Exercise as it relates to Disease/Do the US National Arthritis Foundation’s recommendations stack up? Evaluating exercise guidelines against functional outcomes in arthritis

This Wikibook page is a fact sheet and critique of the journal article "Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis (2003)" by Suomi, R. & Collier, D.

Arthritis and its prevalence in Australia

A fifth of the Australian population suffers from some form of Arthritis, that is around 3.85 million people. These figures are set to soar in the coming decades with a projection of 7 million Australians suffering from Arthritis by 2050. The following evidence based research indicates that we can improve the quality of life of those suffering from Arthritis, through Arthritis focused exercise programs.

What is the background to this research?

The research is based around the National Arthritis Foundation of America and two community based exercise programs they have developed. One of the exercise programs is a land-based exercise program by the name of People with Arthritis Can Exercise (PACE). They have also developed a water based exercise program by the name of Arthritis Foundation Aquatic Program (AFAP). Both of these programs claim that physical function, flexibility, strength, balance and mobility will all improve as a result of attending classes on a regular basis. This study was aimed at determining whether the National Arthritis Foundation's claims are true. In addition to assessing the affect that these two exercise programs have on functional fitness, they also assessed the affect they have on the participant’s ability to perform activities of daily living (ADL).

Where is the research from?

This research was conducted by Suomi and Collier from the School of Health, Exercise Science and Athletics, University of Wisconsin. This Article was published in the Archives of Physical Medicine and Rehabilitation 2003, Vol. 84, No. 11, pp. 1589–1594.

What kind of research was this?

This research was based around using a repeated-measures analysis of variance (ANOVA). They also used a planned comparison approach to analyze the collected data. This style of analysis is very similar to a one way ANOVA but is more suitable for related groups and not independent groups.

What did the research involve?

The research involved testing each individual’s fitness levels before and after the exercise intervention. The tests fell under the following categories:

• Flexibility
• Coordination
• Balance and agility
• Strength and endurance
• Cardio-respiratory endurance

Suomi and Collier also evaluated the subject’s reported ability to perform ADLs. The pain subjects experienced when performing specific ADLs was also one of the areas of focus. Isometric tests of both hip and shoulder abduction were also assessed. These isometric tests were conducted using a hand held muscle strength tester called a Nicholas Manual Muscle Tester. The reason why hip and shoulder abduction capabilities were tested is that these two movements are not likely to have been used often by the subjects. Hence, they were more likely to reflect a training effect post exercise program. All of the above tests were administered in the same sequence and format in both the pre and the post test evaluations. The ADL self report, physical fitness, and isometric tests were all conducted in singular test sessions. The Initial test day was 2 days before commencing the respective program, and the follow up test day was 2 days after completion of the program.

The following conditions had to be met by the participants:

• Must attend at least one of the two forty five minute exercise program sessions offered per week
• Attend at least ten classes over the eight week duration of the program
• Do not participate in any other exercise programs during the duration of the study

What were the basic results?

Analysis of pre and post exercise program test results indicated significant improvements in participants of both exercise programs. Although, the land based exercise program participants obtained the most notable increases in physical capability. For one example, They exhibited increases in right shoulder abduction isometric measures by 15.3%. Whereas the aquatic based program participants exhibited an increase of only 13.9%.

Land-based right shoulder abduction isometric measures (Nm)

Before	After	% Diff
30.4 +/- 18.9	35.9 +/- 19.6	15.3%

Aquatic-based right shoulder abduction isometric measures (Nm)

Before	After	% Diff
26.1 +/- 13.0	30.3 +/- 13.0	13.9%

The greatest difference between land based participants and aquatic participants is that the land based participants had gains in balance and agility that the aquatic based people didn’t. This has been attributed to the land based participants participating in exercise where they were supporting their own body weight against gravity. The water based participants were suspended in water and didn't receive as great benefit to balance and agility. This is due to the fact that their muscles weren't working as hard to stabilize their body. Both the land and aquatic program participants reported less pain with ADLs and less difficulty in completing ADLs post exercise intervention.

The control subjects did not exhibit any statistically significant differences in scores between the pre and post test results.

How did the researchers interpret the results?

The researchers were happy with the rate of participation. The researchers believed that the attendance rate was higher than normally observed in exercise programs for people who suffer from arthritis. They believe the fact that participants were paid and the programs only went for 8 weeks both contributed to high attendance rates. Both exercise programs claim that physical function, flexibility, strength, balance and mobility will all improve when those who suffer from arthritis participate in their programs. The researchers believe that their findings support this claim.

What conclusions should be taken away from this research?

The conclusion to be taken from this research is that both the land and aquatic exercise programs designed by the American National Arthritis Foundation are beneficial for arthritis sufferers. Participants in these programs should see increases in the ability to perform ADLs pain free and should also see increases in functional fitness levels. One should also keep in mind that the level of benefit will differ from person to person and from program to program. Results may differ from program to program as the land based program seemed to be more beneficial.

What are the implications of this research?

This research implies that sufferers of arthritis who don’t actively manage or treat their condition with exercise interventions, will not see potential improvements in their condition.