two sub-projects were based on the exercise study and evaluated, among other things, changes in physical function, fatigue and depressed moods. The third part of the study, used in-depth interviews to explore the experiences of participation in exercise and the transition to independent training seven months after the intervention. In the fourth part of the project, participants were followed up after four years regarding their continued levels of physical activity and physical performance.
What were the results?
The results showed positive effects of exercise on a number of different measures of physical performance, as well as on fatigue and depression symptoms. However, activity limitations were not significantly affected by exercise when the groups were compared.
The training was perceived as manageable and equipped the participants for their transition to continued training, among other things by developing knowledge, and making the training their own. After four years, the exercise group was significantly more physically active than at the beginning of the study, but there was no significant difference between the groups.
In summary, the thesis shows that medium to high-intensity training is manageable and beneficial for people 65+ with RA, and the recommendation to include physical activity and training in the management of RA is suitable for this group. However, continuing to train for several years is challenging for them.
Why was it important to investigate this?
Purely as a physiotherapist, I am very interested in what a person does after being with a physiotherapist and how they continue with their exercise on their own. It usually goes well when people are exercising with a physiotherapist, but the question is if we are managing to create changes that will last? These are purely general challenges - it is difficult to keep up your exercise program over time. How can we physiotherapists make it easier?
What have you gained from this?
We have used a person-centered approach, which means seeing the patient as a person with all their responsibilities, roles, resources and everything else. With that perspective, it has become clear that different people need different help. For some, this may mean that you need to be able to be contacted whenever they need you, while others may need a planned follow-up.
Some of the participants mentioned that they wanted annual visits to their physiotherapists just like their annual visit to the rheumatologist. By recording physical activity during the existing conversation with the rheumatologist, you could identify when a patient needs contact with a physical therapist, for example, if they have stopped their activity. Sometimes a phone follow-up can go a long way.
During part three we could see that if you are both elderly and have a chronic illness, the risk of reducing exercise is greater. There may simply be obstacles to the exercise is maintained long-term. Physical illness can be a major obstacle. It can be anything from having a cold and stopping from training for a few weeks and then having to restart until you have been admitted or have new problems in your RA which means your previous program no longer works. We need to remember that things change over time for any number of reasons, but physiotherapists can help adapt the exercise program.
Do you have any personal insights?
It's part of the process of writing a dissertation that sometimes I felt "this is not rocket science". It is useful to exercise, as we knew before. People get stronger, they get fitter and it also reduces both fatigue and depression. This is what we expect with exercise, although it has not been studied in this group to the same extent before.
The results are thus in line with what I expected. At the same time, it is a group where so much has happened over the past 20 with the advent of better drugs. The clinical reflection is that it is very good to exercise, even for the elderly. But both patients and physiotherapists remain unnecessarily cautious. Of course, it needs to be adapted to the age group and the individual, but it is possible for the over 65s to exercise and we need to continue to work to make it happen.
It is also extremely interesting to think about how we should up our healthcare in order to support a changed lifestyle over time. Much of the help these people need could be the same as many other people need. After all, they’re not the only group who talk about the challenge of exercise. Then there are also those that are RA-specific, such as obstacles that arise in relation to the disease. Here we need to continue to learn more about how we as physiotherapists support the transition to independent training and also how we can support continued exercise over a long period of time.
What’s in the future?
My colleague Anneli Bilberg, has previously studied high-intensity interval training for people with spondylarthritis. That got good results, and now she is looking at people with RA. If we push ourselves even harder, can it produce more of the anti-inflammatory effects of exercise? It will be exciting to see what happens.
In terms of physiotherapy research, it is important to continue studying how we best organize health care to support and facilitate exercise throughout life.
Do you have any tips for the elderly?
My key message is that you as a senior with RA can exercise. It's about learning how and in what way, and developing your own approach. You may not trust your ability completely, but the more we do with our bodies, the more confidence we’ll have in what it can do. If we exercise and dare to test ourselves, self-confidence and body awareness will gradually increase. The important thing is just to do some exercise and find what works for you. That's probably my most important advice.
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Read the full dissertation in English:
Photo: Thomas Harrysson