Give It 60 Seconds

Rheumatic diseases create a “vicious cycle”² of physical impairment. Patients with inflammatory rheumatic disease are significantly less likely to be physically active and the reduction in physical activity contributes to muscle wasting and chronic inflammation. The most effective way for you to engage and break this vicious cycle is by prescribing regular physical movement—if only it were that easy!

Research suggests that 1 of the many benefits of movement is the production of myokines² (protein released by skeletal muscle cells in response to muscular contraction) which create an anti-inflammatory response. Regular movement improves autonomic functioning4 which can help reduce the risk of cardiovascular disease associated with rheumatic disease. Movement also improves the malaise that accompanies rheumatoid arthritis (RA) with the related endorphin, hormone, and neurotransmitter releases and leads to stronger memory, better sleep, and more energy. Almost all research reports that after 20-30 minutes of movement activity, people feel calming effects that can last for several hours.⁵

Natalie Golub, MA

Of course, you are already prescribing physical movement and your patients are not actually making use of the recommendation. In fact, the word “exercise” elicits shame and dread in equal measures so how can you leverage the benefits of movement? One way to increase patient compliance is by reframing your prescription for “exercise” in terms like “healthy movement” and to talk about movement during all of your meetings (not after weighing patients or on the way out the door). Ask about their activity (not their exercise history) and listen for concerns that limit their movement in a day. Work together to craft a collaborative movement plan that addresses their reservations and is tailored to meet their needs and then ask about their progress at your next meeting. Where possible, discuss the physiological benefits to their body and their circumstance. For example, aerobic exercises increase endurance in muscles and the cardiorespiratory system. Resistance training produces significant improvements in muscle strength as well as reductions in systemic inflammation, pain, morning stiffness, and RA disease activity. Yoga has been proven to increase muscle strength and endurance, improve proprioception and balance, and increase flexibility and mobility. Yoga also teaches relaxation and body awareness.

Regular healthy movement is beneficial for the treatment of rheumatic disease specifically because it can strengthen the muscles around the effected joints, gain control over joint swelling, aid in bone loss decrease, and improve joint lubrication which helps to decrease stiffness and improve pain. A movement plan for patients with rheumatic disease should aim to preserve or restore range of motion, increase muscle strength and endurance, improve mood, and decrease risk of comorbidities associated with a sedentary lifestyle.⁹ As patients take on the endeavor of a customized movement program, they should track their progress. This can be done through journaling, fitness trackers, or through a fitness log app on a phone (such as Habit Hub). This should be a collaborative process between patient and provider to engage the patient in their own research endeavor along their movement journey.

Healthy movement plays a critical role in the treatment of rheumatic disease. It allows for the optimization of both mental⁸ and physical health and extends the reach of your efforts to the rest of your patient’s lives. Healthy movement matches patient interests and abilities and can be added to any routine. In our biomarker lab here at the University of Denver where we are studying mouse brains to quantify Brain Derived Neurotrophic Factor (BDNF) production and protection, we incentivize the mice to run for just 60 seconds at a time—it may be just that simple for people too.

Natalie Golub is a current University of Denver graduate student in the first year of the Sport and Performance Psychology masters program. During her first year in Denver, Golub has been involved in traumatic brain injury and concussion research, in the partners in pedagogy teaching program, in sports psychology consulting with youth athletes, and with COVID-19 graduate health and wellness ambassadors. She aspires to be a sport psychologist..

References:

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2. Benatti, F. B., & Pedersen, B. K. (2014). Exercise as an anti-inflammatory therapy for rheumatic diseases—myokine regulation. Nature Reviews Rheumatology, 11(2), 86–97. https://doi.org/10.1038/nrrheum.2014.193

3. Cooney, J. K., Law, R.-J., Matschke, V., Lemmey, A. B., Moore, J. P., Ahmad, Y., … Thom, J. M. (2011). Benefits of Exercise in Rheumatoid Arthritis. Journal of Aging Research, 2011, 1–14. https://doi.org/10.4061/2011/681640

4. Crowson, C. S., Liao, K. P., Davis, J. M., Solomon, D. H., Matteson, E. L., Knutson, K. L., … Gabriel, S. E. (2013). Rheumatoid arthritis and cardiovascular disease. American Heart Journal, 166(4). https://doi.org/10.1016/j.ahj.2013.07.010

5. Jackson, E. M. (2013). Stress relief: the role of exercise in stress management. ACSM'S Health & Fitness Journal, 17(3), 14–19. https://doi.org/10.1249/fit.0b013e31828cb1c9

6. Matcham, F., Rayner, L., Steer, S., & Hotopf, M. (2013). The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology, 52(12), 2136–2148. https://doi.org/10.1093/rheumatology/ket169

7. Metsios, G. S., Stavropoulos-Kalinoglou, A., & Kitas, G. D. (2015). The role of exercise in the management of rheumatoid arthritis. Expert Review of Clinical Immunology, 11(10), 1121–1130. https://doi.org/10.1586/1744666x.2015.1067606

8. Middendorp, H. V., & Evers, A. W. M. (2016). The role of psychological factors in inflammatory rheumatic diseases: From burden to tailored treatment. Best Practice & Research Clinical Rheumatology, 30(5), 932–945. https://doi.org/10.1016/j.berh.2016.10.012.

9. Musumeci, G. (2015). Effects of exercise on physical limitations and fatigue in rheumatic diseases. World Journal of Orthopedics, 6(10), 762. https://doi.org/10.5312/wjo.v6.i10.762