How to help your patients form an
exercise habit (and maintain it)
While there’s no doubt that physical activity can pro- vide a myriad of benefits for patients with rheumatic diseases, there is significant
uncertainty around how to help and
motivate patients to make it a habit so
they can reap its long-term rewards.
At a European Congress of Rheumatology session titled “Exercise –
more than a wonder drug,” Dr. Keegan
Knittle of the University of Helsinki
offered advice on how to help patients
maintain physical activity by taking
delegates through behavioural science
theories on self-determination, self-regulation, and habit formation.
According to Dr. Knittle, rheumatology health professionals can help patients begin on their physical activity
journey by helping them to identify
the types of physical activities that
they most enjoy doing.
“This is easy for some individuals,
but it could be a struggle for others.
Offering individuals opportunities to
try new ways of being active is a
good start as people are more likely
to maintain behaviours that they enjoy,” he said in an interview.
Helping patients to identify the positive outcomes that they can gain from
being physically active – such as feelings of strength, health, and strong
social behaviours – can also help them
to maintain those activities.
“To be maintained over time,
Careful planning can help people to
strengthen their habits for physical
activity behaviour,” he noted.
Dr. Knittle also
change techniques that patients can use to
help them form
a strong physical
“While helping patients to
maintain physical activity is always
a challenge, especially in the face of
degenerative or progressive arthropa-thies, behavioural science can offer
health professionals in rheumatology
some theory and evidence-based
methods to support physical activity
maintenance in practice,” he added.
But once patients have established
a physical activity habit how do they
know how much is optimal for them?
According to Prof. George Metsios
of the Faculty of Education Health
and Wellbeing at the University of
Wolverhampton (England), there is
ample evidence to show the benefits
of exercise in people with rheumatic
and musculoskeletal diseases (RMDs),
but a consensus on the “dosage” of
exercise is currently missing.
“Similar to receiving the right dos-
age of medication for alleviating and
managing disease symptoms, receiv-
ing the appropriate exercise dosage
is equally important in people with
RMD,” Prof. Metsios said in an inter-
dosage – par-
building up the
sively to ame-
effects – may op-
timise the man-
agement of RMD symptoms.”
In his talk, he explored the data re-
quired from RMD patients to develop
the best exercise prescription.
For example, the appropriate exercise dosage can be identified and
prescribed if patients undergo an exercise tolerance test to identify their
maximum cardiorespiratory capacity.
“We can then utilise intensities
of maximum cardiorespiratory fitness [and/or maximum heart rate] to
prescribe appropriate intensities that
may alleviate symptoms,” he said.
Research in cardiovascular diseases
suggests that intensities between
60% and 90% of maximum heart
rate elicit beneficial effects in multiple
different disease outcomes, which
are relevant to RMDs, including
reduced fatigue and inflammation,
improved cardiorespiratory health,
quality of life, and functional ability.
“Exercise is safe, even when pro-
gressively higher exercise intensities
are applied, this has multiple different
benefits in different physiological and
psychological outcomes in RMDs.
“The benefits of using exercise as
an adjunct treatment in RMDs are
too many to ignore. As such, targeted
efforts need to be made to effectively
implement physical activity in clinical
practice,” he added.
Dr. Knittle Prof. Metsios