Aerobic and resistance exercise with person-centred guidance improved the wellbeing of older people with RA. Article and researcher in focus: Elvira Lange

Article: Effects of aerobic and resistance exercise in older adults with rheumatoid arthritis: a randomized controlled trial. Link to the article.

Researcher: Elvira Lange

Appointment: Doctoral student at the Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Registered Physiotherapist at Närhälsan (the largest primary care provider in Sweden).

Age: 34

What are your personal resources, and how do you apply them in your research? That is an interesting question! My curiosity is a driver for my research. Staying positive makes things easier, not least when I hit rocky ground. In those situations, my creativity and flexibility are of great help.

You evaluated the effects of aerobic and resistance training supervised by physiotherapist with a person-centred approach in older persons with rheumatoid arthritis (RA) and not only could you show that they were able to handle this type of training, but also that it made them feel considerably much better. Please tell me how you proceeded. The study was a randomized controlled multicentre trial, conducted in 2015-2016 in Göteborg and Skövde. Older persons with RA were recruited from a register and instructed to take part in gym-based aerobic and resistance training for 20 weeks under the supervision of a physiotherapist using a person-centred approach. The exercise held a moderate-to-high intensity, which is in line with the general recommendations for healthy persons. Simultaneously, a control group followed a more simplified home-based exercise programme of light intensity.

What were the results of the study? The study results showed that exercise had more effect on improving the aerobic capacity, physical function and strength in the intervention group compared to the control group. 71% of the participants in the exercise group rated their health as much or very much improved after the intervention, compared to 24% in the control group. The exercise regime had no harmful side effects, and no participants in the exercise group left the study during the intervention period, a proof that the exercise regime is doable.

What conclusions could be drawn from the study? Moderate-to-high intensity aerobic and resistance training, under the supervision of a physiotherapist who is using a person-centred approach, may complement the treatment of RA in older persons with a low to moderate disease activity.

The physiotherapists that were active in the study, had they been trained in person-centred care? The physiotherapists who were leading the intervention participated in literature studies and received onsite training in person-centredness by experienced colleagues from GPCC.

Could you describe some examples of ”a physiotherapist’s supervision according to a person-centred approach” compared to the exercise regime of the persons in the control group? For both groups, the intervention was initiated with an individual person-centred dialogue. The focus of these meetings was the person’s narrative, to establish a partnership, set up goals and to document. In addition, the exercise instruction was person-centred in the sense that it was designed based on the person’s previous experience. The main difference between the groups regarding the person-centredness was that the control-group only had one meeting with the physiotherapist whilst the intervention group met with the physiotherapist up to 40 times during the intervention. The latter resulted in more favourable conditions for the physiotherapist when it came to establishing a deeper relationship with the person, making it easier to follow his/her development and giving him/her more space.

Which other aspects of the exercise programme with person-centred guidance had an effect? The measured differences in this study, concerning above all the physical function is most probably due to the difference in intensity and duration of the exercise that existed between the groups. We believe that the person-centred design of the exercise was a strong contributor towards making the exercise doable despite age and chronic illness.

Is it rare that older persons with RA exercise at the same intensity as the intervention group (moderate-to-high intensity), something that is normally recommended for healthy persons? If yes, why? From a historical perspective, persons with RA have been told to refrain from exercising due to the fear for joint problems. For the past decades, there has been more and more evidence that exercising is good for this patient group, unlike previous assumptions. However, the group with RA had not been studied previously and there has been some caution in recommending exercise to older persons with RA. Hence, health care professionals have rarely allowed older persons to perform this type of intensive and strenuous exercise.

Is this exercise programme with person-centred guidance utilised in any way; has it been made available for RA-patients? Are physiotherapists being trained in this programme and are they offering it? If not, is it on the agenda? The observations and results from this study have been presented at international conferences and for physiotherapists in rheumatology in the region of Västra Götaland.

What is your current research about? I am currently involved in a qualitative follow-up study where the intervention group participants are being interviewed about their participation in the person-centred intervention and their experiences of continuing to exercise afterwards. The effects of exercise on fatigue and depression is studied in a parallel study.