Exercise: what stands in the way?

Arthritis symptoms and a busy life can be obstacles to exercising. But focusing on what motivates you to exercise and the benefits of this activity will help you get moving.

Regular exercise is especially important for people with arthritis. In addition to its general health benefits, physical activity makes living with arthritis easier. It helps to reduce pain, improve joint function, delay disability, and enhance quality of life. But despite these benefits, people with arthritis are less likely to exercise than people in the general population.

To find out why, researchers brought together 68 adults with arthritis and asked them about their experiences with exercise. The participants, divided into 12 focus groups, included regular exercisers (at least 3 days a week) and those with no routine, who were classified as non-exercisers. These groups were to help researchers better understand how people with arthritis perceive exercise barriers, motivators, and benefits. From the participants’ responses, the researchers identified 4 types of barriers to exercise: physical, psychological, social, and environmental.

Physical barriers

Pain before, during, or after exercise was the physical barrier mentioned most often. The exercisers in the focus groups were more likely to overcome the pain barrier by modifying the type or intensity of their exercise, easing up during arthritis flares or working through the pain in order to reap the benefits of exercise. Non-exercisers, in contrast, often simply quit exercising.

Fatigue was viewed as a significant physical barrier by exercisers and non-exercisers. But they differed in how they coped with the problem. Exercisers tended to adjust their exercise routine to reduce or accommodate fatigue, whereas the non-exercisers exercised less. Reduced mobility and other health problems were cited as additional obstacles to regular exercise.

Psychological barriers

Psychological barriers included attitudes and beliefs, fear, and perceived negative outcomes of exercise. Some people said they simply weren’t motivated to exercise or didn’t enjoy it; others concluded that they didn’t have the time. Non-exercisers considered these attitudes to be major barriers, whereas the exercisers viewed them as factors that simply made exercising a challenge.

A water workout is often recommended for arthritis sufferers because it’s good for the joints and easy on them. Fear of water, however, was a psychological barrier for non-exercisers. Their fear of experiencing pain was another. But both groups expressed concern about possible negative consequences of physical activity. Citing personal experience, several said they knew they would “pay for” the exercise later. Most participants agreed that negative outcomes were usually the result of pushing themselves too hard. Non-exercisers questioned whether exercise was “worth it” if it didn’t improve their arthritis symptoms.

Social barriers

Some participants mentioned lack of support or encouragement from family members, friends, and healthcare providers as a barrier to exercise. Not having an exercise partner discouraged some. Family responsibilities and lack of energy from having to fulfill multiple roles were also seen as exercise obstacles, especially by non-exercisers.

Environmental barriers

Environmental barriers included the lack of exercise facilities or programs geared toward people with arthritis. Some respondents cited the need for an exercise instructor who was knowledgeable about arthritis-related physical limitations. For some, cost and transportation were limiting factors. Cold, damp weather was another barrier mentioned.

What keeps exercisers motivated?

Group participants cited improvements in pain and stiffness and increased energy as important benefits of exercise. They also mentioned weight management and increased strength and flexibility, noting that exercise helped them move more easily and improved their functional ability. Exercisers frequently expressed the need to “use it or lose it” as an important motivator. Some were concerned that if they didn’t exercise, they would “freeze up” or “shut down.”

Other exercise benefits reported were:

• increased self-confidence
• stress relief
• independence
• socializing with other exercisers
• a feeling of well-being.

When asked what motivates—or would motivate—them to exercise, respondents mentioned the encouragement and support of friends, family, and healthcare providers; having an exercise partner; or belonging to an exercise group. In addition, access to a water-based program or home exercise equipment was viewed as helpful.

From Arthritis & Rheumatism (Arthritis Care & Research)