Fitness for Fatigue
We’ve all heard it over and over (and over and over) again: it’s so important for people living with rheumatoid arthritis (RA) to exercise. Physical fitness can be extremely useful in managing many of the symptoms that come with RA, including fatigue, stiffness, and pain.
But does anyone else think this advice is easier to hear than actually follow?
And have you ever had a doctor give you this guidance but fail to offer practical suggestions for how on earth you’re really supposed to make it happen?
A recent session at the 2017 American College of Rheumatology Annual Meeting focused on this topic for an audience of healthcare professionals, exploring the real impact of fatigue on patient’s lives and offering practical suggestions to help doctors promote fitness realistically.
Daniel Clauw, director of the Chronic Pain and Fatigue Research Center at the University of Michigan, explained that fatigue is very common in patients with RA. He also pointed out that residual fatigue is still possible, even after successful treatment of other RA symptoms with a biologic medication. But even though fatigue is often as functionally limiting as joint pain, Dr. Clauw cited a study (F Wolfe, T Pincus. A&R 1999) showing that only about 10% of rheumatologists even evaluate fatigue in their care of RA patients!
What is the exact cause of fatigue in RA?
Rheumatologists may disregard fatigue more often than they should because it can be really complicated to determine exactly why it is happening in each patient. Is it caused by RA inflammation? Depression or anxiety? Sleep issues? Diet? Underlying medical conditions? A side effect from medications? Hormones? Fatigue can also be a very difficult symptom for doctors to address because the word doesn’t necessarily mean the same thing to every patient.
When it comes to treating fatigue, other than properly treating any underlying medical conditions, Dr. Clauw concluded that research shows the most effective treatment for fatigue is exercise. Based on this conclusion, David Williams, Associate Director Dr. Clauw’s research center, offered strategies for rheumatologist to help enable their patients to realistically improve their level of fitness.
Strategies for combating fatigue with exercise
Dr. Williams first encouraged the healthcare professionals in the audience to consider the myriad barriers that RA patients have in attempting to increase their level of physical activity: joint and muscle pain, lack of energy, lack of time, family or work obligations, lack of motivation, dislike of physical activities, and more. He argued that without helping the patient figure out how to address these barriers, a recommendation to exercise more could be both futile and frustrating. With this in mind, Dr. Williams emphasized the importance of doctors initiating patient-centric conversations that focus not only on the merits of exercise but also help patients engage in problem solving to address the specific barriers they face.
As for practical advice about how to get started on a better exercise routine, Dr. Williams gave the example of using a step counter (such as a pedometer or Fitbit) as a helpful starting place for patients to get feedback on their level of activity. Getting exercise “credit” for activities you already do every day can help with overall motivation. He also suggested brainstorming ways to incorporate more activity into a regular daily routine, such as parking slightly farther away or taking the stairs instead of the elevator.
For patients who are really struggling with exercise, Dr. Williams focused on the importance of “pleasant activity scheduling.” The idea behind this technique is for patients to start not by focusing on exercise but by actively scheduling activities that they truly enjoy – whether those activities are active or not. Once patients get into the habit of altering their schedule in a way that feels doable, it may make it more likely that they can find time to schedule additional physical activity in the future.
Do you struggle with exercise even though you know it can be an important management tool for life with RA? When it comes to doctors recommending exercise, what has your experience been like? Has the conversation been patient-centric, with your doctor helping you address the barriers you face? Or, if not, have you tried any of Dr. Williams’ suggestions yourself?